Abstract Details

Title Catatonia: An Elusive Diagnosis

Topic Behavioral Neurology

Presentation(s) P05 - (-)

Poster/Presentation
Number 127

Objective

Background BACKGROUND: Catatonia is as well known clinical entity yet the diagnosis remains challenging. A diagnostic benzodiazepine challenge is often not considered till late.

Design/Methods DESIGN/METHODS: Case report.

Results RESULTS: 41 year old female with history of porencephalic cyst, paranoid schizophrenia, and epilepsy was admitted to ICU for severe sepsis secondary to pneumonia. Patient was extubated on day 12 and transferred to medicine floor. However the patient continued to be unresponsive, was mute and immobile and unable to follow commands. On examination patient demonstrated sustained neck and left arm posture with resistance to passive movements by examiner. She was responding to painful stimuli only by grimacing and opened her eyes spontaneously but was resisting passive eye opening. When her arm was stretched out above her head, it fell down missing her face. Patient had extensive work up including imaging studies, serial EEGs and serologic tests that did not explain her poor mental status and unresponsiveness. A presumptive diagnosis of Catatonia was made and 2 mg of lorazepam IV was administered. Within 5 minutes patient showed dramatic response and started following verbal commands and answered questions appropriately. Oral Lorazepam was continued and few days later patient was able to sit up in a chair and feed herself. Subsequently, she was discharged to rehabilitation facility.

Conclusions CONCLUSIONS: This case demonstrates the challenging nature of the disease and dramatic response to appropriate treatment. Exact nature and patho-physiology of the disease continue to remain elusive and warrants further investigation.

Authors/Disclosures
Abdulrahman Alwaki, MD PRESENTER	Dr. Alwaki has nothing to disclose.
Vivek Rai, MD	Dr. Rai has nothing to disclose.
Eric Anderson, MD, PhD, FAAN (Intensive Neuro)	Dr. Anderson has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Sindler Law firm, WVU, MayerLLP, KBA attorneys. Dr. Anderson has or had stock in Synapticure. The institution of Dr. Anderson has received research support from NIH.
Keyur Patel, MD	No disclosure on file
	No disclosure on file

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