eMedicine Specialties > Neurology > Movement and Neurodegenerative Diseases
Catatonia: Differential Diagnoses & Workup
Updated: Sep 25, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Differential Diagnoses
Other Problems to Be Considered
Acute stress disorder
Astrocytoma
Autistic disorder
Brief reactive psychosis with catatonia
Carotid disease and stroke
Central pontine myelinolysis
Conversion disorder
Cortical basal ganglionic degeneration
Dystonia
Encephalopathy - HIV infection
Extrapontine myelinolysis
Fibromuscular dysplasia with dissection of basilar artery
Inherited neurometabolic disorders
Latah betul
Major depression, single episode with catatonic features
Medication adverse effect - Levetiracetam, zotepine
Mood disorders
Neuroleptic malignant syndrome
Posttraumatic stress disorder
Progressive multifocal leukoencephalopathy
Progressive supranuclear palsy
Renal failure
Schizophrenia
Stroke
Stupor
Substance intoxication - Cyclosporine, phencyclidine
Subdural hematoma
Syphilis
Systemic lupus erythematosus
Tay-Sachs disease
Thermal injury
Tuberculosis
Vegetative states
Von Economo encephalitis
Workup
Laboratory Studies
- Complete blood counts, electrolytes, and chemical analyses of blood are appropriate. In particular, hyponatremia and other metabolic abnormalities must be ruled out.
- Because elevations of serum creatine kinase, white blood cell counts, and liver function test results are common laboratory manifestations of catatonia, immediately measuring serum creatine kinase, white blood cell count, and liver function tests is appropriate to rule out neuroleptic malignant syndrome.
- Serum ceruloplasmin is needed to rule out Wilson disease.
- Encephalitis must be ruled out. See Encephalitis for additional information about the laboratory studies for encephalitis.
Imaging Studies
- Imaging of the head by means of MRI or CT is indicated to rule out treatable mass lesions. If no evidence of increased intracranial pressure is noted, lumbar puncture is appropriate to rule out encephalitis and other infections, hemorrhages, and tumors.
- People with catatonia may exhibit increased ventricle-to-brain ratios on CT scan. However, CT scans cannot be used to establish the diagnosis of catatonia. The main value of CT scans in patients with catatonia is to rule out other treatable disorders.
- Single-photon emission computed tomography (SPECT) has demonstrated increased cerebral blood flow in the parietal, temporal, and occipital regions of some patients with catatonia secondary to mood disorders after treatment with ECT. However, SPECT scans cannot be used to establish the diagnosis of catatonia. The main value of SPECT scans in patients with catatonia is to rule out other treatable disorders.
- Positron emission tomography (PET) with fluorodeoxyglucose (FDG) reveals bitemporal hypometabolism in catatonia. Patients with various vegetative states have demonstrated decrements in regional cerebral blood flow in the prefrontal and the parietotemporal association areas. However, PET scans cannot be used to establish the diagnosis of catatonia. The main value of PET scans in patients with catatonia is to rule out other treatable disorders.
Other Tests
EEG is indicated to rule out a seizure disorder. Nonconvulsive status epilepticus can readily be identified on EEG. Obtaining a portable EEG in the emergency department may quickly confirm the presence of nonconvulsive status epilepticus. For further information on nonconvulsive status epilepticus, see Epileptic and Epileptiform Encephalopathies and Focal Status Epilepticus.
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 Differential Diagnoses & Workup: Catatonia |
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Further Reading
Keywords
catatonia, unresponsiveness, deficits in fetal cortical development, dopaminergic blockade, glutamatergic dysfunction, dysfunction in neurotransmission of noradrenaline, dysfunction in neurotransmission of serotonin, frontal anomalies, motoric immobility, excessive motor activity, extreme negativism, mutism, peculiarities of voluntary movement, echolalia, echopraxia, stupor, oppositionism, posturing, catalepsy, automatic obedience, echophenomena, rigidity, verbigeration, withdrawal, akinesia, stupor
