A case of area-specific stimulus-sensitive postanoxic myoclonus.
The authors report a case of area-specific stimulus-sensitive postanoxic myoclonus and discuss possible pathophysiology. A 71-year-old man sustained cardiorespiratory arrest that lasted 10 minutes and remained unresponsive. On the first EEG obtained 8 hours after the arrest there was no cerebral electrical activity before stimulation of the trigeminal-innervated areas. Periorbital stimulation was associated with bursts of spike-wave activity and generalized myoclonic jerks, whereas other types of stimulation did not elicit any response. A second EEG obtained 32 hours later showed a nonreactive alpha coma pattern. The patient died 7 days after the arrest. Area-specific stimulus-sensitive postanoxic myoclonus is very rare. The regularity of generalized bursts of spike-wave activity (cortical response) in response to stimulation of trigeminal-innervated areas suggests that the resting EEG electrocerebral silence may have been a result of cortical suppression with disinhibition of stimulus-sensitive brainstem-generated myoclonus.
Zivkovic
Sasa A
SA
Department of Neurology, University of Pittsburgh School of Medicine, Pennsylvania, USA. zivkovics@msx.upmc.edu
Brenner
Richard P
RP
D000368:Aged; D001921:Brain / Q000503:physiopathology; D003128:Coma / Q000209:etiology / Q000503:physiopathology; D004569:Electroencephalography / Q000379:methods; D005073:Evoked Potentials, Somatosensory; D005123:Eye / Q000503:physiopathology; D006323:Heart Arrest / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D002534:Hypoxia, Brain / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D009207:Myoclonus / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D010812:Physical Stimulation; D012867:Skin / Q000503:physiopathology; D014110:Touch