title: Ganser-like syndrome after loss of psychic self-activation syndrome: psychogenic or organic?
abstract: Very few data are available on the long-term changes in the cognitive abilities of patients with loss of psychic self-activation syndrome (LPSAS). Here, we present a 25-year follow-up study on a case of LPSAS resulting from bilateral pallidal lesions caused by carbon monoxide intoxication. Typical signs of LPSAS were observed, showing no changes in severity, but Ganser syndrome (GS) gradually developed and worsened during the follow-up period. GS is generally assumed to be a psychogenic syndrome, but an organic etiology has been suspected by the authors of several case reports. Here, atypical features of GS plead against the independence of GS and LPSAS. DaTSCAN and brain 18FDG-PET were performed. Since left hippocampal hypometabolism has been previously described in patients with functional amnesia, it is possible that long periods of mental inactivity may have psychological consequences, but the atypical features of GS also suggest that an organic mechanism may be involved.
authors.affiliation: Service de Neurologie, Pôle de Neurosciences cliniques, AP-HM Timone, Marseille 13005, France elsa.kaphan@mail.ap-hm.fr.
authors.forename: Elsa
authors.initials: E
authors.lastname: Kaphan
authors.affiliation: Service de Neurologie et Neuropsychologie, Faculté de Médecine, Pôle de Neurosciences cliniques, AP-HM Timone and LNN INSERM U751, Marseille 13005, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Barbeau
authors.affiliation: Service de Neurologie et Neuropsychologie, Faculté de Médecine, Pôle de Neurosciences cliniques, AP-HM Timone and LNN INSERM U751, Marseille 13005, France.
authors.forename: Marie L
authors.initials: ML
authors.lastname: Royère
authors.affiliation: Aix-Marseille Université, CNRS UMR7289, INT, & CERIMED, Marseille13005, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Guedj
authors.affiliation: Service de Neurologie, Pôle de Neurosciences cliniques, AP-HM Timone, Marseille 13005, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Pelletier
authors.affiliation: Service de Neurologie, Pôle de Neurosciences Cliniques, AP-HM Timone and INCM, UMR 6193, CNRS Aix-Marseille, Aix-Marseille Université, Marseille13005, France.
authors.forename: André
authors.initials: A
authors.lastname: Ali Chérif
mesh_terms: D000328:Adult; D000405:Akinetic Mutism / Q000139:chemically induced / Q000175:diagnosis / Q000503:physiopathology; D001921:Brain / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D002249:Carbon Monoxide Poisoning / Q000150:complications*; D005162:Factitious Disorders / Q000139:chemically induced / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans
keywords: Basal ganglia; CO intoxication; Decision-making; Functional neuroimaging; Ganser syndrome; Loss of psychic self-activation syndrome; Neuropsychological assessment; Pallidal lesion