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[Spinal myoclonus in association with brain death]
Rinsho Shinkeigaku = Clinical Neurology
|November 1, 1989
Summary
A patient with a severe brain hemorrhage developed brain death but later exhibited multifocal myoclonus. This case highlights spinal myoclonus as a potential sign even after brain death criteria are met.
Area of Science:
- Neurology
- Neurosurgery
- Critical Care Medicine
Background:
- A 56-year-old male with hypertension presented with acute confusion and left hemiplegia.
- Initial assessment revealed a large right putaminal hemorrhage with ventricular perforation, leading to deep coma.
Observation:
- The patient's condition rapidly deteriorated, showing loss of reflexes, anisocoria, papilledema, and absent Doll's head-eye movements.
- Advanced imaging confirmed significant brain edema, collapsed cisterns, and suspected tentorial herniation.
- Electroencephalograms (EEGs) demonstrated electrocerebral silence, and brainstem auditory evoked potentials were absent, indicating brain death.
Findings:
- Despite meeting criteria for brain death, the patient later developed multifocal myoclonus involving lower limbs and abdominal muscles.
- The myoclonus was characterized by intermittent, brief, arrhythmic, stereotyped jerking contractions, sometimes violent enough to move the body.
Implications:
- This case suggests that spinal myoclonus can manifest even after brain death has been declared.
- Understanding the neurophysiological basis of spinal myoclonus in such contexts is crucial for accurate diagnosis and prognosis.