A 33-year-old man, quadriplegic and ventilator dependent for 2 years due to a cervical injury, was successfully resuscitated after asystole for 1 hour. Post resuscitation, examination demonstrated a Full Outline of UnResponsiveness score of absent eyelid (E0) or motor response (M0) to noxious stimuli, present pupils and corneal reflexes (B4), and breathing above the ventilator (R1). There was facial myoclonus status (Video 1). EEG was unreactive with a burst-suppression pattern and bursts time linked to myoclonus (Figure, A). Three days post cardiac arrest, his serum neurofilament light chain was >1,500 pg/mL, and MRI examination revealed cortical and deep gray matter restriction (Figure, B). High-dose propofol resolved the myoclonus status.
Figure. Characteristic Findings on Ancillary Tests in Myoclonus Status Following Cardiopulmonary Resuscitation.
On EEG performed on admission (A), there was burst-suppression pattern and bursts linked to myoclonus. (B) MRI of the brain was performed 3 days after his initial cardiac arrest. On diffusion-weighted imaging there is profound diffusion restriction of the entire cortex, caudate heads and putamen (not shown).
Continuous high-frequency irregular jerking of the facial muscles and on the chest. Eyes are deviated.Download Supplementary Video 1 (3.5MB, mp4) via http://dx.doi.org/10.1212/209127_Video_1
Myoclonus status after prolonged cardiac standstill and cortical laminar necrosis presumably originates from subcortical or brainstem structures1 and reflects poor prognosis.2 Vigorous facial myoclonus is clinically significant due to dyssynchrony with mechanical ventilation. It often does not respond to antiseizure medications.
Author Contributions
C.Y. Itoh: drafting/revision of the article for content, including medical writing for content; major role in the acquisition of data. M. Tsikvadze: major role in the acquisition of data. J.E. Fugate: drafting/revision of the article for content, including medical writing for content; major role in the acquisition of data. E.F.M. Wijdicks: drafting/revision of the article for content, including medical writing for content; study concept or design; and analysis or interpretation of data.
Study Funding
No targeted funding reported.
Disclosure
The authors report no relevant disclosures. Go to Neurology.org/N for full disclosures.
References
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Supplementary Materials
Continuous high-frequency irregular jerking of the facial muscles and on the chest. Eyes are deviated.Download Supplementary Video 1 (3.5MB, mp4) via http://dx.doi.org/10.1212/209127_Video_1