A Rare Case of Arnold Chiari Malformation Type 1 Presenting With Features of Catatonia

TL;DR

A 19-year-old postpartum woman with Arnold Chiari Malformation Type 1 showed symptoms of catatonia, highlighting the importance of thorough evaluation in similar cases.

Contribution

This case report presents Arnold Chiari Malformation Type 1 presenting with catatonia, an unusual clinical manifestation.

Findings

Arnold Chiari Malformation Type 1 was diagnosed in a patient presenting with catatonia.

The patient's symptoms included fixed gaze, mutism, and rigidity, which are typical of catatonia.

Neuroimaging confirmed Arnold Chiari Malformation Type 1 with hydrocephalus.

Abstract

The Arnold Chiari malformation is a congenital neurological condition. It occurs due to a defect in the cerebellum. Our patient is a 19-year-old postpartum female who presented to our ER with headaches, crying spells, reduced interaction, poor self-care, and neglect of her newborn for the past five days. Before the onset of her presenting symptoms, the patient had complained of a severe headache in the back of the head and dizziness. Her baseline investigations were normal. On examination, the patient was noticed to have a fixed gaze, ambiguity, mutism, and rigidity. So, she was diagnosed with catatonia, a differential diagnosis of mental and behavioral disorders associated with pregnancy, childbirth, and puerperium, and was treated with medications appropriately. As her headache showed minimal relief with adequate analgesic measures, neuroimaging was done, which showed Arnold Chiari malformation type I with hydrocephalus. A liaison was made with the neurology team, who confirmed the diagnosis and advised her on the decompression procedure. Her family refused to undergo the procedure. Once she showed minimal improvement in her symptoms, her family members requested her discharge. In our case, the Arnold Chiari malformation type I presented with features of catatonia, unlike the usual reported presentation of depression and anxiety. This case highlights the need for a thorough evaluation of any patient presenting with catatonia.

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