Poster 187: Electromyography-Confirmed Bell's Palsy in Association With Conversion Disorder Involving a Rigid Equinovarus Deformity Responsive to Cryotherapy: A Case Report

Abstract

Setting: Inpatient rhabilitation unit. Patient: A 25-year-old woman with electromyography-confirmed right Bell's palsy, with right hemiparesis, hypesthesias, and equinovarus deformity of unclear etiology. Case Description: Symptoms began with a severe right postauricular pain and right facial paresthesias, which progressed to right facial weakness and pain over the next 2 days. She then developed complete right upper- and lower-extremity paralysis and anesthesia. Local treatment involving outpatient physical and occupational therapy was unsuccessful, and she presented to our institution for further evaluation. Electromyography was consistent with Bell's palsy but otherwise normal; somatosensory evoked potentials (right median and tibial nerves), brain magnetic responance imaging (MRI)/angiography, and cervical spine MRI were all normative. The patient was admitted to our rehabilitation unit with a diagnosis of Bell's palsy in association with conversion disorder. At admission, despite a moderate improvement in her facial and right lower-extremity strength, her anesthesias and upper-extremity paralysis persisted. She had also developed a variable right ankle equinovarus deformity. Assessment/Results: Strength and sensation improved significantly during her 2-week stay with its focus on functional activities. However, her ankle inversion worsened to the point of developing a rigid equinovarus deformity that was refractory to stretching. An ankle-foot orthosis (AFO) was initially avoided, but when evaluated was not beneficial because her tone prevented proper fitting. Ice bath dips described to the patient as a sports medicine treatment (5 repetitions, 3–5 times per session) were initiated with a significant reduction in her ankle tone; the reduction in abnormal tone allowed her to walk with only a cane and AFO. Discussion: This appears to be the first reported case of both of a conversion disorder associated with Bell's palsy and the response of a conversion-related equinovarus deformity to cryotherapy. Conclusions: Rehabilitation of a conversion disorder-related equinovarus deformity may benefit from cryotherapy.