Neuropsychiatric presentation of Wilson’s disease – a case report

The article describes a 22-year-old woman who presented with neuropsychiatric symptoms in the course of Wilson’s disease. The patient, diagnosed with para- noid schizophrenia, was transferred to a university hospital’s psychiatric ward due to treatment failure in the past eight months of progressing disease. On admission the patient showed severe extrapyramidal symptoms: rigidity, tremor, dystonia, dysphagia, sialorrhoea, masked facies, flat affect, and dysarthric speech. Initially, these symptoms were interpreted as side effects of the neuroleptic treatment. Despite the modification of the antipsychotic treatment, the aforementioned symptoms persisted. After performing the following tests: ceruloplasmin level, head MRI, 24-hour urine copper test, and CT of the abdomen, and cooperating with a neurologist, ophthalmologist, and gastroenterologist, Wilson’s disease was diagnosed. To provide an adequate treatment, the patient was transferred to a neurological medical ward. Despite the anti-copper treatment, the patient’s state was constantly worsening. Generalised dystonia and overall medical complications resulted in the patient’s death.