A Startling Neuropsychiatric Functional Syndrome

Abstract

Startle syndromes are heterogeneous groups of disorders and this paper reports an uncommon neuropsychiatric syndrome to alert the medical community to these conditions and their diagnostic and treatment implications. A 35-year-old male was brought to the Psychiatric Emergency Room due to sudden behavioral changes and mutism. Exhibiting fever and exuberant limb startle reflexes when elicited by the menace reflex and tactile stimulation, the neurologist was called. He had a history of previous hospitalizations due to schizoaffective disorder and he had suspended his antipsychotic medication. All requested exams (MRI, EEG, lumbar puncture, lab tests) were normal, except for hyperglycemia, hypophosphatemia and hyperglycorrachia. Excluded several organic causes, a functional neuropsychiatric Startle syndrome appears as the most probable diagnosis. It is an unusual clinical presentation with an overlap of physical signs shared with other neurological disorders, which demands a multidisciplinary approach to establish the correct diagnosis and not delay the correct treatment.