ID:15744 Atypical Complex Regional Pain Syndrome or Functional Neurologic Disorder: A Case Report

Abstract

A 41 year-old, male was referred by neurology to the outpatient pain clinic with an initial tentative diagnosis of a functional neurologic disorder. Upon interview the patient endorsed an approx. 3 year history of progressive, ascending numbness and neuropathic pain in bilateral lower extremities that was precipitated following a ligamentous injury involving the right ankle. He also reported temperature sensitivity and noted delayed healing of on an ulcer on his 5th digit. On physical examination the patient was neurologically intact and did not display allodynia. EMG/NCS revealed no evidence of a pathologic process. Given the post traumatic onset of his pain and possible trophic symptoms it was hypothesized that his neurologic symptoms could be related to a sympathetically mediated process. He subsequently underwent a fluoroscopic guided unilateral lumbar sympathetic block using local anaesthetic and dexamethasone. Pre-procedurally he rated his pain as 8/10. Within two days the patient reported complete resolution of his pain with lasting benefit at 2 weeks’ follow up.