Objective: Description of a patient with psychogenic movement disorder showing cerebellar atrophy in neuroimaging.

Background: Psychogenic movement disorders are typically characterized by abnormal involuntary movements not attributable to a known neurological cause. However, clinical presentation is challenging, especially in the presence of abnormal neuroimaging.

Methods: A case report.

Results: A 46-year old woman of Peruvian origin was admitted to our department due to a subacute onset of limb and gait ataxia. Extensive exploration of the family history revealed no neurological disorders. A week before admission, a computer tomography was performed in another hospital due to a syncope and concussion showing cerebellar atrophy. Additionally to the aforementioned ataxia, our patient suffered from a Willis-Ekbom-Disease with an excellent Dopa-treatment effect. Neither further cerebellar signs nor Parkinsonian symptoms were observed. Magnetic resonance imaging confirmed a cerebellar atrophy. Further neuro- and nuclear imaging laboratory studies as well as cerebrospinal fluid showed no abnormalities. Furthermore, extensive genetic testing revealed no pathology. Due to these findings, the diagnosis of an adult onset sporadic cerebellar ataxia was set. The cerebellar type of multiple system atrophy was discussed as an important differential diagnosis. It was surprising, that remission of ataxia was gradually observed during the next few weeks. Furthermore, additional observation revealed no impairment in activities of daily living. Because of that, due to this unusual course and a comorbid anxiety disorder the diagnosis of ataxia associated to psychogenic movement disorder was made. As a differential diagnosis, we also discussed a post concussion syndrome.

Conclusions: This case report emphasizes the need of profound knowledge in clinical neurological examination of psychogenic movement disorders. Furthermore, it is of utmost importance to be aware that psychogenic movement disorders are an important differential diagnosis in the field of movement disorders. However, additional diagnostic methods, i.e. neuroimaging in our patient, can be misleading.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/psychogenic-movement-disorder-in-cerebellar-atrophy/