Unresponsive in the PACU: A Case Report of Functional Neurological Symptom Disorder and Review of Recent Literature

 

• James P. Chung
• Arnav Sugavanam1
• Joseph G. Tharion,

Journal of Obstetric Anaesthesia and Critical Care 16(2):p 172-178, Jul-Dec 2026. | DOI: 10.4103/JOACC.JOACC_68_26

Functional neurological symptom disorder (FND), also known as conversion disorder, is a somatoform disease that can cause neurological deficits without anatomical or physiological causes. It can be caused by any physical or psychological stressor, including trauma, hospital admission, surgery, as well as having to undergo anesthesia. We report about a pediatric patient (with a history of previous FND) who became suddenly unresponsive and exhibited seizure-like activity in the postanesthesia care unit after undergoing general anesthesia for a gynecological procedure (intrauterine device placement). After undergoing largely normal testing, including electrolytes, imaging, and consultation from pediatric neurology, she spontaneously recovered and was eventually discharged to psychiatry follow-up. FND is a debilitating disease both physically and mentally for both patients and families; diagnosis and treatment both need multidisciplinary involvement. Ultimately, individually tailored perioperative care is needed for patients with a history of FND; the anesthesiologist’s role in preparing patients and their families for surgery and anesthesia, as well as appropriate follow-up care, may improve long-term patient outcomes.

https://www.ovid.com/jnls/joac/fulltext/10.4103/joacc.joacc_68_26~unresponsive-in-the-pacu-a-case-report-of-functional