Atypical Presentation of Neuropsychiatric Variant of Wilson’s Disease and Clinical Improvement with Elemental Zinc Monotherapy

Abstract

Wilson’s disease has been referred to as “the great masquerader” because it has a plethora of clinical manifestations based on the organ system involved.1 Current understanding is that neuropsychiatric WD develops after years of subclinical hepatic dysfunction.1 Neurologic dysfunction typically begins at approximately 20 years of age but can present earlier or later.2 In WD, the predominant neurologic manifestations (60%) are dysarthria, tremor and ataxia, followed by dystonia (15%) and parkinsonism (11%).3,4 In WD, pure psychiatric presentations are typically seen in patients in their teens. However, symptoms are often non-specific and frequently misdiagnosed as behavioral problems.5 Therefore, in many cases, when the clinical suspicion is low, the diagnosis of Wilson’s disease is often delayed or missed.