Table 1 Main clinical and paraclinical data of the case
Medical history | Esophageal stenosis complicating caustic ingestion |
Psychiatric history | Followed up for schizophrenia Several catatonic relapses Poor treatment compliance |
Symptoms of the current relapse | Social isolation Refusal to communicate with others Refusal to eat and to take the treatment |
Psychiatric examination | Catatonic syndrome: No eye contact Sub-mutism Motionlessness Maintenance of body position Waxy flexibility Refusal of the examiner outstretched hand Refusal of the execution of simple orders |
Physical examination | Blood pressure: 10/06 mmHg Sinus tachycardia 103 b/min Respiratory rate: 19 breaths/min Oxygen saturation: 96% |
Neurological examination | Mental confusion (temporo-spatial disorientation, anxious perplexity and terrifying visual hallucinations) Central vestibular syndrome (ataxia and bilateral multidirectional nystagmus) |
Neuroimaging (MRI) | Hyperintense signaling in the periaqueductal area, in mammillary bodies, and in medial thalamic nuclei on T2-FLAIR sequences |
Laboratory testing | Thiamine blood level = 32 nmol/l [normal range: 78 to 185 nmol/l] |
Therapeutic interventions | Benzodiazepine (lorazepam) Parenteral nutrition Parenteral vitamin B1 supplementation (500 mg*3/day) |