Why do neurologists miss catatonia in neurology emergency? A case series and brief literature review

Abstract Catatoniais a well-described clinical syndrome characterized by features that range from mutism, negativismand stuporto agitation, mannerisms and stereotype. Causes of catatoniamay range from organic brain disorders to psychiatric conditions. Despite a characteristic syndrome, catatoniais grossly under diagnosed. The reason for missed diagnosis of catatoniain neurology setting is not clear. Poor awareness is an unlikely cause because catatoniais taught among conditions with deregulated consciousness like vegetative state, locked-in state and akinetic mutism. We determined the proportion of catatoniapatients correctly identified by neurology residents in neurology emergency. We also looked at the alternate diagnosis they received to identify catatoniamimics. Twelve patients (age 22–55 years, 7 females) of catatoniawere discharged from a single unit of neurology department from 2007 to 2017. In the emergency department, neurology residents diagnosed none of the patients as catatonia. They offered diagnosis of extrapyramidal syndrome in 7, meningitis in 2, and conversion reaction, acute psychosis/encephalopathy and non-convulsive status epilepticusin one each. Their final diagnosis at discharge was catatoniadue to general medical condition in 6 ( progressive supranuclear palsyin 2, post- status epilepticus, uremic encephalopathy, glioblastoma multiforme and tuberculous meningitisin one each), catatoniadue to major depression in 4, schizophrenia and idiopathic catatoniain one each. Extrapyramidal syndrome appeared as common mimic of catatonia. The literature reviewed also revealed the majority of organic catatoniasecondary to causes that are usually associated with extrapyramidal features. Therefore, we suggest that neurologists should consider catatoniain patients presenting with extrapyramidal syndromes.