A 66-year-old woman with hypothyroidism presented after months of progressive cognitive and functional decline, abnormal movements, and acute onset unresponsiveness consistent with catatonia. The patient was intubated for airway protection due to her mental status.

Ten months earlier, she developed abrupt psychiatric symptoms that progressed to paranoia and suicidal ideation, requiring psychiatric hospitalization. In the ensuing months, she experienced rapid memory and cognitive decline, from forgetting routine tasks to inability to perform activities of daily living, such as working and cooking. Family reported a progressive tremor of the hands and jaw and fluctuating insomnia and mental status. Weeks before admission, her extremities became markedly rigid, with loss of ambulation and dependence for basic self-care. The day before presenting, she was found unresponsive to verbal and tactile stimuli with a fixed stare and no apparent alertness.

An extensive work up, including brain magnetic resonance imaging, electroencephalography, and cerebral spinal fluid was normal. She was empirically treated with high-dose corticosteroids, plasma exchange, dopaminergic therapy, and a lorazepam challenge with no improvement. The patient’s neurologic status did not improve, and care was transitioned to comfort measures with postmortem brain pathology confirming frontotemporal dementia.