Department of Neurology, University Hospital Giessen and Marburg, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany.
Department of Neuroradiology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392, Giessen, Germany.
J Med Case Rep. 2021 Jul 10;15(1):353. doi: 10.1186/s13256-021-02902-6.
Superficial siderosis is a rare disease involving hemosiderin deposits on the surface of brain or spinal cord that are thought to cause clinical symptoms, which usually consist of cranial nerve dysfunction, cerebellar ataxia, or myelopathy. Pseudohallucinations have been described as the patient being aware of the nonreality of hallucination-like phenomena. Data on pseudohallucinations of cerebral somatic origin are sparse. We present a case of auditory and visual pseudohallucinations due to superficial siderosis. Siderosis was diagnosed using cerebrospinal fluid analysis and magnetic resonance imaging as part of the clinical routine for newly emerged psychiatric symptoms.
An 84-year-old white/european female presented to our hospital with no prior history of psychiatric or neurological disease and no history of trauma. She reported seeing things and hearing voices singing to her for some days. She was aware these phenomena were not real (pseudohallucinations). On examination, no relevant abnormalities were detected. Cerebrospinal fluid analysis showed elevated ferritin. Magnetic resonance imaging with susceptibility-weighted sequences revealed diffuse superficial siderosis in several parts of the brain, among other occipital and temporal gyri. The pseudohallucinations resolved with a risperidone regime. The patient was treated with rivaroxaban because of atrial fibrillation. Potentially elevating the risk of further hemorrhage, this therapy was discontinued, and an atrial appendage occlusion device was implanted.
We report the first case of pseudohallucinations in superficial siderosis. The risk of missing this diagnosis can be reduced by applying a standardized diagnostic pathway for patients presenting with the first episode of psychiatric symptoms. Somatic and potentially treatable causes should not be missed because they might lead to unnecessary treatments, stigmatization, and legal restrictions of self-determination, especially for elderly people.
脑脊髓表面铁沉积症是一种罕见疾病，其特征为脑或脊髓表面有含铁血黄素沉积，据认为这些沉积会导致临床症状，通常包括颅神经功能障碍、小脑共济失调或脊髓病。假性幻觉是指患者意识到幻觉样现象不真实。关于源于大脑躯体的假性幻觉的数据很少。我们报告了一例因脑脊髓表面铁沉积症引起的听觉和视觉假性幻觉。铁沉积症是通过脑脊液分析和磁共振成像诊断的，这是为新出现的精神症状进行的临床常规检查的一部分。
一位 84 岁的白人/欧洲女性因无先前的精神或神经病史和无创伤史就诊于我院。她报告说，几天来她看到了东西并听到有人唱歌给她听。她意识到这些现象不真实（假性幻觉）。检查时，未发现相关异常。脑脊液分析显示铁蛋白升高。磁共振成像的磁敏感加权序列显示大脑的几个部位弥漫性脑脊髓表面铁沉积症，包括一些枕叶和颞叶回。利培酮治疗后假性幻觉消失。该患者因心房颤动接受利伐沙班治疗。鉴于可能增加进一步出血的风险，停止了这种治疗，并植入了心房附件闭塞装置。
我们报告了首例脑脊髓表面铁沉积症的假性幻觉。通过为出现首发精神症状的患者应用标准化的诊断途径，可以降低漏诊的风险。不应忽视躯体性和潜在可治疗的病因，因为它们可能导致不必要的治疗、污名化和对自决的法律限制，尤其是对老年人。
