PMC8805594_01
Persistent catatonic features of patient. (A) This spontaneously adopted attitude could remain unchanged for hours on end (catalepsy). (B) Active opposition to passive elevation of the lids (active negativism). (C) Sustained attitude of the left arm which was passively imposed by examiner (waxy flexibility).
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F1
On examination, she kept her eyes shut most of the time (Figure 1A), vigorously resisting even gentle attempts by the examiner to open them (Figure 1B); she sustained passively imposed attitudes of body segments for several minutes (Figure 1C).
MRI of patient obtained during the stage of catatonic stupor. (A,B) Vermal atrophy, and volumetric reduction of right side of ventral pons (A) and cerebral peduncle (B). (C,D) Enlargement of sylvian fissures (S), more pronounced on the right, is evident on both axial (C) and coronal (D) planes. (E) Enlargement of intraparietal sulci (IPS), more pronounced on the right. (F) More evident atrophy of polar and superomedial prefrontal lobes (circled in white) in relation to the posteromedial parietal lobes. L, left; R, right.
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F2
Magnetic resonance imaging (MRI) revealed asymmetric cerebrocerebellar and brainstem atrophy, which was more marked in the right frontal and parietal lobes, right ventral midbrain and pons as well as in the anterior temporal lobes (Figure 2).
Timeline of the main events that took place during our patient's illness.
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F3
She died at age 96, seven years after the first symptoms of the disease (Figure 3).