Greenberg Karen, D'Ambrosio Michael, Liebman Kenneth M, Veznedaroglu Erol
Capital Health Center For Neurologic Emergencies, Capital Health Regional Medical Center, Trenton, NJ 08638.
Capital Health Center For Neurologic Emergencies, Capital Health Regional Medical Center, Trenton, NJ 08638.
Am J Emerg Med. 2014 Oct;32(10):1303.e3-4. doi: 10.1016/j.ajem.2014.03.047. Epub 2014 Apr 3.
Catatonia was first described by a German psychiatrist, Karl Kahlbaum, in 1874. It is a behavioral syndrome marked by an inability to move normally, which can occur in the context of many underlying general medical and psychiatric disorders. A wide variety of neurologic, metabolic, drug-induced, and psychiatric causes of catatonia have been reported. We present a unique case of late onset catatonia in a 56-year-old man with no prior medical or psychiatric history initially presenting with stroke-like symptoms. The patient was awake and alert, with spontaneous eye opening, but completely nonverbal and not following any commands. Specifically, the patient demonstrated stupor, catalepsy, mutism, and negativism. After extensive emergency department testing, including negative computed tomography head, negative magnetic resonance imaging brain, negative electroencephalogram, and normal laboratory results, the patient was diagnosed with new-onset bipolar disorder with depressive features presenting as catatonia. Recognizing catatonia is important because it may be caused or exacerbated by treatment of the underlying disorder. Failure to institute treatment early in the course of catatonia is associated with a poor prognosis.
紧张症最早由德国精神病学家卡尔·卡尔鲍姆于1874年描述。它是一种行为综合征，其特征是无法正常活动，可发生于多种潜在的普通医学和精神疾病背景下。已报告了多种导致紧张症的神经、代谢、药物诱发和精神方面的原因。我们呈现了一例独特的迟发性紧张症病例，患者为一名56岁男性，既往无医学或精神病史，最初表现为类似中风的症状。患者清醒且警觉，能自主睁眼，但完全不言语，不遵循任何指令。具体而言，患者表现出木僵、僵住、缄默和违拗。经过急诊科的广泛检查，包括头颅计算机断层扫描阴性、脑部磁共振成像阴性、脑电图阴性以及实验室检查结果正常后，患者被诊断为新发双相情感障碍伴抑郁特征，表现为紧张症。认识到紧张症很重要，因为它可能由潜在疾病的治疗引发或加重。在紧张症病程早期未能开始治疗与预后不良相关。
