Published 9 September 2009, doi:10.1136/bmj.b3494
Cite this as: BMJ 2009;339:b3494

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Eye sign in an 18 year old man with psychosis

Annu Aggarwal, research fellow in cognitive and behavioural neurology1, Mohit Bhatt, movement disorders specialist2

1 Department of Neurology, Royal Adelaide Hospital and University Department of Medicine, University of Adelaide, Adelaide, SA 5000, Australia, 2 Department of Neurology, Jaslok Hospital and Research Centre, and Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai 400053, India

Correspondence to: M Bhatt drmbhatt@gmail.com

The first 150 words of the full text of this article appear below.

An 18 year old man presented after developing progressive dysarthria and abnormal limb postures. From the age of 15 he had been increasingly irritable, belligerent, and difficult to discipline. He played truant from school, wandered aimlessly around the city claiming to be a dynamic entrepreneur, and heard voices plotting against him. Examination revealed psychosis, severe dysarthria, and generalised dystonia with prominent oromandibular involvement. A diagnostic eye sign was noted (fig 1Go). Treatment for 18 months led to considerable clinical improvement and regression of the abnormality in the eye.


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  		Fig 1 Diagnostic eye sign

 
1 What is the eye sign shown?
2 What clinical features and investigations can support the diagnosis?
3 How can it be treated and what is the prognosis?

1 The eye sign shown is Kayser-Fleischer rings—greenish discoloration at the outer corneal circumference (fig 2Go). This abnormality was named after ophthalmologists Bernhard Kayser and Bruno Fleischer, . . . [Full text of this article]


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