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Case Reports
. 2011 Apr;15(2):137-9.
doi: 10.4103/0972-5229.83010.

Difficulties with neurological prognostication in a young woman with delayed-onset generalised status myoclonus after cardiac arrest due to acute severe asthma

Arvind Rajamani  1 , Ian Seppelt, Joan Bourne
Affiliations
Case Reports

Difficulties with neurological prognostication in a young woman with delayed-onset generalised status myoclonus after cardiac arrest due to acute severe asthma

Arvind Rajamani et al. Indian J Crit Care Med. 2011 Apr.

Abstract

Neurological prognostication in cardiac arrest survivors is difficult, especially when the primary etiology is respiratory arrest. Prognostic factors designed to have zero false-positive rates to robustly confirm poor outcome are usually inadequate to rule out poor outcomes (i.e., high specificity and low sensitivity). One of the least understood prognosticators is generalised status myoclonus (GSM), with case reports confusing GSM, isolated myoclonic jerks and post-hypoxic intention myoclonus (Lance Adams syndrome [LAS]). With several prognostic indicators (including status myoclonus) having been validated in the pre-hypothermia era, their current relevance is debatable. New modalities such as brain magnetic resonance imaging (MRI) and continuous electroencephalography are being evaluated. We describe here a pregnant woman resuscitated from a cardiac arrest due to acute severe asthma, and an inability to reach a consensus based on published guidelines, with a brief overview of myoclonus, LAS and the role of MRI brain in assisting prognostication.

Keywords: Generalised myoclonus; Lance Adam syndrome; MRI; hypoxic encephalopathy; neurological prognostication.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
T2- fluid attenuation inversion recovery image showing basal ganglia infarction
See this image and copyright information in PMC

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