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ABSTRACT
Post-hypoxic myoclonus is a rare finding after cardiorespiratory arrest. Clinical Case: We present a case of a 40-year-old woman with toxic neuropathy due to hyperthyroidism. She was under prolonged resuscitation due to a neural cardiorespiratory attack. Four days later, she developed rhythmic and involuntary movements of high frequency and low amplitude. Video-electroencephalographic monitoring was normal. Cerebral NMR showed extensive and diffuse hyperintensity in multiple encephalon areas and microhemorrhages in both cerebral hemispheres. She was managed with valproic acid. The treatment of this condition must be multidisciplinary; it includes medication (valproic acid, levetiracetam, and clonazepam), physical and occupational therapy with close collaborative management alongside the neurology service.
Key Words
Lance Adams Syndrome, Hypoxia, Brain, Myoclonus, Neuropsychiatry, Cardiopulmonary resuscitation, Consultation-Liaison Psychiatry
Implications for Practice
Myoclonus is a rare finding after heart attacks; its prevalence is about 1.5 per cent. Fewer than 150 cases have been reported in the literature. It has been hypothesized that transient cerebral hypoxia causes permanent synaptic modification of motor neuronal networks. It is an entity that is underdiagnosed by most doctors with the subsequent delay in treatment. Treatment and diagnosis must be multidisciplinary with close collaborative management alongside Neurology and Consultation-Liaison Psychiatry.
Background
Myoclonus is defined as a sudden muscle contraction or lapse in muscle tone. They are brief, involuntary, and shocklike events.1,2 Myoclonus is a descriptive term for heterogeneous phenomena. Most myoclonic cramps result from a short burst of muscular activity, resulting in positive myoclonus.3 Myoclonus is a rare finding that occurs after heart attacks; its prevalence is about 1.5 per cent.4,5 Fewer than 150 cases have been reported in the literature.6 Two types of myoclonus have been described: Post hypoxic acute or epileptic myoclonus and Lance Adams Syndrome (LAS) or chronic post-hypoxic myoclonus. Acute Posthypoxic myoclonus, termed post-hypoxic myoclonic status epilepticus (MSE), occurs soon after a hypoxic insult in patients who are profoundly comatose, and it implies a poor prognosis. On the...