To describe a patient presenting with catatonia following resection of an extensive choroid plexus carcinoma.

Catatonia is a neuropsychiatric syndrome characterized by altered awareness, atypical behaviors, and abnormal movements. Historically considered a psychiatric syndrome, catatonia has been increasingly associated with a variety of underlying medical etiologies.

A previously healthy, typically developing 15-year-old male initially presented to an outside hospital following 3 months of vomiting, right-sided weakness, expressive aphasia, and declining school performance. Neuroimaging revealed an extensive left hemispheric intracranial mass with vasogenic edema and subfalcine and transtentorial herniation, prompting PICU admission. He underwent angiography for tumor embolization and subsequent partial resection followed by EVD placement for obstructive hydrocephalus. Post-op course was complicated by recurrent fevers. Pathology revealed grade 3 choroid plexus carcinoma.  Starting post-operative day 7, he became progressively more unresponsive to all stimuli and stopped following commands, prompting transfer to our hospital. Extensive infectious and toxic/metabolic evaluation was unrevealing.  Family reported rapid improvement in his responsiveness following lorazepam 3 mg given prior to brain MRI, followed by decline in mental status over several hours. Bush-Francis Catatonia Rating Scale Score was 10 (no interaction, minimal incomprehensible speech, rare shifts of attention and posture), consistent with a clinical diagnosis of catatonia. Lorazepam 2 mg QID was continued along with extensive neurorehabilitation, resulting in improvement in his mental status and movements. Persistent expressive aphasia is likely related to his underlying tumor.

Catatonia is a rare but important, treatable etiology of a decline in mental status associated with various neurologic conditions including brain tumors.  Interestingly, our patient developed symptoms of catatonia following resection of his extensive left hemispheric tumor. Catatonia is a key differential consideration in patients with brain tumor and altered mental status with negative workup and lack of response to typical therapies.