Ladowsky-Brooks Ricki L, Fischer Corinne E
Department of Psychology, St. Michael's Hospital, Toronto, Ont., Canada.
J Clin Exp Neuropsychol. 2003 Sep;25(6):761-8. doi: 10.1076/jcen.25.6.761.16473.
Neuropsychological testing was completed in a patient who showed cognitive decline of mental functions, unusual answers to questions, and other characteristics of what has typically been described in the literature as the "Ganser Syndrome." Clear evidence of malingering on a memory test seemed to confirm that this patient was exaggerating deficits for psychiatric reasons or secondary gain, yet the patient showed evidence of mild organic impairment on MRI and continued to deteriorate in cognitive functions and basic self-care. Although an initial SPECT scan had suggested a pattern inconsistent with dementia, a second scan showed frontal-temporal perfusion deficits. Based on this scan and the clinical picture of progressive deterioration, a diagnosis of frontal-temporal lobe dementia was made. This case illustrates that the seemingly deliberate selection of incorrect responses may occur in the early stages of an organic dementia, and that a diagnosis of frontal-temporal lobe dementia should be considered in cases where symptoms appear to be psychiatric or nonorganic. The case further raises the question of whether the reported symptoms of Ganser Syndrome may be accounted for by frontal-temporal lobe dysfunction, since there appears to be some overlap between symptoms of Ganser Syndrome and frontal-temporal lobe dementia. It is also important to note that many reported cases of Ganser Syndrome had a history of head injury.
对一名患者进行了神经心理学测试，该患者表现出心理功能认知衰退、对问题回答异常以及其他文献中通常描述为“甘塞尔综合征”的特征。在一项记忆测试中，明显的伪装证据似乎证实该患者出于精神原因或继发获益而夸大缺陷，但患者在磁共振成像（MRI）上显示有轻度器质性损害的证据，且认知功能和基本自我护理能力持续恶化。尽管最初的单光子发射计算机断层扫描（SPECT）显示出与痴呆不符的模式，但第二次扫描显示额颞叶灌注不足。基于此扫描结果和进行性恶化的临床症状，诊断为额颞叶痴呆。该病例表明，在器质性痴呆的早期阶段可能会出现看似故意选择错误答案的情况，并且在症状看似为精神性或非器质性的病例中应考虑额颞叶痴呆的诊断。该病例进一步提出了一个问题，即甘塞尔综合征所报告的症状是否可能由额颞叶功能障碍引起，因为甘塞尔综合征的症状与额颞叶痴呆之间似乎存在一些重叠。还需要注意的是，许多报告的甘塞尔综合征病例都有头部受伤史。
