The turning point of our patient's health was when he lost his right-hand fingers II–IV in an accident at the age of 25. His first symptoms were cold soreness and stiffness of the hand. At the age of 26, he started having dysarthria, and he contacted a otorhinolaryngologist who did not find a cause for the complaint. He remitted the patient to a psychiatrist who assumed that it was caused by a post-traumatic conversion.
When he was 27 years old, neuropsychological tests failed to detect any prominent findings. In the same summer the patient went to a neurologist, owing to other conditions he had to endure during that time, such as increased salivation, dysarthria, motor restlessness and curling of lips. The patient attributed the symptoms to the accident happened. No neurological diagnosis was established.
Soon after this, the patient drove out of the highway with his car. After this accident he was confused, disoriented and aggressive and had a generalised seizure. However, his EEG was not clearly irritative. Brain MRI- and CT-scans revealed non-specific findings in the right temporal pole. Because a brain tumour was suspected as a cause of the symptoms, a stereotactic biopsy was taken. There were to some extent degenerative axons, but no tumour. The only diagnosis was epilepsia suspecta.
The patient was referred to a psychiatric clinic at the age of 28. He had moved back to his parents, considering the risk and insecurity involved in living alone while experiencing these new epileptic seizures. Speech and eating had slowly deteriorated, and changes in personality occurred. He mutilated his head on the wall, especially when the accident was discussed. The neurologists suspected Gilles de la Tourette syndrome, even though the symptoms had emerged late. But still the final diagnosis remained unestablished. The main focus in psychiatric treatment was social rehabilitation, because the patient had started to isolate.
Untill the age of 29, the main diagnosis was conversion symptoms related to the psychological trauma as a consequence of the accident. The psychiatric staff assumed that the patient had regressed to an earlier developmental level after the accident. They thought that this idea was supported by the fact that the patient had moved back to his parents and did not have a girlfriend. His psychiatrist, however, still suspected a neurological illness and consulted Turku PET-centre.