Insights from a rare clinical presentation of herpes simplex encephalitis: adding to the catatonic dilemma?

Catatonia is associated with a variety of psychiatric and medical illnesses. Very little research is available on the syndrome and the exact neurobiological correlates are not known. Though various cortical and subcortical circuits are implicated in the pathogenesis, the role of cerebellum is unknown. We report an unusual presentation of herpes simplex encephalitis, clinically as catatonic stupor and radiologically as isolated symmetrical cerebellar involvement affecting the posterior cerebellum. We discuss the possible role of the cerebellum in producing a catatonic state.

We describe the clinical presentation of catatonia in a 19-year-old woman with herpes simplex encephalitis. Her magnetic reasonance imaging showed features of viral cerebellitis involving the posterior cerebellum with hemorrhagic transformation. She lacked the classical frontotemporal involvement of herpes and recovered completely without physical or neuropsychological sequelae. She did not show signs associated with cerebellar disease at any point during the illness.

This case provides compelling evidence for the possible role of the posterior cerebellum in the clinical presentation of catatonia. This is probably related to its role in controlling the nonmotor cerebral functions through corticocerebellar connections. Further studies of catatonic syndromes are needed to establish this association.