ORGANIC CATATONIA DUE TO CENTRAL PONTINE MYELINOLYSIS- A CASE REPORT

Catatonia is a syndrome reported in psychiatric patients. Rarely medical and neurological conditions contribute to the catatonic state. We report a case of catatonia due to central pontine myelinolysis. A 54 year old man, chronic alcoholic presented with acute onset of hypokinesia, generalised rigidity with no weakness. The limbs were kept in the same position during passive movements for prolonged period eventhough the position and posture seemed uncomfortable and bizarre. Patient also had dysphagia to liquids, dysarthria and urinary incontinence. Deep tendon reflexes were normal. There was no significant past medical illness. Complete haemogram, basic biochemical tests and other relevant blood tests were normal. MRI brain showed symmetrical T2 hyperintense signals in the centre of pons representing Central Pontine Myelinolysis. Patient recovered completely with supportive line of management. Keyword : Catatonia, central pontine myelinolysis(CPM), alcoholism, hyponatremia INTRODUCTION: It is customary to consider catatonia as a purely psychiatric disorder, despite many case reports demonstrating a wide range of medical and neurologic disorders associated with catatonic symptomatology (Barnes et al 1986, Clark & Richards 1999 a). The Central Pontine Myelinolysis(CPM) presenting as catatonia is an unususal clinical presentation(9,10) . There are only very few case reports of CPM presenting as catatonia especially in this subcontinent.