1624 - Lorazepam Unlocked: Breaking the Chains of Catatonia on a Patient Living with TBI

A 40-year-old male was admitted to an acute hospital following a TBI from a motor vehicle collision. He initially presented with a GCS of 7, polytrauma, and decorticate posturing. Imaging revealed bilateral subdural and subarachnoid hemorrhages, right frontal hemorrhagic contusions, and a midline shift. After 56 days, he was discharged to rehabilitation, nonverbal, unresponsive to commands and pain, with only spontaneous left-sided movement and no visual tracking. Despite 28 days of treatment with donepezil, amantadine, and methylphenidate, there was no significant progress. Catatonia was suspected when he scored 19 on the Bush-Francis Catatonia Scale. Lorazepam was administered, leading to increased alertness, and he began communicating verbally for the first time, answering “yes” or “no” questions. Increasing lorazepam to 2 mg TID enabled him to follow motor commands. Within a week, his GCS improved to 14, and he showed functional gains in attention, perception, verbalization, upper body dressing, toileting, and transferring.

Discussions:

Our case report highlights the importance of recognizing catatonia, a neuropsychiatric syndrome with motor and behavioral abnormalities, in TBI patients. Catatonia symptoms can mimic neurological deficits like global aphasia, leading to misdiagnosis. If a patient shows significant delays in neurological recovery after a TBI, catatonia should be considered. Benzodiazepines, such as lorazepam, can both diagnose and treat catatonia, as demonstrated by this patient’s significant improvement.

Conclusions:

Catatonia may be an under-recognized complication of TBI, often mistaken for other neurological conditions. Early recognition and treatment with benzodiazepines are crucial for optimizing functional improvements and quality of life in TBI patients, potentially transforming their rehabilitation outcomes.