From Code Stroke to Cultural Formulation: A Case of Postpartum Functional Neurologic Disorder
Bibliographic record
Abstract
Functional neurologic disorder (FND) is an underrecognized but important cause of acute neurological presentations in the postpartum period, particularly among culturally diverse patient populations. We present the case of a female Nepali immigrant (G5P3023 [fifth pregnancy, three term births, zero preterm births, two pregnancies that ended before 20 weeks, three living children]) in her late 30s with no prior medical or psychiatric history. She developed sudden neurological deficits on postoperative Day 0 following an uncomplicated Cesarean delivery. Approximately 11 hours after delivery, the patient became dizzy, pale, and diaphoretic, then developed right-upper and bilateral-lower extremity paralysis with impaired eye and mouth opening. A code stroke was initiated. Extensive workup (including computed tomography head, computed tomography angiography head/neck, and magnetic resonance imaging brain) was unremarkable. Neurological deficits resolved within hours after ammonia inhalant stimulation. The patient was ultimately diagnosed with postpartum FND. This case highlights key diagnostic and management challenges in distinguishing FND from stroke, catatonia, and dissociative states in medically complex postpartum patients. It also underscores the importance of trauma-informed, culturally sensitive approaches to diagnosis and care. Our discussion explores the limited but evolving literature on postpartum FND-potentially inclusive of sensory-motor mismatch, loss of agency, hormonal shifts, and psychosocial stressors-while also exploring strategies for culturally grounded psychoeducation. Clinicians must vigilantly watch for functional presentations postpartum to avoid unnecessary interventions and promote holistic recovery. Cross-disciplinary collaboration among psychiatry, neurology, and obstetrics is essential for optimal care.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".