Selective stimulus-sensitive myoclonus in acute cerebral anoxia. A case report

We report a 69-year-old patient, a chronic diabetic, who had a cardiac arrest after myocardial infarction. In the state of acute anoxic coma, massive myoclonic jerks occurred, and it was found that myoclonus could be elicited by light touch of the right trigeminal area (but of no other body region). The myoclonus was associated with complex EEG discharges against an almost flat background of activity. Findings of the autopsy showed cerebral edema with bilateral uncal herniation and prominence of the right cerebellar tonsil. Stimulus-sensitive myoclonus based on proprioceptive stimuli has been reported in chronic postanoxic states. This type of somatosensory elicitation seems to be extremely rare. We discuss the neurophysiological substratum; it is presumed that the cortex was still reached by the somatosensory stimuli.