A 29-year-old medical student from Germany was hysterical when she presented in the Emergency Room. She explained that she had had an argument with her boyfriend. The doctors suspected that the hysteria may be the linked to the emotional stress she had experienced.
The woman was anxious, restless, and experienced numbness and tingling in her hands and feet but showed no other physical signs. Therefore, the doctors could only make a differential diagnosis of an underlying psychiatric illness.
“The woman seemed very anxious and was constantly tossing and turning on the stretcher.”
DR. THILO WITSCH, A CARDIOLOGIST AT THE UNIVERSITY OF FREIBURG HEART CENTER IN FREIBURG, GERMANY
Hysteria: The preliminary diagnosis
Since she was restless, the doctors could not take proper history or examine her thoroughly. Thus, they labeled her as a case of “panic attack with hyperventilation syndrome”. In this condition, a person finds it difficult to breathe because they think they are not getting enough oxygen.
An odd clue: change in diagnosis
Amidst the chaos in the emergency room, Dr. Thilo Witsch noticed that the woman’s lips had a blue tinge. Furthermore, she looked pale and had slight discoloration in her arms and legs. While he was pondering over these subtle findings, the patient’s blood tests confirmed that she did not have hyperventilation syndrome.
The final diagnosis
The doctors then thoroughly examined the patient. The examination findings revealed reduced blood flow to both arms and legs. The doctors performed an echocardiogram which confirmed Dr. Witsch’s suspicion; the woman had an aortic dissection. An Aortic dissection is a tear in the wall of a major artery of the body called the aorta.
“In a very busy emergency room, her physical findings may have easily been overlooked because these patients may get labeled as ‘psychogenic,’ meaning they have a psychological origin rather than a physical one.”
Dr Witsch
Management
The doctors performed surgery and repaired the tear in the wall of the artery.
Prospect
This case indicates that cases in the emergency may be misdiagnosed. This may be due to psychological symptoms masking the physical symptoms present in the patient. Thus, if all psychiatric emergency cases are thoroughly assessed, there could be a significant reduction in the deaths caused by such cases.
