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Yıl:2008; Cilt: 19; Sayı: 1>> Özet
TAM METİN
Türk Psikiyatri Dergisi; 2008;19(1):101-107
Konversiyon Bozukluğunda Uyarılmış Potansiyeller ve Beyin Kan Akımı Değişiklikleri: Olgu Sunumu ve Gözden Geçirme
N Gürses. ÇM Temuçin, EL Ergün, A Ertuğrul, S Özer, B Demir
Hacettepe Ü Psikiyatri AD., Ankara
Konversiyon bozukluğu (KB); hareket, duyu ve nörovejetatif sistemle ilgili organlarda organik bir temele dayanmayan
işlev yitimi, işlev azalması ya da çoğalması şeklinde tanımlanmaktadır. Tanı sistemlerinde konversiyon bozukluğunda
saptanan işlev bozukluğunun “organik” bir temeli olmadığına vurgu yapılmakla birlikte, son yıllarda
konversiyon bozukluğuna eşlik eden beyin bulgularına yönelik giderek artan bir ilgi vardır. Bu bağlamda beyin
görüntüleme ve elektrofizyoloji en çok odaklanılan araştırma alanlarıdır. Bu olgu sunumunda konversiyon bozukluğu
belirtileri olan bir hastada saptanan bölgesel beyin kan akımı değişiklikleri ve uyarılmış potansiyellere ilişkin
bulgular sunulmaktadır. Hareket bozukluğu belirtileri olan bu olguda somatosensoryel uyarılmış potansiyeller
değerlendirildiğinde, N20, P25 dalga ortaya çıkış sürelerinin (‘latans’) normal sınırlar içerisinde olduğu ancak,
P25-N33 tepeden tepeye (‘peak’) genliğinin (‘amplitüd’) çok yüksek olduğu ( dev SEP ) gözlenmiştir. Beyin bölgesel
kan akımı değerlendirmesinde ise sol paryetal bölgede belirgin ve sol temporal bölgede orta derecede perfüzyon
azalması saptanmıştır. İlk değerlendirmenin ardından 3 ay sonra gerçekleştirilen kontrol değerlendirmesinde sol
paryetal bölgede saptanmış olan perfüzyon azalmasının tamamen düzeldiği ancak sol temporal bölgedeki perfüzyon
azalmasının sürdüğü gözlenmiştir. Hastanın ayaktan izlem dönemi sırasında üçer ay aralıkla 2 kez daha uyarılmış
potansiyelleri çalışılmış ve ilk muayenede saptanan patolojik bulguların sürdüğü saptanmıştır. Bu bulgular
yazında bildirilmiş olan veriler gözden geçirilerek tartışılmıştır.
Evoked Potentials and Regional Cerebral Blood Flow Changes in Conversion Disorder: A Case Report and Review
Conversion disorder is defined as the presence of functional impairment in motor, sensory or neurovegetative
systems which cannot be explained by a general medical condition. Although the diagnostic systems emphasize
the absence of an organic basis for the dysfunction in conversion disorder, there has been a growing interest
in the specific functional brain correlates of conversion symptoms in recent [year]s, particularly by examining
neuroimaging and neurophysiological measures. In this case report, regional cerebral blood flow changes and
evoked potentials of a patient with conversion symptoms are presented. Somatosensory evoked potentials (SEP)
of this patient with conversion disorder who had signs of movement disorder revealed that the latency to N20, P
25 waves were in normal limits while the amplitudes of the P25 and N33 components were extremely high (giant
SEP). Regional cerebral blood flow assessment revealed hypoperfusion in the left parietal and temporal lobes of
the brain. Three [month]s after the first assessment, the control scans showed that the left parietal hypoperfusion
disappeared while the left temporal hypoperfusion was still present. The following SEP evaluations which were
repeated twice in three [month]s intervals after the initial recordings, showed the persistence of the abnormalities
in somatosensorial measures. The neurophysiological and neuroimaging findings in conversion disorder were
reviewed and the results of the evaluations of this case were discussed in this article.

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