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Wilson Disease: A Case Report of Psychosis Preceding Parkinsonism.
Dunkerton, Sophie; Clarke, Antonia J; Thompson, Elizabeth O; Xie, Peter; Tisch, Stephen; Worthington, John M; Azadi, Azadeh; Halmagyi, Gabor M.
Afiliación
  • Dunkerton S; Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
  • Clarke AJ; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
  • Thompson EO; Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
  • Xie P; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
  • Tisch S; Department of Radiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
  • Worthington JM; Department of Psychiatry, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
  • Azadi A; Department of Neurology, St Vincents Hospital, Sydney, NSW, Australia.
  • Halmagyi GM; School of Medicine, University of New South Wales, Sydney, NSW, Australia.
Am J Case Rep ; 24: e940561, 2023 Aug 16.
Article en En | MEDLINE | ID: mdl-37583127
ABSTRACT
BACKGROUND A first psychotic episode requires the exclusion of toxic-metabolic, inflammatory, infective, and neoplastic causes. Wilson disease is a rare, autosomal recessive disorder of copper metabolism and can present with neuropsychiatric symptoms secondary to copper accumulation in the brain. CASE REPORT We describe the case of a 48-year-old man with parkinsonism on a background of longstanding schizophrenia and psychotic depression in the setting of previously undiagnosed Wilson disease. The common history of neuropsychiatric disturbance and neuroleptic use complicated the assessment of parkinsonism. However, close attention to the temporal appearance of symptoms and signs differentiated his case from drug-induced parkinsonism, which commonly develops hours to weeks after commencement or uptitration of antipsychotic medication. The early features of sialorrhea and dysarthria were also atypical for idiopathic Parkinson disease. The diagnosis was confirmed by serum copper testing and supported by Kayser-Fleischer rings on bedside ophthalmological examination. Magnetic resonance imaging (MRI) of the brain demonstrated copper accumulation in the basal ganglia and pons, contributing to the characteristic neurological manifestations of an akinetic-rigid syndrome with dysarthria. CONCLUSIONS Serum copper testing is easily obtained and should be considered as part of the first-line investigations for new neuropsychiatric disturbances. Although rare, Wilson disease, if diagnosed early, is a potentially treatable and reversible cause of psychosis. With advanced disease, extrapyramidal findings on examination correlate with MRI brain changes, aiding the clinical assessment in differentiating the disease from drug-induced parkinsonism.
Asunto(s)

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Trastornos Psicóticos / Trastornos Parkinsonianos / Degeneración Hepatolenticular Tipo de estudio: Diagnostic_studies / Etiology_studies Límite: Humans / Male / Middle aged Idioma: En Revista: Am J Case Rep Año: 2023 Tipo del documento: Article País de afiliación: Australia

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Trastornos Psicóticos / Trastornos Parkinsonianos / Degeneración Hepatolenticular Tipo de estudio: Diagnostic_studies / Etiology_studies Límite: Humans / Male / Middle aged Idioma: En Revista: Am J Case Rep Año: 2023 Tipo del documento: Article País de afiliación: Australia