[Somatoform disorder or neurological syndrome? Complex mental and movement disorder and autonomic dysfunction in a 65-year-old patient - Case 1/2011].
METHODS
A 65-year-old female patient presented with increasing vertigo, tendency to fall, dry cough and, in addition, numerous psychic and somatic symptoms since 6 years. Former diagnostic attempts did not yield clarifying results. In part, the patient had not followed up on former recommendations for further diagnostic procedures. With a suspected somatization disorder the patient was admitted to the Department of Psychosomatic Medicine.


METHODS
The neurological examination at admission revealed vertical oculomotor palsy and tendency to fall backwards indicating an affection of the brain stem. A magnetic resonance imaging of the head showed atrophy of the mesencephalon.


METHODS
In light of these findings the patient was diagnosed Steele-Richardson-Olszewksi syndrome. The therapy which comprises training measures and medication with a cholinesterase inhibitor aims to retain neuropsychological and motional abilities. Besides, psychotherapy is offered alongside to help the patient to cope with the disease.


CONCLUSIONS
Treating patients with somatic and psychological symptoms calls for careful anamnestic exploration and clinical examination. Psychological alterations following neurological affection of the brain can imitate somatization disorder.
Abteilung für Psychosomatische Medizin und Psychotherapie, Medizinische Universitätsklinik Tübingen.
Irmtraud
I
Wettach
Florian
F
Junne
Norbert
N
Schäffeler
Rejko
R
Krüger
Isa
I
Sammet
Stephan
S
Zipfel
Martin
M
Teufel
D000223:Adaptation, Psychological; D000368:Aged; D001284:Atrophy; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003371:Cough / Q000209:etiology* / Q000523:psychology; D003937:Diagnosis, Differential; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008636:Mesencephalon / Q000473:pathology; D009460:Neurologic Examination; D009788:Occupational Therapy; D048448:Phenylcarbamates / Q000627:therapeutic use; D011613:Psychotherapy; D000068836:Rivastigmine; D012803:Sick Role; D013001:Somatoform Disorders / Q000175:diagnosis* / Q000523:psychology; D013494:Supranuclear Palsy, Progressive / Q000175:diagnosis* / Q000523:psychology / Q000534:rehabilitation; D013575:Syncope / Q000209:etiology* / Q000523:psychology
D002800:Cholinesterase Inhibitors; D048448:Phenylcarbamates; D000068836:Rivastigmine