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Catatonia is a neuropsychiatric syndrome characterised by a combination of psychosocial withdrawal and various movement disorders. Kahlbahm first described this syndrome in 1868 when he noted this condition of “profound mental anguish”. In 1893, Kraeplin limited catatonia to a subtype of dementia praecox, later redefined by Bleuler in 1906 as catatonic schizophrenia. Since then, it has become increasingly apparent that the catatonic syndrome can be seen not just in schizophrenia, but in affective disorders as well as secondary to various underlying medical conditions, leading the DSM-IV to broaden its categorisation of catatonia to include these other entities. In the early 1900s, a condition known variously as epidemic encephalitis, encephalitis lethargica, or Von Economo's disease was described, affecting more than 65 000 patients from 1919 to 1929.1Case descriptions reported during this time bear striking similarities to our modern definitions of catatonia. Throughout recent years, isolated cases of encephalitis lethargica have been reported.2 3 We present a patient with features of sporadic encephalitis lethargica and discuss management of this entity in the context of catatonia.
The patient was a 22 year old previously psychologically and neurologically healthy woman who was transferred to the Barrow Neurological Institute after a 4 week stay in hospital for progressive immobility, mutism, posturing, and tremor. Initial evaluation had shown a CSF lymphocytosis, increased …