"Hemiplegic Migraine"?

I have a lady in her 30’s who collapsed suddenly in the street in September last year, and was admitted with dense left hemiplegia with complete sensory loss. She was in hospital for 6 months for intensive rehab. During that time she gradually regained some motor function twice and then lost it again in subsequent “attacks”. The best she had got to was walking short distances with a gutter rollator and a lot of help.
She never had any return of sensation, and has instances of quite severe injury (eg contusions abrasions and broken fingers) with no apparent awareness.

No scans etc showed any focal abnormality, and she tells me the diagnosis is hemiplegic migraine, (the diagnosis on her referral is “hemiplegia of non-organic cause”) and they believe the attacks to be hormonal linked, and that she has a gynae referral for removal of her ovaries. I became involved after she lost consciousness while using the standing frame at a local day centre, and was taken on by the intermediate care team as readmission was judged not appropriate/necessary. I don’t have access to her medical notes, but I have spoken to the senior physio at the hospital who spent a lot of time with her with little progress. She is wheelchair independent.

She’s also referred to as “the lady with the hysterical paralysis”. She has an unfortunate history of self-harm two years ago following a miscarriage. She is on the waiting list for a psychiatric referral, and though she says she doesn’t think it is psychosomatic, she’s willing to accept anything if it helps!

I’m not sure what to make of her; she is starting to regain some movement, from the periphery first, as she can better use her eyes to get feedback of movement. She is helped by using a mirror. She still claims total sensory loss, and though her sitting balance is quite good, has a tendency over activity ++ with her right side to compensate. This is vastly exacerbated in standing, she is terrified!

I am reserving judgement on the psychological diagnosis, but have explained to her that she is “all there” as far as the motor element, which she accepts. She is definitely depressed, and also very anxious and angry at the moment as she is being rehoused to somewhere that she feels is inappropriate and totally unsatisfactory.

Any ideas???? Has anyone ever met anything quite like this?

jehaana

[tattoomd]

If it sounds too weird to be an organic syndrome, it usually is, but some kind of alternative therapy may be helpful anyway . How about acupuncture or reiki?

[toadhall]

this describes my husband to a tee, after ahead injury 18 months ago he suffered left side hemi-plegia, 2 months ago he regained his left arm, but his left leg has no sensation at all.

he's had various tests, scans and all we are told is that it must be a neuro problem, he is about to try acupuncture on the nhs.

any other suggestions would be appreiciated

[psychophysio]

Originally Posted by Jehaana

I have a lady in her 30’s who collapsed suddenly in the street in September last year, and was admitted with dense left hemiplegia with complete sensory loss. She was in hospital for 6 months for intensive rehab. During that time she gradually regained some motor function twice and then lost it again in subsequent “attacks”. The best she had got to was walking short distances with a gutter rollator and a lot of help.
She never had any return of sensation, and has instances of quite severe injury (eg contusions abrasions and broken fingers) with no apparent awareness.

No scans etc showed any focal abnormality, and she tells me the diagnosis is hemiplegic migraine, (the diagnosis on her referral is “hemiplegia of non-organic cause”) and they believe the attacks to be hormonal linked, and that she has a gynae referral for removal of her ovaries. I became involved after she lost consciousness while using the standing frame at a local day centre, and was taken on by the intermediate care team as readmission was judged not appropriate/necessary. I don’t have access to her medical notes, but I have spoken to the senior physio at the hospital who spent a lot of time with her with little progress. She is wheelchair independent.

She’s also referred to as “the lady with the hysterical paralysis”. She has an unfortunate history of self-harm two years ago following a miscarriage. She is on the waiting list for a psychiatric referral, and though she says she doesn’t think it is psychosomatic, she’s willing to accept anything if it helps!

I’m not sure what to make of her; she is starting to regain some movement, from the periphery first, as she can better use her eyes to get feedback of movement. She is helped by using a mirror. She still claims total sensory loss, and though her sitting balance is quite good, has a tendency over activity ++ with her right side to compensate. This is vastly exacerbated in standing, she is terrified!

I am reserving judgement on the psychological diagnosis, but have explained to her that she is “all there” as far as the motor element, which she accepts. She is definitely depressed, and also very anxious and angry at the moment as she is being rehoused to somewhere that she feels is inappropriate and totally unsatisfactory.

Any ideas???? Has anyone ever met anything quite like this?

jehaana

The course doesn't sound like a hemiplegic migraine - the ones I have seen usually resolve over the course of a few days with little intervention other than analgesia. Hemiplegia of non-organic cause suggest a conversion disorder of some type, which can be hard to treat, especially if she had a 6 month rehab stint and is still W/C bound. Psych input can help to establish the basis of her disorder but there isn't a lot of evidence for psychiatric input to improve or accelerate recovery.

The patients I have seen with "non-organic hemiplegia" either recovered in a few days or 2-3 weeks, otherwise they had a long and protracted course with minimal overall recovery (although they were W/C independent). Goal setting is important.

Good luck!

[austenjonesufg]

hi

thanks for ur post. its give me some important information.