A Case of Ganser Syndrome Presenting as a Stroke Alert: Fact or Factitious?

Ganser syndrome is a rare and historically controversial disorder characterized by approximately correct (but not quite correct) answers to simple questions (called vorbeigehen or vorbeireiden), visual and auditory hallucinations, and "clouded consciousness" or encephalopathy. These symptoms usually co-occur with various functional neurological symptoms. We present the case of a 53-year-old man who arrived as a stroke alert with sudden-onset left-sided weakness and numbness, one day after being reported to police by a neighbor for indecent exposure. During his emergency department evaluation, the examiner noticed that he exhibited an inconsistent bedside mental status examination, responding with approximate but not quite correct answers that indicated awareness of his own thought content, in addition to reporting nondescript hallucinations. He had one previous hospitalization in our records with a similar presentation but without these characteristic mental status changes. He serves as his own control, demonstrating that fear of punishment or legal action was necessary to elicit a presentation of Ganser syndrome in his case.