• Bahadar S Srichawla, Vincent Kipkorir, and Lawrence Hayward.
• Department of Neurology, University of Massachusetts Chan Medical School, MA, USA.
• Medicine (Baltimore). 2023 Nov 3; 102 (44): e35371e35371.

RationaleToxic leukoencephalopathy, a condition resulting from exposure to toxic substances, can lead to malignant catatonia, a severe motor dysfunction with symptoms such as muscle rigidity and high-spiking fever, hypertensive urgency, and tachycardia. This case study investigates the relationship between toxic leukoencephalopathy-induced malignant catatonia and heart rate variability (HRV), a marker of autonomic nervous system function.Patient ConcernsA 51-year-old male presented to the emergency department with acute onset of progressively worsening mental status.DiagnosesThe patient was diagnosed with cocaine-induced toxic leukoencephalopathy causing malignant catatonia.InterventionsA 5-day escalating treatment regimen was instituted for the management of malignant catatonia until resolution. Daily HRV parameters in the temporal and frequency domain, geometric data, and cardiac entropy were recorded using HRVAnalysis v.1.2 (ANS Lab Tools). The HRV analysis was correlated with pharmacologic management, the Bush-Francis catatonia rating scale, and hemodynamic parameters, including blood pressure, heart rate, and temperature.OutcomesThe results showed a correlation between the severity and frequency of malignant catatonic episodes and the patient autonomic dysfunction. Improvement in malignant catatonia with pharmacological management was associated with an improved HRV, including elevated rMSSD, SDNN, cardiac entropy, and pNN50%.LessonsMalignant catatonia is associated with decreased HRV, and its management is associated with an increase. This suggests a link between malignant catatonia and autonomic dysfunction, highlighting the potential benefits of treating malignant catatonia to improve autonomic function and reduce cardiovascular risk.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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