#7197 A case report of malignant catatonia associated with reversible MRI changes in the splenium of the corpus callosum

<h3></h3> This report describes a case of malignant catatonia associated with reversible MRI changes in the splenium of the corpus callosum. We admitted a 22 year-old man mainly treated with olanzapine for schizoaffective disorder, first episode of psychosis diagnosed at age 20. He presented to a general hospital being initially elated, disinhibited with marked increased psychomotor activity transitioning to clouded consciousness and prominent catatonic symptoms over a week. He deteriorated to an akinetic state with waxy flexibility and mutism, associated with fever and rise in creatinine kinase (CK). A diagnosis of malignant catatonia was made. He required nutritional support entirely through enteral feeding via nasogastric tube for 2 weeks. He was initially treated with intravenous lorazepam, and later switched to oral lorazepam. Improvement was achieved with gradual increase of daily dose of lorazepam, with the most significant clinical change at the dose of oral lorazepam 16 mg/day, when the patient became more responsive to external environment, verbally engaging and not displaying rigidity. MRI changes restricted to the splenium were seen (figures 1a and 1b), which have disappeared on repeat scanning 4 weeks later (figures 1c and 1d). This was consistent with findings of reversible splenial lesion syndrome (RESLES) and suggests that splenial MRI changes may be an under-reported but non-specific feature of malignant catatonia. Malignant catatonia is a rare life-threatening neuropsychiatric condition. It often shows symptom overlap with neuroleptic malignant syndrome (NMS). The mainstays of treatment for these conditions are benzodiazepines and electroconvulsive therapy (ECT). Mild encephalopathy with reversible splenial lesions (MERS) associated with RESLES has most frequently been described in children in far east and Japan.¹ There are a wide range of other reported associations and neuropsychiatric diseases are increasingly being described.² Malignant catatonia does not seem to have been reported as an association with RESLES. <h3>References</h3> Zhang S, Ma Y, Feng J. Clinicoradiological spectrum of reversible splenial lesion syndrome (RESLES) in adults: a retrospective study of a rare entity. <i>Medicine (Baltimore)</i> 2015;<b>94</b>(6):e512. Xu Z, Zhou Z, Jang W, Tian J, Hou G. Reversible splenial lesion syndrome with mental disorders as only manifestation. <i>BMC Neurology</i> 2021;<b>21</b>(1):356.