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Facial myokymia in brain death
G Saposnik1, J Mauriño, R Saizar
1Department of Neurology, Movements in Brain Death Study Group, Hospital J M Ramos Mejía, Buenos Aires, Argentina. gsaposnik@yahoo.com
European Journal of Neurology
|May 1, 2001
Summary
Facial myokymia, a rare movement disorder, was observed in a patient diagnosed with brain death (BD). Recognizing this movement is crucial for accurate BD diagnosis and organ donation processes.
Area of Science:
- Neurology
- Neuroscience
- Critical Care Medicine
Background:
- Brain death (BD) signifies the irreversible cessation of all brain and brainstem functions.
- While limb movements are documented in BD, facial myokymia (FM) has not been previously reported.
- The pathophysiology of FM in living patients remains debated, with proposed supranuclear, nuclear, and peripheral origins.
Observation:
- A 40-year-old male presented with right-sided weakness and decreased consciousness, later meeting criteria for BD.
- A CT scan revealed a large putaminal hemorrhage, and EEG confirmed an isoelectric state.
- Spontaneous, fine, rhythmic twitches of the left cheek (FM) were observed for 6 hours, occurring every 2-10 minutes.
Findings:
- This case documents facial myokymia in a patient fulfilling established criteria for brain death.
- The observed FM movements were characterized by repetitive, rhythmic twitches lasting less than 5 seconds.
Implications:
- The presence of movements beyond recognized spinal reflexes in BD can complicate diagnosis and impact organ procurement for transplantation.
- Acknowledging FM as a potential manifestation in brain death has significant practical and legal implications for patient management and donation protocols.