Reference no: EM133296046

A 45 year old male patient presents at the emergency room with a fever, vomiting and nausea, loose stool, and self-reports feeling weak, confused, lethargic and some tremors when initiating movements. The cranial nerve exam was normal, but the patient exhibited slow movements when asked to point at objects and walk and some movements occurred in short, jerked movements (i.e., cogwheel rigidity). Heart rate was also elevated (92-97 beats/min) and temperature was 37.9°C. No cough or sore throat was reported and no indication or history of recent or historical head trauma. In the absence of other indicators and lack of sufficient healthcare staff, the patient was discharged. 10 days later, the same patient is brought back to the emergency room by a family member. The patient had obvious and worsening tremors, a continuation of the slowed (and sometimes jerky) movements and frequently experienced disorientation in relation to time. Bloodwork revealed no signs of infection and no fever recorded at the time of presentation. Discussions with the patient and family member revealed several features of catatonia: frequently averbal, persistent negativism, and increasingly withdrawn. Further, all of these symptoms were not experienced prior to 2 months ago and have been progressively worsening since then. Family members have become increasingly concerned, especially with respect to the catatonia and disorientation.

What is most likely responsible for the symptoms? What brain region or regions are affected? How do the symptoms relate to the function of the brain regions? How would you determine that the brain region(s) in question is involved in the symptomology of the patient? What course of treatment is advised.