A Challenging Case of Malingering Mimicking Psychogenic Visual Impairment with Higher Brain Dysfunction

Abstract

A 43-year-old male, who was blinded in his righteye in a traffic accident10 years earlier,complained of visual disturbances in his left eye. He was initially diagnosed with psychogenic visual impairment in the left eye caused by the stress of a divorce. Two years later, he visited our clinic again with a left orbital fracture, having been punched in the left eye during a dispute with a customer, and complained once again of visual loss in his left eye. No accompanying organic lesions were found. He persistently demanded a visual handicap certification. MRI showed diffuse brain atrophy, and intelligence tests revealed decreased impressibility. We suspect that his psychogenic visual impairment became malingering as time passed. The higher brain dysfunction might have been overlooked for 10 years, which made difficult to diagnose this case.