Case Description: A 15-year-old male with a history of vaping and asthma presented to inpatient rehabilitation after a hypoxic brain injury. He received CPR and was intubated by EMS after a fight with another boy precipitated an asthma attack. He was in status asthmaticus and remained intubated and sedated for 4 days. MRI demonstrated bilateral posterior frontal and posterior parietal-occipital lobe ischemia extending into the posterior temporal lobes. There was also T2 hyperintensity in the lentiform nucleus including the caudate heads and putamen bilaterally. On arrival to rehab, deficits included apraxic speech, poor visual acuity, and bilateral upper greater than lower extremity weakness. The patient developed increasing bilateral lower extremity tone and, eventually, dystonia.

Setting: Inpatient Rehabilitation Hospital.

Patient: 15-year-old male with a history of vaping and asthma. Assessment/

Results: Baclofen, gabapentin, and clonidine were initiated and titrated, but the patient developed rhabdomyolysis, acute kidney injury, and high-grade fevers, prompting transfer to acute care for aggressive medication titration and hydration for treatment of status dystonicus. The patient’s tone slowly improved with titration of lorazepam and clonidine over the course of 2 weeks.

Discussion: Status dystonicus is a rare medical emergency which manifests as a life-threatening movement disorder. While status dystonicus typically occurs in those with a known history of dystonia for a mean duration of 6 years, this case demonstrates the development of status dystonicus in a patient with a history of dystonia for only weeks.

Conclusion: Status dystonicus should be considered as a possible diagnosis in any pediatric patient with worsening dystonia. With a mortality rate of approximately 10%, a high clinical index of suspension is required for an early diagnosis and transfer to proper treatment area. This is paramount to ensure prompt, appropriate treatment and to reduce morbidity and mortality.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/early-presentation-of-status-dystonicus-in-a-child-with-hypoxic-brain-injury-a-case-report/