Steroid-responsive encephalitis lethargica syndrome with malignant catatonia.
We report a 47-year-old man who is considered to have sporadic encephalitis lethargica (EL). He presented with hyperpyrexia, lethargy, akinetic mutism, and posture of decorticate rigidity following coma and respiratory failure. Intravenous methylprednisolone pulse therapy improved his condition rapidly and remarkably. Electroencephalography (EEG) showed severe diffuse slow waves of bilateral frontal dominancy, and paralleled the clinical course. Our patient fulfilled the diagnostic criteria for malignant catatonia, so we diagnosed secondary malignant catatonia due to EL syndrome. The effect of corticosteroid treatment remains controversial in encephalitis; however, some EL syndrome patients exhibit an excellent response to corticosteroid treatment. Therefore, EL syndrome may be secondary to autoimmunity against deep grey matter. It is important to distinguish secondary catatonia due to general medical conditions from psychiatric catatonia and to choose a treatment suitable for the medical condition.
Ono
Yoichi
Y
Department of Neurology, National Hospital Organization Okayama Medical Center.
Manabe
Yasuhiro
Y
Hamakawa
Yoshiyuki
Y
Omori
Nobuhiko
N
Abe
Koji
K
D002389:Catatonia / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D004569:Electroencephalography; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D010301:Parkinson Disease, Postencephalitic / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome
D005938:Glucocorticoids; D008775:Methylprednisolone