When Grief Mimics Conversion Disorder: New-Onset Focal Neurologic Deficits Revealing Demyelinating Disease

Acute neurologic presentations in the setting of profound emotional trauma can create significant diagnostic complexity, particularly when symptoms overlap with Functional Neurologic Disorder (FND), formerly referred to as Conversion Disorder. In these situations, clinicians may be vulnerable to diagnostic overshadowing, in which emotionally salient psychosocial factors bias interpretation of objective neurologic findings and lead to premature psychiatric attribution. This risk may be further amplified when initial non-contrast neuroimaging is unrevealing. We present the case of a 26-year-old previously healthy female who developed severe headache, dysarthria, right-sided facial droop, and bilateral extremity weakness one week after the sudden death of her sister-in-law. Initial vascular imaging and non-contrast computed tomography (CT) were unremarkable, raising concern for FND in the context of acute bereavement, and psychiatry was consulted to evaluate for a possible functional or psychiatric etiology. Subsequent multidisciplinary reassessment involving psychiatry and neurology prompted advanced neuroimaging. Magnetic resonance imaging (MRI) of the brain demonstrated multifocal T2/FLAIR hyperintense lesions, including enhancing lesions in the bilateral thalami, left cerebellar peduncle, and left insular/temporal regions; cervical and thoracic spinal cord T2 hyperintensities were also identified without reported enhancement. Collectively, these findings were concerning for an active demyelinating process and highly suggestive of multiple sclerosis (MS), but a definitive diagnosis was not established because cerebrospinal fluid studies and subsequent neurologic follow-up were unavailable. This case highlights several important clinical lessons: acute emotional stressors should not substitute for a neurologic evaluation when objective deficits are present; FND is a rule-in diagnosis supported by positive functional signs rather than psychosocial stress alone; normal CT imaging does not exclude demyelinating disease; and interdisciplinary evaluation may help reduce premature diagnostic closure. The temporal association between bereavement and symptom onset in this case is observational and does not establish that stress caused or precipitated demyelinating disease.