Disclosures: Mia Song, DO: No financial relationships or conflicts of interest

Case Description: A 57-year-old female presented to primary care with significant flat affect, poor initiation and motor slowness in various tasks. Provigil was initiated to improve her executive function; however, she exhibited worsening mental status with posturing, stupor, worsening appetite, decreased verbal responsiveness and decline in functional independence. She was admitted to the hospital for neurological workup which was negative for acute changes. Psychiatry evaluated the patient for possible diagnosis of catatonic disorder. Provigil was discontinued and she was started on a trial regimen of high dose benzodiazepines. She demonstrated improvement of motor performance and was discharged to acute inpatient rehabilitation for further functional gain.

Setting: Tertiary care rehabilitation hospital.

Patient: 57-year-old female with past medical history of an aneurysmal subarachnoid hemorrhage status post coil embolization and VP shunt placement Assessment/

Results: On admission to rehabilitation, her pharmacological treatment included lorazepam 3 mg TID, zolpidem 10 mg TID, memantine 10 mg in the morning and memantine 5 mg at bedtime. She received comprehensive neurorehabilitation including physical, occupational and speech therapy, neuropsychology and nutrition therapy. By the time she was discharged, she had improved verbal and motor response time, increased oral intake, increased verbal output and increased alertness. Furthermore, she exhibited good insight into her condition, including asking questions about “red-flags” symptoms.

Discussion: This case demonstrates that catatonic disorder can present with similar cognitive and executive dysfunction seen in other neurological disorders, especially in patients who have suffered from a stroke. It is crucial to distinguish and correctly diagnose catatonic disorder because the treatment is vastly different. Furthermore, these patients benefit from intensive rehabilitation to increase functional mobility, endurance, and higher level cognitive tasks.

Conclusion: Catatonic disorder can present similarly to other neurological disorders in patients after stroke, although the treatments are vastly different. These patients benefit from a comprehensive approach to improve and maintain function through rehabilitation.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/under-recognized-diagnosis-of-catatonic-disorder-after-subarachnoid-hemorrhage-a-case-report/