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Hallervorden-Spatz syndrome is characterized by pyramidal and extrapyramidal signs, and dysarthria and dementia. Psychiatric symptomatology can emerge in the course of the disorder. Mutations in the pantothenate kinase 2 gene have been found in many cases. We report a case with psychosis as sole presenting symptom.
A 41-year-old man presented with change in behavior and paranoid delusional ideation. Six months later, spasticity, extrapyramidal rigidity and dysarthria were added to the picture. Eventually, the patient became mute and wheel-chair bound. The brain magnetic resonance imaging (MRI) was consistent with iron depositions in the globus pallidus and substantia nigra.
In this case, the combination of clinical and MRI findings was consistent with Hallervorden-Spatz syndrome. The combination of psychiatric and MRI findings should lead to further neurological investigation.
Peduncular hallucinosis is a rare stroke-related phenomenon that may occur in cases of ischemic lesions localized in the cerebral peduncles, the pons, the upper midbrain or the thalamus and is mostly characterized by transient visual hallucinations.
We report the case of an insufficiently treated hypertensive patient who presented with constantly elevated blood pressure values and persistent visual hallucinations, which ceased a few hours later after medically achieved blood pressure normalization. Magnetic resonance imaging (MRI) revealed a symmetric paramedian ischemic lesion of the upper pons, which seems to be the cause of this case of peduncular hallucinosis.
Although uncommon, this entity needs to be differential diagnostically considered in cases of transient visual hallucinations in persons with known vascular risk profile. MRI can be a useful diagnostic tool.
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