1000 - Catatonia in a Patient with Anoxic Brain Injury Secondary to Spontaneous Coronary Artery Dissection Postpartum: A Case Report

Case Diagnosis: Catatonia is a neuropsychiatric syndrome characterized by behavioral and motor disturbances that can occur in psychiatric disorders as well as general neurologic conditions, including anoxic brain injury. In the context of an anoxic brain injury, catatonia can mimic other critical illness signs. Recognition is critical because it is treatable and associated with significant morbidity and mortality if missed.

Case Description: We present the case of a 38-year-old female who developed catatonia after an anoxic brain injury secondary to spontaneous coronary artery dissection (SCAD) following a Cesarean delivery. The patient experienced prolonged ICU and rehabilitation courses, marked by cognitive fluctuations, hallucinations, emotional lability, and eventual mutism which were initially attributed to post ICU delirium, an ongoing UTI or a psychiatric illness. An initial Bush Francis Catatonia Rating Scale (BFCRS) assessment revealed a score of 24. She had marked subsequent improvement with lorazepam treatment one month later, with her BFCRS showing a score of 18.

Discussions: Catatonia is often underrecognized in medically complex patients, especially when symptoms overlap with delirium or psychiatric conditions. In this case, the patient’s cognitive fluctuations, confabulation, and mutism were initially misattributed, delaying diagnosis. The American Psychiatric Association recommends structured assessment tools like the Bush Francis Catatonia Rating Scale to differentiate catatonia from other neuropsychiatric syndromes. In medically ill patients, including those postpartum or post-anoxic, catatonia is best treated with benzodiazepines—typically lorazepam. A lorazepam challenge is both diagnostic and therapeutic, with dose titration as needed. This patient’s rapid improvement following lorazepam confirmed the diagnosis and highlights the importance of early intervention. Antipsychotics should be used cautiously, only when indicated and after excluding neuroleptic malignant syndrome.

Conclusions: This case highlights the importance of structured neuropsychiatric assessments in patients with prolonged encephalopathy in post ICU/neurorehabilitation settings. Early recognition of these neurological findings may significantly improve patient participation in therapy and their neurologic prognostic outcome.