title: Cortical myoclonus during IV thrombolysis for ischemic stroke.
abstract: We describe a patient with an acute middle cerebral artery ischemic stroke developing subtle involuntary movements of the paretic upper limb with cortical origin during rt-PA perfusion. Despite the multiple potential pathophysiological mechanisms for the relationship between thrombolysis and epileptic activity, seizures during this procedure are scarcely reported. Our hypothesis is that subtle and transient clinical seizures, like those described in our patient, may not be detected or are misdiagnosed as nonepileptic involuntary movements. We aimed to draw attention to the recognition challenge of this paroxysmal motor behavior, highlighting this clinical and neurophysiological identification using video recording and back-average analysis of the EEG.
authors: Department of Neurology, Hospital de Santa Maria, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal ; EEG/Sleep Laboratory, Department of Neurology, Hospital de Santa Maria, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal.
authors: Carla
authors: C
authors: Bentes
authors: Department of Neurology, Hospital de Santa Maria, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal ; EEG/Sleep Laboratory, Department of Neurology, Hospital de Santa Maria, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal.
authors: Rita
authors: R
authors: Peralta
authors: Department of Neurology, Hospital de Santa Maria, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal.
authors: Pedro
authors: P
authors: Viana
authors: Department of Neuroradiology, Hospital de Santa Maria, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal.
authors: Carlos
authors: C
authors: Morgado
authors: Department of Neurology, Hospital de Santa Maria, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal ; Stroke Unit, Department of Neurology, Hospital de Santa Maria, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal.
authors: Teresa P
authors: TP
authors: Melo
authors: Department of Neurology, Hospital de Santa Maria, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal ; Stroke Unit, Department of Neurology, Hospital de Santa Maria, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal.
authors: José M
authors: JM
authors: Ferro
keywords: Back-average analysis; Cerebral infarct; EEG; Recombinant tissue-type plasminogen activator (rt-PA); Seizures