An undiagnosed stupor in the acute medical unit: a case of malignant catatonia

Abstract

### Learning Point for Clinicians Malignant catatonia is a rare cause of a reduced Glasgow Coma Score. It is difficult to diagnose as it has no specific investigation findings, and it may mimic a number of other conditions. A dramatic response to benzodiazepines however is characteristic and may assist in the diagnosis. A 45-year-old man was brought to our hospital by Ambulance having been found lying unconscious on the pavement. On admission he was obtunded with a Glasgow Coma Score (GCS) of 6 (E1, V1, M4), but maintaining his airway. He was pyrexial (temperature 38.5°C) and tachycardic with a pulse rate of 106 beats per minute. His blood pressure was 142/96 mmHg and capillary blood glucose 6.2 mmol/l. There was no evidence of trauma or needle marks. Neurological examination revealed mildly increased tone and brisk …