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Case Report

Diagnostic Overshadowing in Functional Neurological Disorder Leading to a Diagnosis of Acute Motor and Sensory Axonal Neuropathy: A Case Report

by
Alicia Roldan
1,
Julieanne Shulman
2,3,
Rohini Singh
4,
Eli Dayon
3,
Andrew Abdou
2,3,
Josette Hartnett
3 and
Erika L. Trovato
2,3,*
1
Glendale Memorial Hospital and Health Center, Glendale, CA 91204, USA
2
Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY 10461, USA
3
The Burke Rehabilitation Hospital, White Plains, NY 10605, USA
4
Rehabilitation and Electrodiagnostics Physician Associates, Tampa, FL 33602, USA
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2026, 15(9), 3501; https://doi.org/10.3390/jcm15093501
Submission received: 13 March 2026 / Revised: 21 April 2026 / Accepted: 26 April 2026 / Published: 3 May 2026
(This article belongs to the Special Issue Recent Progress in Rehabilitation Medicine—3rd Edition)
Versions Notes

Abstract

Background: Features intersecting neurological and psychiatric disorders impose differential diagnostic challenges, especially in younger, healthy patients. Cognitive biases, such as diagnostic overshadowing, can lead to errors for patients with neurologic deficits in the presence of psychiatric comorbidities. Methods: This case report describes a 22-year-old female patient admitted for acute inpatient rehabilitation with an initial primary diagnosis of Functional Neurologic Disorder (FND), who subsequently underwent additional neurologic work-up following clinical and functional inconsistencies. Results: Physical exam findings, lack of response to therapeutic modalities, and electromyography/nerve conduction study findings led to a full neurological work-up consistent with Acute Motor and Sensory Axonal Neuropathy (AMSAN), treated with intravenous immunoglobulin. Conclusions: Systemic peripheral neuropathies must be addressed during differential diagnosis in suspected FND, a potential gap in current practice. This report emphasizes the essential role of physiatry and the value of an unbiased, patient-centered approach, integrating clinical knowledge and compassion to ensure accurate diagnosis and appropriate treatment.
Keywords: acute motor and sensory axonal neuropathy; functional neurologic disorder; case report; diagnostic overshadowing acute motor and sensory axonal neuropathy; functional neurologic disorder; case report; diagnostic overshadowing

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MDPI and ACS Style

Roldan, A.; Shulman, J.; Singh, R.; Dayon, E.; Abdou, A.; Hartnett, J.; Trovato, E.L. Diagnostic Overshadowing in Functional Neurological Disorder Leading to a Diagnosis of Acute Motor and Sensory Axonal Neuropathy: A Case Report. J. Clin. Med. 2026, 15, 3501. https://doi.org/10.3390/jcm15093501

AMA Style

Roldan A, Shulman J, Singh R, Dayon E, Abdou A, Hartnett J, Trovato EL. Diagnostic Overshadowing in Functional Neurological Disorder Leading to a Diagnosis of Acute Motor and Sensory Axonal Neuropathy: A Case Report. Journal of Clinical Medicine. 2026; 15(9):3501. https://doi.org/10.3390/jcm15093501

Chicago/Turabian Style

Roldan, Alicia, Julieanne Shulman, Rohini Singh, Eli Dayon, Andrew Abdou, Josette Hartnett, and Erika L. Trovato. 2026. "Diagnostic Overshadowing in Functional Neurological Disorder Leading to a Diagnosis of Acute Motor and Sensory Axonal Neuropathy: A Case Report" Journal of Clinical Medicine 15, no. 9: 3501. https://doi.org/10.3390/jcm15093501

APA Style

Roldan, A., Shulman, J., Singh, R., Dayon, E., Abdou, A., Hartnett, J., & Trovato, E. L. (2026). Diagnostic Overshadowing in Functional Neurological Disorder Leading to a Diagnosis of Acute Motor and Sensory Axonal Neuropathy: A Case Report. Journal of Clinical Medicine, 15(9), 3501. https://doi.org/10.3390/jcm15093501

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