Disclosures: Chris Benhatzel, DO: No financial relationships or conflicts of interest

Case Diagnosis: Catatonia

Case Description or Program Description: A 19-year-old male suffered a severe traumatic brain injury after a motor vehicle accident. At time of first admission to inpatient rehabilitation he was a Rancho III, PEG dependent, nonverbal and dependent for all ADLs and transfers. He emerged to a Rancho V, still PEG dependent, and discharged home. He developed behavioral issues (namely episodic violence) and regressed in his levels of communication, over the next 4 months. He was readmitted to inpatient rehabilitation for behavioral management and medication management. We discovered that during a recent Emergency department visit, the patient received midazolam for sedation for PEG replacement. The patient’s mother noted him “waking up” and becoming more interactive with his surroundings. With this information, we suspected catatonia and completed a 2mg IM lorazepam trial, which reproduced the same results.

Setting: Inpatient rehabilitation

Assessment/Results: He was subsequently started on PO lorazepam TID with plan to wean over several months. He improved and was subsequently discharged from in inpatient rehabilitation and as a Rancho V, had increased levels of communication, and was tolerating a PO diet.

Discussion (relevance): This is the first case report, to our knowledge, of delayed onset catatonia after emergence from a disorder of consciousness following a traumatic brain injury. We utilized the Bush-Francis Catatonia rating scale to evaluate for the severity of catatonia prior to and after the administration of lorazepam. Family and therapy observations in addition to the objective data suggests the diagnosis and successful treatment of catatonia.

Conclusions: Catatonia should be considered in the differential for patients with brain injury, specifically lower functioning patients with impaired ability to communicate, where progress has regressed and there has been a change in their behavioral pattern.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-case-of-delayed-onset-of-catatonia-after-traumatic-brain-injury/