Navigating the Confusion: Functional Neurological Disorder Diagnosis
Hello to all the medical professionals and fellow patients out there! I'm reaching out for some guidance regarding a perplexing situation I'm currently facing. At 27 years old and feeling disoriented, I hope some of you might share your insights or experiences related to my condition. Not long ago, I was informed that I may have Functional Neurological Disorder (FND). While I certainly recognize that FND is a valid and serious condition, I find myself feeling quite ashamed at the thought that my symptoms might simply be functional in nature. While I can appreciate that FND could potentially explain my symptoms, I'm struggling to reconcile this diagnosis with the clear abnormalities evidenced in my imaging and medical history. I’m open to the possibility of this diagnosis, but I need reassurance that no significant structural issues are being overlooked. Here’s an overview of my situation: - I have a diagnosis of antiphospholipid syndrome (APS), which I manage with warfarin, occasional injections of lovenox, and regular check-ups at an anticoagulation clinic. - Imaging has revealed unilateral stenosis on the right side of my brain that looks similar to moyamoya syndrome, although it doesn't fit the classic profile (the narrowing starts at my neck and affects only one side). This finding was first noted back in 2019 when I had my very first MRI due to a seizure episode. - I also have a documented history of chronic infarcts in both hemispheres of my brain, as shown on MRI scans. These were determined to be unrelated to the stenosis based on their locations. The left-side infarcts were diagnosed in January 2023, despite not being present in my prior MRI from 2021. - Additionally, I suffered a subdural hematoma and a severe concussion in January due to a head injury, which was confirmed by imaging studies. After a lengthy evaluation in the ER, I was discharged after 7 hours when follow-up CT scans indicated that the bleed had stabilized. - Since 2019, I have experienced several grand mal seizures, which I have little memory of. They were proceeded by an unusual rubbery odor, and witnesses validated the seizure events. I’ve been diagnosed with epilepsy and currently take lamotrigine at a dosage of 150 mg twice daily. However, I feel that the infrequency and mild nature of my seizures do not warrant the epilepsy classification. - A recent transcranial Doppler ultrasound indicated significantly elevated pressure on the right side of my brain (measured between 190 and 200 cm/s). - A few weeks ago, I had an alarming episode involving sudden vision loss in my right eye, facial drooping, and slurred speech, which resulted in a three-day hospital stay. The MRI did not show any acute infarcts, leading to the conclusion that I likely experienced a transient ischemic attack (TIA). - Following this episode, I’ve been dealing with ongoing right-sided weakness and difficulties with facial movements. Clinicians have suggested that these persistent symptoms do not align with TIA criteria and seem more consistent with a stroke; however, imaging taken during my hospitalization did not show acute damage. As a result, I have been directed towards the idea that this is likely a functional disorder despite the array of objective findings supporting my condition. Although I do not aim to undermine FND, I can’t shake the feeling of embarrassment, as if I have wasted resources and time, questioning whether I might have been exaggerating or imagining my symptoms. Yet, I review the scans and test results, and it's clear that there are indeed abnormalities present. I have a few pressing questions for anyone who can provide clarity: - Has anyone experienced a similar transition in diagnosis from clear neurological anomalies to being classified with FND? - What methods do clinicians typically employ to differentiate between functional and organic symptoms in complex cases like mine? - Is there a potential for FND to occur alongside structural brain injuries, and how do medical professionals manage that distinction in practice? - Could ongoing deficits resulting from a TIA or a stroke be misidentified as FND when no acute lesions can be detected? - Should I seek a second opinion or consult a neurovascular specialist, or is it reasonable to embrace the FND diagnosis as outlined by my case? Any insights on how a functional diagnosis could fit into my circumstances or whether I might be jumping to conclusions would be enormously appreciated.
Answers (1)
8/1/2025, 4:20:58 PM
OpenHealth AI
It’s understandable to feel overwhelmed and confused by your diagnosis and complex medical history. Your concerns regarding Functional Neurological Disorder (FND) and its relationship with your established neurological conditions are valid and warrant careful consideration. Here’s a structured approach to address your situation:
Main Points
- FND can coexist with organic conditions; it doesn't invalidate your symptoms.
- Differentiating between FND and organic disorders is complex and requires thorough evaluation.
- Seeking a second opinion could provide clarity and reassurance.
Explanation
Functional Neurological Disorder (FND) involves neurological symptoms that cannot be explained by traditional neurological diseases, even when physical changes exist. This does not mean your symptoms are "imagined" or exaggerated; rather, they may result from how your brain functions rather than structural abnormalities.
Given your history of antiphospholipid syndrome, chronic infarcts, and transient ischemic attacks (TIAs), it’s crucial to acknowledge that while you may exhibit signs of FND, the underlying structural issues can still influence your condition. The relationship between structural brain injuries and FND is complex; ongoing deficits can sometimes be mistakenly attributed to a functional cause, especially if imaging is normal during acute episodes.
Next Steps
-
Second Opinion: Consider seeking a second opinion from a neurovascular specialist or a neurologist familiar with FND. This can provide further insights into managing both your structural issues and potential FND.
-
Specialist Evaluation: Ask specifically about:
- How your symptoms can fit into both the organic and functional categories.
- Methods used to differentiate between FND and ongoing deficits from your previous neurological events.
-
Symptom Diary: Maintain a diary of your symptoms, noting triggers, durations, and severity. This can help in future consultations and give healthcare providers a clearer picture of your experience.
-
Support Resources: Seek support from groups focused on FND or chronic neurological conditions, where you can connect with others sharing similar experiences.
You are not alone in navigating these complexities, and taking proactive steps towards your health concerns is commendable. Make sure to prioritize your well-being and advocate for the comprehensive care you deserve. If you have further questions or need clarification, please reach out.
Related Questions
Assessing My Health Concerns: How Anxious Should I Be?
I’m a 32-year-old woman, weighing 124 pounds and standing at 5 feet 6 inches tall. For over a year, I have been experiencing bright red rectal bleeding. Initially, I attributed this issue to hemorrhoids that developed during my pregnancy two years ago. The bleeding occurs with most of my bowel movements, sometimes happens without one, and on a few occasions, has been enough to stain the toilet bowl significantly. The color of the blood is typically darker than what I observe during a hemorrhoid flare-up. There is a notable family history of bowel cancer on both sides; one family member was diagnosed at age 45, and another at 60. In the past six months, I have encountered several episodes of severe abdominal pain—3 to 4 instances—intense enough to consider a trip to the emergency room. However, the pain usually subsides within about an hour. It’s unusual for me to experience such acute pain, given my high tolerance for discomfort; for example, I once played rugby shortly after dislocating and fracturing my finger. Recently, I mustered the courage to consult with my doctor, who recommended a FIT test, which returned a positive result (30.1). Additionally, I underwent a complete blood test, and aside from having low ferritin levels (7 µg/L), all other results were normal. I have since been referred for a colonoscopy on a two-week waiting list to rule out any possible bowel cancer. Given these circumstances, how concerned should I be? Thank you for your input.
Understanding Possible Seizure Triggers and Recurrence Risks
Health Background: I am a 21-year-old female, standing at 169 cm and weighing 65 kg. Over the past three years, I have been using oral contraceptives. As of this morning, I started taking 25 mcg of levothyroxine along with a weekly vitamin D supplement of 0.266 mg. Recently, I was diagnosed with hypothyroidism and found to have a vitamin D deficiency that I suspect has existed for the last three years. I do not consume alcohol or smoke, and I can confirm I am not pregnant. Two years ago, I experienced a mild concussion. I currently reside in Spain. A couple of months back, in mid-December, I blacked out twice. The second occurrence took place while I was at the doctor’s office after seeking urgent medical care for the initial incident. Following the second episode, I underwent a CT scan and an EKG, both of which returned normal results. Further tests, as directed by my physician, revealed a critical vitamin D deficiency and hypothyroidism; however, he expressed doubt that either of these conditions led to my loss of consciousness. I was then referred to a neurologist, and I am presently awaiting an appointment. Although the waiting period is lengthy, my doctor indicated that I should receive priority for scheduling, although the exact timeframe remains uncertain. The referral document summarized my events, labeling the second episode (which the physician witnessed) as a potential seizure devoid of tonic-clonic movements—a revelation that took me by surprise. After regaining consciousness, I felt extremely disoriented and terrified, struggling to process what was happening. I have no prior history of seizures, epilepsy, or any related conditions, and there is no known family history of these issues. If this indeed was a seizure, what might have triggered it? Additionally, what is the likelihood of experiencing another one? Since that time, I have not had any further incidents, but I have experienced moments where I felt a sense of impending doom, which I managed to overcome. I intend to wait for the neurologist's evaluation, but the uncertainty surrounding a possible neurological condition is quite distressing. Thank you for any insight you can provide!
Understanding EEG Results for My 22-Month-Old Son: Insights Needed
Could someone help clarify this for me? My son, who is just 22 months old, hasn’t started walking yet, becomes tired easily, and has been experiencing behavioral outbursts. He had a febrile seizure in February 2025, followed by another unexplained seizure in April 2025, which led us to consult a neurologist. Since he was 3 months old, he has been receiving therapy from a physical therapist for torticollis. At birth, he spent five days in the NICU due to issues with meconium aspiration. A recent MRI showed normal results, and he also had a follow-up EEG after one conducted in July 2025. The results from this recent EEG were abnormal for a pediatric patient in awake, drowsy, and sleeping states. Notably, there were brief episodes of left frontotemporal delta slowing, which occurred mainly when he was awake and drowsy. There were no signs of epileptiform activity detected. In contrast, the EEG performed back on July 3, 2025, was deemed normal for both awake and drowsy states, again with no evidence of epileptiform irregularities, although it did not capture any sleep data. This examination was prompted by the child's existing history of febrile seizures. Importantly, he is not currently on any anti-seizure medications. The EEG procedure used standard electrode placements per the 10-20 system, conducted a single-lead EKG, and included continuous video monitoring. During the analysis, the background activity was symmetric, indicating some anterior-posterior (AP) organization, with a dominant rhythm of 50-80 microvolts at 7 Hz. His drowsy state was marked by a reduced amount of eye blink activity, less breathing motion interference, and a generalized slowing in theta/delta frequencies. Stage II sleep exhibited spindles and vertex waves patterns. Additionally, there were intermittent bursts of 250-300 microvolts in the left frontotemporal region with semi-rhythmic activity of 2-4 Hz, mostly observed during wakefulness and drowsiness. No definitive epileptiform discharge was noted. Photic stimulation during the test did not elicit a strong response, and hyperventilation was not conducted during this session.
INTENSE Spine Discomfort, Breathing Difficulties, Muscle Twitches, and Sweating
To elaborate on the situation mentioned in the title, I’ve been experiencing unusual muscle twitches and spasms for the past few days, along with some discomfort in my back. However, today, I felt an unexpected sharp pain shoot through my spine, which has left my legs feeling numb and made it impossible for me to sit up straight. Additionally, I’ve been dealing with cold sweats for the last hour and struggling to breathe properly. Perhaps I’m just overanalyzing things and it’s a common occurrence, but the intensity of the pain is overwhelming—it's truly unbearable. I’m shaking quite a bit, and unfortunately, my parents aren’t responding to my attempts to reach them for help. I have a history of a chronic heart condition and arthritis, yet I’ve never experienced pain this severe, especially in my spine. For context, I am nearly 15 years old and female. My current medications include pain relievers, anxiety medication, beta blockers, and some vitamins, though those specifics may not be particularly relevant. I don’t smoke; however, I have tried vaping a few times, which might not matter much, but I thought it was worth mentioning as it was requested.
Understanding Atrial Fibrillation and Thyroid Issues: Variability in Cardioversion Decisions
Hello everyone, I’m reaching out for guidance regarding my mother’s current health situation, and I’d greatly appreciate any shared experiences or thoughts. **My mother's background:** - **Age**: 55 years - **Weight**: Recently dropped to 116 kg from 118 kg in just two days, likely due to diuretics. - **Health history**: Previously an underactive thyroid, undiagnosed and untreated, now presenting as overactive. - **Medications**: Currently taking thyroid medication and a beta-blocker (Rapiblock). **Current health status:** My mother has been hospitalized since Tuesday, experiencing **atrial fibrillation with heart rates exceeding 200** beats per minute due to her thyroid's hyperactivity. - The plan for cardioversion was initially settled on Tuesday. However, the following day, the medical team advised postponing it until her thyroid levels could be stabilized, believing that her heart rate would return to normal once her thyroid condition was managed. - Her **obesity** precludes her from undergoing a transthoracic echocardiogram, and due to her thyroid concerns, she cannot handle contrast dye (this has been a consistent issue for over four years). Therefore, the only feasible option was a **transesophageal echocardiogram (TEE)**, which has yet to be performed. - She has been prescribed various medications including beta-blockers and thyroid treatments in the past. - On Friday, a doctor proposed proceeding with cardioversion; however, the attending senior physician objected. - Today (Saturday), another clinician has expressed a desire to move forward with cardioversion, having initiated a new medication, as the senior physician is unavailable. - **Communication has been unclear**, as we were notified of developments by a nurse rather than the physician in charge, causing confusion and anxiety. - Currently, only a **chest X-ray** is scheduled, and the TEE remains unaddressed. **My inquiries are as follows:** 1. Is it common for medical professionals to have varying opinions and frequently revise medication or treatment plans like cardioversion? 2. Is it safe to conduct cardioversion in the absence of a TEE? I presumed that this was a standard procedure to exclude the presence of blood clots. 3. Is it usual practice to have only a chest X-ray prior to moving ahead with cardioversion? 4. How typical is it for patients or their families to not be directly informed about treatment changes and learn about them through nursing staff instead? I recognize that this cannot substitute for professional medical advice. I’m simply trying to discern whether these circumstances are typical or if we should express our concerns more assertively with the healthcare facility. Thank you for your insights!