Abstract Details

Title A Case of Malignant Catatonia Complicated by Seizures and Respiratory Failure Mimicking Autoimmune Encephalitis: A Diagnostic Challenge

Topic Neuro Trauma and Critical Care

Presentation(s) P8 - Poster Session 8 (11:45 AM-12:45 PM)

Poster/Presentation
Number 18-006

Objective NA

Background Malignant catatonia is a rare, life-threatening neuropsychiatric emergency characterized by rigidity, autonomic instability, and altered mental status. It can closely resemble neuroleptic malignant syndrome, severe infection, or autoimmune encephalitis, often delaying diagnosis and treatment. Seizures are uncommon, occurring in fewer than 5% of cases. Electroconvulsive therapy (ECT) is considered the gold-standard treatment with high response rates, but recovery without ECT remains exceptional.

Design/Methods A 46-year-old woman with bipolar disorder presented with disorganized behavior, mutism, and psychomotor slowing. She was febrile, tachycardic, and exhibited generalized rigidity. Brain imaging was unremarkable. Cerebrospinal fluid analysis showed elevated protein and albumin without inflammatory markers, and autoimmune and paraneoplastic panels were negative. Abdominal imaging revealed a chronic hydrosalpinx, further complicating the differential diagnosis. Despite treatment with benzodiazepines and dantrolene, the patient developed recurrent fevers, autonomic instability, and seizure-like activity. Continuous EEG confirmed right temporo-occipital focal seizures with diffuse cerebral dysfunction. She required intubation, valproic acid loading, and intensive care management. Over several weeks, her rigidity and autonomic symptoms improved with clonazepam titration. She was successfully extubated and discharged in stable condition without neurological deficits.

Results This case underscores the diagnostic complexity of malignant catatonia, particularly when seizures are present. After excluding infectious, autoimmune, and structural causes, abrupt cessation of olanzapine was identified as the most likely precipitant, leading to dopaminergic and GABAergic imbalance. Clinical recovery following benzodiazepine escalation rather than dantrolene highlights the central role of GABAergic modulation in treatment.

Conclusions

Malignant catatonia can mimic several medical and neurological conditions, complicating diagnosis. This case illustrates that, even in the absence of ECT, timely recognition, sustained benzodiazepine therapy, and comprehensive supportive care can achieve full recovery and prevent life-threatening complications.

Authors/Disclosures
Muhammad Zubair, MBBS PRESENTER	Dr. Zubair has nothing to disclose.
Hesham Kelani, MD (One Brooklyn Health)	Dr. Kelani has nothing to disclose.
Mohammad Jadidi, MD	Dr. Jadidi has nothing to disclose.
Tarek Elshourbagy, MD (SUNY Downstate At One Brooklyn Health - Brookdale Hospital)	Dr. Elshourbagy has nothing to disclose.
Noah George Anderson, MD	Dr. Anderson has nothing to disclose.
Oluwasina G. Williams	Mr. Williams has nothing to disclose.
Tariq A. Muamar, MBBS	Mr. Muamar has nothing to disclose.
Mohamed Sabra, MD	Dr. Sabra has nothing to disclose.
Nuveed Loqman, MD	Dr. Loqman has nothing to disclose.
Artem Sunik, MD (Brookdale University Hospital Medical Center)	Dr. Sunik has nothing to disclose.
Moshe A. Mizrahi, MD, FAAN (The Brookdale Hospital Medical Center)	Dr. Mizrahi has nothing to disclose.
Lisa R. Merlin, MD, FAAN (SUNY Downstate Medical Center)	Dr. Merlin has nothing to disclose.
David P. Lerner, MD (One Brooklyn Health)	Dr. Lerner has received publishing royalties from a publication relating to health care.

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