The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.
A 20-year-old man who no longer speaks is undergoing studies to clarify his condition. Although his parents reported that his early development was normal, they describe unusual behaviors prior to age 5 years. He would spin string and paper from his father's cigarette cartons for hours. His early speech exhibited disarticulation, agrammatism, truncated sentence structures, and a sing-song intonation.
When the boy first entered school, he demonstrated attentional and learning disabilities, as well as impaired motor coordination. At age 9 years 5 months, neurologic assessment revealed visual perceptual problems, impaired left-right discrimination, agrammatism, poor memory, and abnormal soft signs. However, his parents denied the presence of abnormalities. They did not continue treatment with a pediatric neurologist.
At age 13 years, the boy's teacher told him that he would not be promoted to high school. When he returned home from school, he told his mother he wanted to go to high school. That was the last time that anyone heard him speak. For a few weeks, he made clicking sounds in his throat to communicate. Then verbal communication stopped altogether.
After presenting to a psychiatry clinic at age 14 years, he was treated orally with haloperidol (1 mg) and benztropine (1 mg) twice daily for a month. The medications were then discontinued due to lack of response. His father was born in Barbados, and the boy has a paternal family history of mental illness. However, the details are unknown.
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Cite this: James Robert Brasic. A 20-Year-Old Man Who Stopped Speaking - Medscape - Jul 31, 2017.