Aim: To consider the possibility of an organic cause vs mental health-related cause in a young patient of cerebral palsy presenting with catatonic features. Background: The catatonic symptoms in a young patient with cerebral palsy and intellectual disability can either be a sequelae of the preexisting organicity or has an independent organic or psychological cause. One of the organic causes is the white matter loss in the brain parenchyma-like periventricular leukomalacia (PVL) due to perinatal hypoxic insult that leads to cerebral palsy and consequent intellectual disability. Case description: We present the case report of a 20-year-old male who presented with acute onset of catatonic symptoms in the absence of any preexisting psychiatric disorder. His general physical examination manifested spastic diplegia, mutism, negativism, posturing, and staring gaze without any other focal neurological deficits. The routine blood investigations were within normal limits, whereas the MRI brain was suggestive of PVL with white matter loss and thinning of corpus callosum. The neurology consults suggested conservative management for the same, and the patient was managed with Lorazepam and Olanzapine, following which his catatonic symptoms started improving. During his hospital stay, intellectual quotient was assessed that revealed moderate level of intellectual disability. Conclusion: It is difficult to absolutely ascertain whether the organicity had direct influence on the patients presenting psychiatric symptoms or not. However, due to the neuropsychological changes, one cannot exclude the possibility that the sequelae of PVL or intellectual disability might have played a role in this case. Clinical significance: This raises considerable problems when it comes to choosing a therapeutic strategy for such a patient like whether the medical intervention alone or along with assistive therapies for the damaged white matter and intellectual disability would change the course, prognosis, and the outcome of the psychiatric symptoms or whether the psychopharmacological intervention would be sufficient for a better outcome and quality of life of the patient.
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