A 35-year-old woman arrives on the floor after an uneventful hysteroscopy to evaluate her
long history of uterine fibroids. About 30 minutes after her arrival, she begins to complain of
nausea and has two episodes of vomiting. The physician administers 0.625 mg of droperidol and
400 mg of acetaminophen by mouth. On follow-up evaluation, the patient’s neck is involuntarily
flexed to one side. She is alert, oriented, and conversant and has an otherwise normal neurologic
examination. Which of the following is the most likely diagnosis?
A. Cerebral vascular accident
B. Conversion disorder
C. Dystonic reaction to droperidol
D. Munchausen syndrome
E. Seizure
Explanation:
The correct answer is C. The most likely diagnosis is a dystonic reaction to the droperidol.
Droperidol causes its antiemetic effect by antagonizing dopaminergic receptors in the vomiting
center (central chemoreceptor zone) of the brain. This antidopaminergic action can produce
torticollis or other dystonias.
A cerebral vascular accident (choice A) is unlikely given that the patient is alert and oriented, has
no detectable language deficit, and has an otherwise nonfocal neurologic examination.
A conversion disorder (choice B) is unlikely since the patient has no prior history of a psychiatric
disorder and has a viable medical reason (dystonia from droperidol) for her neuromuscular
deficit.
Munchausen syndrome (choice D) is also unlikely since the patient had valid medical reasons for
her initial admission and your current visit. We are also not informed of any prior history of
hospitalizations or seeking of medical attention without appropriate cause.
A seizure (choice E) is similarly unlikely since the patient has no history of a seizure disorder
and is alert, oriented, and conversant.