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Joaquina Antunes1, Neide Urbano2, João Estrada3, José Ramos3, Joana Afonso2, José Pedro Vieira4, Lurdes Ventura3.

1 - Pediatric Department, Centro Hospitalar Tondela, Viseu;
2 - Child Psychiatry Department, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central, E.P.E.;
3 - Pediatric Intensive Care Unit, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central, E.P.E.;
4 - Neurology Department, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central, E.P.E.

 - Excellence in Paediatrics, Madrid, Espanha, 28 Novembro-1 Dezembro 2012 (Poster).

Introduction: Catatonia is a syndrome characterized by immobility that can be almost absolute with apparent unresponsiveness to external stimuli. It may be due to an underlying psychiatric, neurologic or medical disorder. Differential diagnosis is difficult and includes diffuse encephalopathy, non-convulsive status epilepticus, malignant neuroleptic syndrome, among others. In acute and severe presentations PICU admission is appropriate.

Case report: We present the case of a 14 year-old teenager admitted to the Pediatric Emergency Department with severe psychomotor agitation and self and hetero-aggression, followed by progressive depression of consciousness. Other history facts were unknown. He was unresponsive to external stimuli. Remaining physical exam was normal. Creatine kinase 10600U/L. All other blood and urine tests were negative, including the search for alcohol and substance abuse. Cerebral CT scan normal. During a short period of consciousness he reported having smoked a non-specified substance. He was transferred to the PICU. Lumbar puncture, cerebral MRI and EEG: normal. During hospitalization he had 2 episodes of psychomotor agitation and self and hetero-aggression that resolved with haloperidol, olanzapine and midazolam. Consumption of mephedrone ("Hell") was confirmed. He remained in a pseudo-comatose state with resistance to eyes and mouth opening and conjugated roving eyes movements for 6 days. The diagnosis of catatonia was considered, lorazepam was started, with a complete recovery 12 hours later. Afterwards he presented isolated episodes of hypnopompic hallucinations/psychotic activity.

Discussion: This case illustrates a severe manifestation, secondary to smoking a substance, easily acquired by Portuguese teenagers, given the free sale and low cost.

Palavras-chave: catatonia, mephedrone.