Disclosures: Fabienne Saint-Preux, MD: Nothing to disclose

Case Description: 32-year-old male with history of unintentional heroin overdose complicated by cardiac arrest and anoxic brain injury presenting with functional decline, mutism, catalepsy, rigidity and negativism consistent with catatonia. Marked improvement with lorazepam titration to 4 mg QID but symptoms were subsequently refractory. Eventual lysis of catatonia was achieved with electroconvulsive therapy (ECT) with improvement of Bush Francis Catatonia Rating Scale (BFCRS) from 17 to 0. 65-year-old male with cardiac arrest and anoxic brain injury presenting with mutism, rigidity, negativism, ambitendency, catalepsy. Treatment with lorazepam for 19 days produced significant functional gains and improved BFCRS from 26 to 9.

Setting: Acute Inpatient Rehabilitation Facility; Acute Inpatient Psychiatry Unit

Patient: 32- and 65-year-old males with catatonia

Assessment/Results: Two patients with catatonia following anoxic brain injury. One patient responded to lorazepam and later ECT. A second patient improved with lorazepam alone. Improvement was demonstrated by significant decrease in BFCRS scores.

Discussion: Catatonia, a psychomotor dysregulation disorder characterized by difficulty initiating/inhibiting behavior, can occur in the context of psychiatric or medical/neurologic illness and can be difficult to distinguish from static brain injury. Features include stupor, catalepsy, waxy flexibility, mutism, negativism, posturing, mannerisms, stereotypy, agitation, grimacing, echolalia and echopraxia. Standard treatment includes lorazepam, ECT, glutamate antagonists, and anticonvulsants but data is limited on best treatment approaches in the brain injury. While benzodiazepines are typically avoided in patients with brain injury due to their effects on neuroplasticity and sedating properties, and ECT has shown generally poor outcomes after anoxic injury, both can be safe and effective for select patients.

Conclusion: Catatonia is a potentially treatable mimic of static cognitive deficits after brain injury. Successful treatment of catatonia after anoxic brain injury can be achieved with lorazepam or ECT. Further research is needed to differentiate catatonia from brain injury-related cognitive and motor deficits for appropriate diagnosis and treatment.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/diagnosis-and-treatment-of-catatonia-in-anoxic-brain-injury-two-case-reports/