Ganser symptoms in a Chinese speaking corticobasal syndrome (CBS) patient.

Dear Editor, Ganser syndrome was fi rst described by Sigbert Ganser in 1897, characterised by approximate answers to real questions, dulling of consciousness, hysterical neurological changes and hallucinations.1-3 Ganser syndrome was mainly considered as a psychiatric illness, based on the theory that Ganser syndrome represents a means of coping with stress in those who are intellectually compromised through a dissociative or factitious reaction.3 However, Ganser syndrome also has been described in varieties of organic brain diseases, such as traumatic brain injury, alcoholism with Korsakoff's psychosis, neurosyphilis,3 and most recently, frontotemporal dementia.4 Neuropsychological characteristics of Ganser symptoms in organic brain syndromes have been described as inconsistent performance plus multiple verbal and visuospatial approximate answers, and suggested that the seemingly deliberate selection of incorrect responses may occur in the early stages of an organic dementia.4 It has been hypothesised that frontaltemporal lobe dysfunction may contribute to the picture of Ganser syndrome by leading to the malingering impulse.4 However, a precise or clear brain behaviour correlation of Ganser syndrome is still yet to be defi ned. In this case, we describe a case of young onset parkinsonism that is suggestive of corticobasal syndrome (CBS), who developed gradual cognitive symptoms and neuropsychological assessment that are consistent with a Ganser episode. This case illustrates again the neuropsychological characteristic in Ganser symptoms in organic brain disease, which is still rare in literature, and reemphasises the potential association with a wide range of neurodegenerative diseases. It also poses a new question in the role of basal ganglia in producing Ganser episode due to its signifi cant contribution to frontal-subcortical network connection.