12-27-2008, 01:46 AM
A previously healthy 24-year-old woman is
brought to the
physician by her husband because of several episodes
of loss of consciousness
over the past 4 days. Her husband reports that during
episodes, she
jerks her arms and legs wildly. Each episode lasts up
to 1 hour; between
episodes, her behavior is normal. She is planning to
move to another
state because of her husband's work. She has been
extremely anxious and
upset about the move because she will have to leave
her mother, who was
recently diagnosed with breast cancer. There is no
family history of
seizure disorder. Her temperature is 36.7 C (98 F),
blood pressure is
130/80 mm Hg, pulse is 84/min, and respirations are
18/min. Neurologic
examination shows no abnormalities.
Electroencephalography shows
normal findings during an episode of shaking. Which
of the following is the
most likely underlying cause?
A
) Catatonia
B
) Complex partial seizure
C
) Conversion reaction
D
) Dissociative fugue
E
) Malingering
F
) Tonic-clonic seizure