Good outcome in a catatonic patient with enlarged ventricles

In the differential diagnosis of the catatonic syndrome, the demonstration of an intracranial anomaly is often taken as evidence of irreversibility. We present the case of a 27-year-old white female with catatonia who was found to have enlarged ventricles on automatic computerized tomographic axial scan. She had a complete resolution of the catatonia and psychotic symptoms without any change in the size of the ventricles. This resolution occurred when the patient was treated for her ulcerative colitis with colectomy and the steroids she received for the colitis were gradually withdrawn. The discovery of a structural anomaly of the brain per se should not discourage the clinician from identifying and treating all other factors that might contribute to the catatonic syndrome.