A Rare Case of Ganser Syndrome: Psychogenic or Organic?

Ganser syndrome (GS) is a rare neurological disorder characterized by answer approximation, clouded consciousness, somatic conversion symptoms, and visual or auditory hallucinations. The objective of this case report is to elucidate the presentation of a patient with GS and to highlight the interplay of psychological and organic determinants in this condition. We present a 66-year-old man with a history of concussion and short-term memory loss who presented with selective, remote, and recent memory loss following the death of his wife, visual hallucinations, approximation of answers regarding his current state, and limited insight into his condition. We found the patient oriented only to place and person, with impaired short-term memory and no language abnormalities. Montreal cognitive assessment (MOCA) exam showed mild-to-moderate cognitive impairment. The patient's presentation can be explained by both psychological and organic causes. Negative results from imaging and testing showed that the patient's recent emotional stressor, the death of his wife, may be contributing to the current state. However, the patient also has a history of hospitalization for traumatic brain injury (TBI) and a recent history of progressive memory loss. Therefore, the combination of psychological and organic factors likely played supplementary roles in the patient's current presentation. This case supports the literature that GS is a psychogenic disorder. However, an organic cause from the long-term sequelae of TBI needs further exploration.