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Somatoform disorder or neurological syndrome? Complex mental and movement disorder and autonomic dysfunction in a 65-year-old patient - Case 1/2011

Somatoform disorder or neurological syndrome? Complex mental and movement disorder and autonomic dysfunction in a 65-year-old patient - Case 1/2011

Deutsche Medizinische Wochenschrift 136(3): 86

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. 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. 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. 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.

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Accession: 055845464

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PMID: 21240844

DOI: 10.1055/s-0030-1247620

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