Neurological symptoms psychiatric presentation

A variety of endocrine, vascular, neurological, and psychiatric diseases disrupt normal sexual and reproductive function in men. Furthermore, sexual dysfunction may be the presenting symptom of systemic disease. 

Metachromatic leukodystrophy is another lysosomal storage disorder caused by a deficiency of arylsulfatase A which leads to the accumulation of 3-0-sulfogalactosylceramide. The defect results in severe demyelination. The disease often takes a presentation of an under- and mis-diagnosed psychiatric affection long before neurological symptoms appear and MRI displays the anatomical lesions. MRI reveals a diffuse demyelination, bilateral and often symmetrical, initially limited to the periventricular areas. 

Several medical, medication-induced, or substance-related causes of mania and depression have been identified (see Table 68-2 for causes of mania and Table 67-1 in Chap. 67 on depressive disorders for causes of depression). " A complete medical, psychiatric, and medication history physical examination and laboratory testing are necessary to rule out any organic causes of mania or depression. An accurate diagnosis is important because some psychiatric and neurologic disorders present with manic-like symptoms. For example, attention-deficit/hyperactivity disorder and a manic episode have similar characteristics thus individuals with bipolar disorder may be misdiagnosed and prescribed central nervous system stimulants. Use of any substance that affects the central nervous system (e.g., alcohol, antidepressants, caffeine, central nervous system stimulants, hallucinogens, or marijuana) can worsen symptoms and decrease the... 

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