Epileptic Münchausen syndrome by idiosyncratic of effect antiepileptic drugs

Between 1996 and 2000, a 36-year-old woman was admitted four times for the presumed diagnosis of status epilepticus. Major skin allergy followed by collapsus occurred each time after intravenous phenytoin therapy. Video-EEG demonstrated non epileptic, psychogenic seizure leading to the diagnosis of Münchausen syndrome by idiosyncratic reaction to antiepileptic drugs.     

The unbearable reality of the child: Münchhausen's syndrome by proxy

The hypothesis of Münchhausen's syndrome arises through a clinical situation. The patient is unable to consider the question of "being a mother". The child takes the place of a real, unbearable object, which she evacuates or which can disappear. This maternal suffering requires psychotherapeutic care.     

A single case report of recurrent surgery for chronic back pain and its implications concerning a diagnosis of Münchausen syndrome

While undergoing treatment in the psychiatric department, A.C., a 40-year-old white male, who had arrived in the casualty department complaining of an uncontrollable anxiety attack and in a state of fluctuating consciousness, was found to be suffering from a psychopathological condition characterized by pathological lying, gambling, compulsive restlessness, a long clinical history of chronic back pain, with multiple invasive diagnostic investigations and repeated surgery for disc hernia with relative complications, culminating in the fitment of a fixed neurostimulator, a slow-discharge morphine pump and the patient being granted a full disability pension. The continual increases in the doses of morphine suggested a tendency towards drug addiction. After providing a brief overview of the historical background and current concepts relating to the relationship between factitious disorders, malingering and hysteria, the authors discuss the differential diagnosis of the case, suggesting a diagnosis of Münchausen syndrome (the hypothesis best supported by the clinical evidence). This diagnosis, although the subject of much academic debate, is, unfortunately, still not frequently encountered in the medical literature, with the result that even today it has a strong clinical, relational and social impact.     

Tachyarrythmias with elevated cardiac enzymes in Münchausen syndrome

We report the case of a woman with Münchausen syndrome who surreptitiously injected epinephrine causing recurrent ventricular tachyarrhythmias accompanied by dramatically high plasma levels of epinephrine and normal norepinephrine levels.     

Long-term neuropsychological follow-up of a child with Klüver-Bucy syndrome

We describe the case of a 10-year-old girl who developed behavioral changes consistent with Klüver-Bucy Syndrome following Listeria meningoencephalitis at 2? years of age. MRI at age 4 revealed evidence of diffuse brain atrophy with predominant temporal lobe involvement. Electroencephalograpy at 9? years of age showed abnormal electrical discharges from the left temporal area. Follow-up MRI with volumetric analysis of the mesial temporal structures at 9 years of age demonstrated decreased hippocampal volume bilaterally. Consistent with the morphological abnormalities, serial neuropsychological evaluations demonstrated expressive and receptive language impairment and an amnestic syndrome that significantly decreased her ability to make new declarative memories and maintain adequate academic progress.     

Mozart's movements and behaviour: a case of Tourette's syndrome?

In this review, we intend to explore the often asked question: “Did Mozart have Tourette''s syndrome?” Although there are numerous reports attributing Mozart''s peculiar personality and behaviour to a spectrum of neurobehavioural disorders such as Tourette''s syndrome, autistic disorder, Asperger''s syndrome, attention deficit hyperactivity disorder, obsessive–compulsive disorder and paediatric autoimmune neuropsychiatric disorders associated with streptococcal infection, the evidence for any of these disorders is lacking. Whether Mozart''s behaviour was nothing more than a reflection of his unique personality or a more complex neurological disorder, aggravated later in life by enormous demands by his father and society, his behaviour has been the subject of many biographies. It will also remain unknown to what extent his accomplishments and failures were shaped by his childhood experiences, pressured lifestyle, and his innate genius and extraordinary talent. Lessons from his life may have important implications for other gifted individuals and savants whose special attributes may lead them to succeed or, on the other hand, suppress their emotional growth and make them more vulnerable to stress and failure.The 250th anniversary of the birth of one of the greatest musical geniuses of all times, Wolfgang Amadeus Mozart (1756–1791), provides an opportunity not only to reflect on his immeasurable contributions to the world of classical music, but also to examine him as a man of exceptional creative power. Mozart''s biographical accounts often comment on his peculiar behaviour which has been interpreted by some as a manifestation of an underlying neurobehavioural disorder, such as Tourette syndrome (TS). Once considered a rare psychiatric curiosity, TS is now recognised as a relatively complex neurobehavioural disorder, affecting approximately 2% of the general population.^1,2 Some studies have suggested that TS affects up to 3.8% of children, and two‐thirds of them have coexistent attention deficit hyperactivity disorder (ADHD), obsessive–compulsive disorder (OCD) or other behavioural comorbidities.³ Although learning disabilities have been suggested to be present in some patients with TS,^4,5 most reach their full potential without any residual psychiatric or neurological handicap. Many notable figures, such as Dr Samuel Johnson, have made extraordinary contributions to the arts and sciences despite, or perhaps because of, their TS.⁶ Several reports have drawn attention to the observation that some TS patients possess unique talents and skills, similar to individuals with autism and savant syndrome.^7,8 Various structural and functional imaging studies of brains of musicians have found that in contrast with non‐musicians, the musicians'' brains tend to have increased gray matter in Broca''s area and in certain portions of the auditory cortex, such as the Heschl''s gyrus and planum temporale.^9,10 Studies of developmental and acquired disorders of musical listening and interpretation have shown that brain plasticity is involved in musical perceptions and integration with cognitive and emotional responses,¹¹ and that music could have both evocative and suppressive effects on some patients with movement disorders such as TS and parkinsonism.¹²Although many individuals with unique talents have been carefully studied, no unified theory has emerged to explain the neurological basis of such exceptional creative or interpretive abilities, as demonstrated by some people with autism or some savant artists. It is beyond the scope of this review to discuss the neurobiology of savant and the reader is referred to other sources,^13,14 but the brain mechanisms giving rise to savant‐like features may be relevant to the understanding of the neurobiology of a genius mind, such as that of Mozart. Whether savant is more frequently observed in patients with TS or whether some savant cases manifest features of TS, such as tics and OCD, has not been systematically studied.Insanity and exceptional musical talent have often been thought to be linked, but the mechanism of this relationship is unknown.¹⁵ As an example, David Helfgott, a prodigious pianist featured in the movie “Shine,” has been thought to suffer from a mild form of schizophrenia with positive symptoms. He grunts, mutters, sings, talks to himself very loudly and exhibits other tic‐like mannerisms as he plays.¹⁶ Creativity has often been associated with bipolar disorder and some composers, artists, authors and other creative geniuses of the past have observed loss of their creative talents with pharmacological treatment of their bipolar disorder. Vincent van Gogh, who committed suicide at the age of 37 years, in the last few years of his life suffered from episodes of mania and depression. Despite the mood swings and mental torment, he completed more than 300 of his best paintings, suggesting that his manic state may have facilitated his creativity.¹⁷ There is a lengthy list of other famous figures such as Ludwig von Beethoven, Robert Schumann, Peter Ilyich Tchaikovsky, Sergei Rachmaninoff, Ernest Hemingway, Leo Tolstoy, Jonathan Swift, Oliver Cromwell, Abraham Lincoln, Theodore Roosevelt, John Nash, Nikolai Gogol, Edgar Allan Poe and many more who have suffered from a variety of mental or personality disorders.^15,18,19 Besides Samuel Johnson and Mozart, many celebrities such as Howard Hughes, Marc Summers, David Beckham, Tim Howard, Jim Eisenreich, Chris Jackson (Mahmoud Abdul‐Raul), David Aldridge, Michael Wolff, Dan Ackroyd, Howie Abdul‐Rauf Mandel and Mel Gibson are among those thought to manifest some features of TS and its comorbidities, particularly OCD.^16,20,21     

Long-term neuropsychological follow-up of a child with Klüver–Bucy syndrome

We describe the case of a 10-year-old girl who developed behavioral changes consistent with Klüver–Bucy Syndrome following Listeria meningoencephalitis at 2½ years of age. MRI at age 4 revealed evidence of diffuse brain atrophy with predominant temporal lobe involvement. Electroencephalograpy at 9½ years of age showed abnormal electrical discharges from the left temporal area. Follow-up MRI with volumetric analysis of the mesial temporal structures at 9 years of age demonstrated decreased hippocampal volume bilaterally. Consistent with the morphological abnormalities, serial neuropsychological evaluations demonstrated expressive and receptive language impairment and an amnestic syndrome that significantly decreased her ability to make new declarative memories and maintain adequate academic progress.     

Is the delayed sleep phase syndrome a physical or psychological disease? A case report of disappearance following a change of latitude

The delayed sleep phase syndrome is characterized by an abnormally late sleeping and arousal time. Among several available treatments, chronotherapy, light therapy and melatonin administration strongly suggest a frequently recurring disturbance of the brain's circadian clock. However, several studies show psychological disturbances, which are either potentially a consequence or a cause or only fortuitously associated. The first case of disappearance of the disturbance after a move to a tropical latitude does not determine the main responsible factor.     

Central nervous system Sjögren's syndrome in a child: case report and review of the literature

We describe a case of pediatric Sj?gren's syndrome with progressive neurologic involvement. At age 4 years, she had been diagnosed with Melkersson-Rosenthal syndrome. After being stable with facial diplegia and swelling for 5 years, she acutely presented with diplopia, vertigo, and ataxia. Cranial magnetic resonance imaging (MRI) showed a left dorsal midbrain lesion. Serologic and histopathologic findings confirmed primary Sj?gren's syndrome. She responded well to intravenous methylprednisolone, with subsequent clinical improvement and MRI resolution. This report reviews the pediatric literature and underscores the importance of considering Sj?gren's syndrome in a child with unexplained facial weakness and in the differential diagnosis of pediatric stroke.     

Hyperalgesia after volar wrist tattoo: a case of complex regional pain syndrome?

Hyperalgesia after a volar wrist tattoo with features consistent with complex regional pain syndrome and a brief literature review is presented. This is the first case of disseminated hyperalgesia reported from a tattoo. It could be related to the increased pain associated with wrist tattooing and the proximity to the palmar cutaneous branch of the median nerve. The response to prednisone was robust. Further cases may appear considering popularization of wrist tattoos by celebrities.     

Clinical course of spontaneous spinal epidural haematoma mimicking Guillain-Barré syndrome in a child: a case report and literature review

We describe a 9-year-old female with thoracic epidural haematoma. The clinical course simulated Guillain-Barré syndrome (GBS) so intravenous immunoglobulin therapy was started at the paediatric clinic. Magnetic resonance imaging (MRI) 3 days after admission showed thoracic epidural haematoma between T2 and T8. An emergency laminectomy was performed and the patient's neurological symptoms began to improve immediately after surgery and she made a full recovery during the 2 weeks of follow-up. Time is a very important factor in achieving reversibility of symptoms of compressive cord lesions, such as spinal epidural haematoma, and MRI is mandatory for patients with progressive paraplegia, even though the signs and symptoms might suggest GBS.