Syncope and Unresponsiveness in an Adolescent With Comorbid Cardiac Disease: An Illustrative Case Report and Literature Review of Functional Neurologic Symptom Disorder

Abstract

Background: This case report with an associated literature review explores the challenges, opportunities, and current evidence in creating a thoughtful diagnostic and management plan for an adolescent with functional neurologic symptom disorder and comorbid cardiac disease.

Methods: We performed a literature review utilizing PubMed to identify the current evidence base related to pediatric functional neurologic symptom disorder in the setting of comorbid cardiac disease. Ultimately, 25 manuscripts were identified for inclusion in this study.

Results: We reported the recent epidemiology, screening, diagnostic, and treatment measures utilized in pediatric syncope with a focus on differentiating psychogenic causes from serious cardiac and benign etiologies. We further described how psychiatric and psychological factors influence assessment, management, and outcomes.

Conclusions: This study provides current, evidence-based suggestions for the assessment, diagnosis, and management of pediatric syncope, with an emphasis on recognizing psychogenic causes of syncope. It includes a description of a novel case of functional neurologic symptom disorder in a pediatric patient with structural cardiac disease. The study highlights how the absence of standardized guidelines, heterogeneity in care delivery, and lack of concurrent mental health management led to worse outcomes.

Keywords: cardiac; conversion disorder; functional neurologic symptom disorder; pediatric; somatic symptom and related disorders; syncope.