PSYCHIATRIC PRESENTATION OF AKINETIC RIGID SYNDROME

Abstract

Akinetic Rigid Syndrome has been reported to be caused by a diversity of etiologies which include inter alia idiopathic Parkinsonism, anoxia, trauma, Wilson’s disease, Huntington’s disease, and may involve the basal ganglia. The entity is known to be characterized by akinesia and rigidity- lead pipe or cogwheel type, accompanied by slowness of movement (bradykinesia) and thought (bradyphrenia), diminishing amplitude of repetitive alternating movements with or without tremor at rest and postural instability. However, an evocative history, symptomatology and neurological findings signifying that of catatonia, along with lack of significant findings on radiological assessment and lack of suspicion may land up the patient in a psychiatric setting, and further to be misdiagnosed and hence mistreated. This is a case report of a 16 years old male presented with decreased speech output, difficulty in initiation and slowness of movement, inability to maintain posture and sleep disturbance of acute onset with past history of suicidal attempt by hanging and other significant findings suggestive of a diagnosis of Akinetic Rigid Syndrome. Diagnostic implications and management of this unique presentation are discussed in the case report.