Ganser Syndrome Clinical Presentation

Updated: Oct 27, 2021
  • Author: Claudia L Reardon, MD; Chief Editor: Glen L Xiong, MD  more...
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Presentation

History

Ganser syndrome has been observed frequently in conjunction with a marked psychosocial or physical stressor (eg, head injury, serious illness). Typically, the duration of symptoms is brief.

Enoch and Trethowan's 4 identified symptoms for the syndrome [3] are as follows:

  • Approximate answers

  • Clouding of consciousness

  • Somatic conversion symptoms

  • Hallucinations

Other commonly observed features include the following:

  • A dreamy or perplexed appearance

  • Memory or personal identity loss

  • No recollection of the syndromal state upon recovery

  • Perseveration

  • No response to painful stimuli

  • Catatonic posturing

  • Echolalia

  • Echopraxia

Next:

Physical Examination

A complete mental status examination should be conducted when Ganser syndrome is suspected.

A complete physical examination should also be performed.  Pay particular attention to the following points:

  • Conduct a complete neurological examination, with attention to any cataonic posturing or sensory or motor abnormalities

  • Assess vital signs

Sample mental status and physical examination

Following are some of the observations that may be made during the mental status and physical examination.

  • Appearance: There may be the appearance of being disheveled.

  • Behavior: The patient may be pleasant but only minimally cooperative. Eye contact may be poor, with long episodes of staring. They may answer questions only after long pauses.

  • Speech: Speech may be notable for latency of response and short, succinct answers.

  • Mood/affect: There may be no evidence that the patient is not euthymic other then a notably blunted affect.

  • Thought form/content: Thought form and content may be difficult to assess due to limited verbal output. There may be no obvious evidence of delusional or obsessive thoughts.

  • Perceptual abnormalities: The possibility of response to auditory or visual hallucinations may be raised by prolonged episodes of staring.

  • Cognitive functioning: The ability to assess cognitive abilities is limited by paucity of verbal output. The patient is clearly alert; however, when asked questions they may frequently give an incorrect answer that shows some understanding of the subject and possible knowledge of the correct answer. For instance, when asked how many legs a dog has, they may answer "3" or when asked for the color of snow, they may answer "black."

  • Neurologic examination: There may be diminished response to pinprick throughout. Tone may be difficult to assess due to the presence of a facilitory paratonia. There may be occasional catatonic posturing, most obvious in the upper extremities. 

  • General examination: Vitals are typically stable. 

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