Abstract
INTRODUCTION:Post hypoxic myoclonus appears as a consequence of brain damage secondary to severe hypoxemia, generally occurring in the first 24 hours after performing cardiopulmonary resuscitation and patients remain in a coma for a long time. In general, the appearance of them is a predictor of poor prognosis. The objective of this case is to highlight the presence of super refractory status epilepticus related to post hypoxic myoclonus.
CLINICAL CASE:A 24-year-old male with a punctured short gun wound in the precordial region and right thoracoabdominal posterior, who was admitted in a coma. He underwent surgery where hemopericardium and grade III heart injury were corrected, with return to spontaneous circulation after 15 minutes from the start of cardiopulmonary resuscitation and intraoperative bimanual cardiac massage, magnetic resonance imaging of the brain with gadolinium was performed, showing extensive areas of cortical ischemia, of both thalamus and minor in brainstem, with electroencephalogram showing epileptic activity under barbituric coma with generalized myoclonus.
CONCLUSIONS:Clinical analysis, paraclinical findings, persistent comatose state of consciousness and seizure activity with myoclonus confirmed the diagnosis of post-hypoxic myoclonus associated with super refractory status epilepticus.
References
Bouwes A, van Poppelen D, Koelman JH, Kuiper MA, Zandstra DF, Weinstein HC, et al. Acute posthypoxic myoclonus after cardiopulmonary resuscitation. BMC Neurol. 2012;12(63). doi: 10.1186/1471-2377-12-63.
Thomke F, Marx JJ, Sauer O, Hundsberger T, Hagele S, Wiechelt J, et al. Observations on comatose survivors of cardiopulmonary resuscitation with generalized myoclonus. BMC Neurol. 2005;5(14). doi: 10.1186/1471-2377-5-14.
Hallett M. Physiology of human posthypoxic myoclonus. Mov Disord. 2000;15(1):8-13. PMID: 10755266.
Mikhaeil-Demo Y, Gavvala JR, Bellinski II, Macken MP, Narechania A, Templer JW, et al. Clinical classification of post anoxic myoclonic status. Resuscitation. 2017;119:76-80. doi: 10.1016/j.resuscitation.2017.07.035.
Freund B, Kaplan PW Post-hypoxic myoclonus: Differentiating benign and malignant etiologies in diagnosis and prognosis. Clin Neurophysiol Pract. 2017;5(2):98-102. doi: 10.1016/j.cnp.2017.03.003.
Waddell A, Dirweesh A, Ordonez F, Kososky C, Reddy Peddareddygari L, Grewal RP. Lance-Adams syndrome associated with cerebellar pathology. J Community Hosp Intern Med Perspect. 2017;7(3):182-4. doi: 10.1080/20009666.2017.1340730.
Arpesella R, Dallocchio C, Arbasino C, Imberti R, Martinotti R, Fruncht SJ. A patient with intractable posthypoxic myoclonus (Lance-Adams syndrome) treated with sodium oxybate. Anaesth Intensive Care. 2009;37(2):314-8. doi: 10.1177/0310057X0903700214.
Ferlisi M, Hocker S, Trinka E, Shorvon S. Etiologies and characteristics of refractory status epilepticus cases in different areas of the world: Results from a global audit. Epilepsia. 2018;59(2):100-7. doi: 10.1111/epi.14496.
Blunck JR, Newman JW, Fields RK, Croom JE. Therapeutic augmentation of ketogenic diet with a sodium-glucose cotransporter 2 inhibitor in a super-refractory status epilepticus patient. Epilepsy Behav Case Rep. 2018;10:61-4. doi: 10.1016/j.ebcr.2018.05.002.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.