After the original description of the Ganser syndrome (GS), in 1898, there has been a great debate over the etiological primacy of either hysteria or psychosis (including organic states). Even now, despite the DSM-IV classification of GS as a dissociative disorder, this condition remains an extensively misunderstood condition. Not only has it been reported in association with various functional psychiatric disorders but also as organic states, most often in patients with head injury and stroke, especially those involving the frontal lobes.

A case of GS in a 47-year-old male patient admitted in the psychiatry ward due to a reactive depressive syndrome along with a personality disorder is presented. Throughout his stay in the inpatient unit, the patient developed a full blown GS after defenestration - in a paranoid context - with consequent head-trauma and internal hemorrhage in the fronto-temporal region of the dominant hemisphere.

The case illustrates some of the problems of nosology, clinical presentation, and psychopathology that this syndrome raises. The authors discuss the etiological dilemma and the complexities of the diagnosis of GS in the presence of an organic lesion accompanied by an overwhelming emotional component.