Two Rare Syndromes, One Patient in Rerun Hell

Michelle E. Grady

November 27, 2020

Dr Nishi Chandrasekaran

When an 86-year-old male patient presented to Nishi Chandrasekaran, MBBS, at the Smell and Taste Treatment and Research Foundation in Chicago, Illinois, he initially complained of impaired memory and concentration as well as some olfactory and gait problems

"Initially that was it. So we talked about these issues together and I suggested a few treatments, but as we got to know one another, the patient also revealed that he was very depressed," Chandrasekaran told Medscape Medical News.

"He believed that no one understood what was going on for him including his son, and he was even hesitant to talk to me. But, through follow-up questions, he finally revealed that the whole world felt familiar no matter where he went."

The patient eventually disclosed that for the past 6 months, every person he encountered was someone he knew — although he was unable to say how he knew him or her. Even though he was adamant that he had met these individuals before, his son reported they were all strangers.

Ultimately, the patient was diagnosed with hyperfamiliarity for faces (HFF) syndrome, which has been linked to seizures, although he had no such history.

On further investigation, the patient also disclosed that he had a similar experience when he watched television, telling doctors that every show he watched was a rerun with identical plots, scenes, settings, and actors.   

"This included game shows with the host asking the same questions and the same contestants providing the same answers, as well as his other favorite shows like CSI NY. He complained to his son that all the TV shows were reruns, even though these shows were being broadcast for the first time," said Chandrasekaran.

While most people have heard of or experienced déjà vu, a brief episode where they feel as though they have lived an experience before, this patient was experiencing a syndrome known as déjà vécu, where a current situation feels like reality.

These two comorbid conditions had researchers stumped. There has been some research on HFF, but hyperfamiliarity for a television show has never been described before, said Chandrasekaran.  

The researchers investigated whether the patient's problem was connected to other delusional misidentification disorders like Capgras or Fregoli syndromes, but with no previous history of delusions or altered sensory experiences, his syndrome was unique.

Disappearing Lesion?

MRI revealed white matter lesions, encephalomalacia, and gliosis in the right frontal lobe, mild global atrophy, and atrophy within the body of the corpus callosum — findings that are consistent with a disconnection syndrome, said Chandrasekaran.

She added that the results of the patient's clock drawing test suggest either a parietal lobe defect or a visual perceptual abnormality.

The patient was treated with mirtazapine for his depression and spontaneously recovered from HFF and déjà vécu after 9 months.

Chandrasekaran said the combination of HFF and the perception of television reruns, which began and resolved at the same time, strongly suggest it is was the same syndrome.

It is unclear why his symptoms spontaneously resolved, and so the case remains a medical mystery. However, Chandrasekaran noted there have been previous reports of brain lesions associated with epilepsy and psychosis "disappearing." Nevertheless, she added, this phenomenon has not previously been described in HFF.

"One can only speculate that maybe with the depression being under control, and with positive reinforcement from family constantly reminding him and explaining the syndrome to him, that neuroplasticity came into play and the brain was somehow healed," she said.

"It makes a huge difference to patients' mental health when they know that their physician and their family understand the reason behind this unusual symptom and that they are not making up stories," said Chandrasekaran.

She added that this case suggests it may be worth screening for television rerun syndrome in patients with HFF déjà vécu or delusional misidentification syndrome.

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