Gretchen L. Harknett, DO
Resident Physician
The Ohio State University
Columbus, Ohio, United States
Michael Guthrie, MD
Associate Professor of Physical Medicine and Rehabilitation
The Ohio State University
Columbus, Ohio, United States
Severe Catatonia following Traumatic Brain Injury
Case Description:
A 55-year-old female with a history of severe MDD with psychotic features, anxiety, diabetes, hypertension, and hyperlipidemia presented after a MVC with LOC. Imaging in ED revealed trace intraventricular hemorrhage, various facial fractures, dental trauma, elbow laceration, and spinal fractures. Though her initial GCS was 15, severity of her TBI as graded as moderate given post-traumatic amnesia of 5 days. Pertinent post-traumatic symptoms included 5 days of PTA, fluctuating cognition, delayed responsiveness, and memory deficits.
Admission exam at IPR was significant for multiple catatonic features including staring, echolalia, fasciculations, waxy flexibility, gegenhalten rigidity. Psychiatry was consulted for assistance. Despite the known contraindication of benzodiazepines in acute TBI, an Ativan challenge was initiated. Symptoms were monitored with the Bush-Francis Catatonia Scale, with corresponding titration of Ativan. A marked improvement in cognition function was evident with improved O-log and Cog-log scales, functional mobility and ADLs. The patient ultimately discharged home with family.
Discussions:
Severe psychiatric conditions can complicate the management of traumatic brain injuries (TBI). This case illustrates an example of catatonic state which confounded the evaluation and management of TBI, emphasizing collaboration with psychiatry and judicious trials of psychoactive medications to achieve better rehabilitation outcomes.
Conclusions:
This case highlights the intersection of severe psychiatric illness and TBI, underscoring the importance of considering underlying psychiatric conditions in TBI patients. It also demonstrates that Ativan, typically avoided in TBI management, can be beneficial when used judiciously to address catatonia.
