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[Patient with encephalitis presenting with olanzapine-responsive malignant catatonia]
Hayato Suzuki1, Takao Fukushima, Kunihiko Makino
1Department of Neurology, Shibata Hospital-Niigata Preferctural Hospital.
Rinsho Shinkeigaku = Clinical Neurology
|June 12, 2010
Summary
A young man with acute encephalitis developed malignant catatonia, a rare neurological condition. Oral olanzapine effectively treated his severe symptoms, including mutism and muscle rigidity.
Area of Science:
- Neurology
- Neuroscience
- Critical Care Medicine
Background:
- Acute encephalitis can present with diverse neurological symptoms.
- Malignant catatonia is a severe, life-threatening syndrome characterized by motor disturbances, autonomic instability, and altered consciousness.
Observation:
- A 29-year-old man initially presented with memory deficits and emotional instability, diagnosed as acute encephalitis.
- His condition progressed to malignant catatonia, exhibiting mutism, akinetism, catalepsy, hyperpyrexia, muscle rigidity, dysphagia, respiratory insufficiency, and rhabdomyolysis.
- Cerebrospinal fluid analysis revealed lymphocytic pleocytosis, and electroencephalogram showed frontal slow activities.
Findings:
- Standard treatments for encephalitis and catatonia, including acyclovir, methylprednisolone, antibiotics, diazepam, and dantrolene sodium, were ineffective.
- The patient showed significant clinical improvement after initiating oral olanzapine.
- Magnetic resonance imaging (MRI) of the brain was normal despite severe neurological symptoms.
Implications:
- This case highlights the potential efficacy of olanzapine in managing malignant catatonia, even in refractory cases.
- It underscores the importance of considering malignant catatonia in the differential diagnosis of severe neurological deterioration following encephalitis.
- Further research is warranted to elucidate the neurobiological mechanisms underlying olanzapine's therapeutic effect in malignant catatonia.
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