Disclosures: Zachary J. McKinney, MD: No financial relationships or conflicts of interest

Case Diagnosis: The patient was diagnosed with Lance-Adams syndrome secondary to hypoxia from hemorrhagic shock earlier in his hospitalization.

Case Description: The patient was a 51-year-old male with past medical history of non-ischemic cardiomyopathy status post left ventricular assist device (LVAD) placement, atrial fibrillation, recurrent gastrointestinal (GI) bleeds, and Type 2 diabetes mellitus who presented to the hospital with recurrent syncopal episodes and melena. The patient was admitted to the hospital for severe lower GI bleeding. He suffered significant loss of blood volume and underwent emergent embolization of an ileocolic vessel. He required massive blood transfusions during this hospitalization. The hospitalization was complicated by hemorrhagic shock which prompted a Code Blue to be called that required cardiopulmonary resuscitation (CPR). The patient slowly recovered and was transferred to the inpatient rehabilitation unit once medically stable. During the patient’s rehabilitation stay, he developed diffuse myoclonic jerks throughout all extremities and his trunk. He was initially treated with Baclofen for presumed muscle spasms. This provided no improvement and therefore Neurology was ultimately consulted for further evaluation.

Setting: A Large Academic Medical CenterAssessment/

Results: The patient was started on valproic acid 500 mg twice daily, and ultimately increased to 750 mg twice daily. This resulted in near complete resolution of the myoclonic jerks, allowing the patient to participate in therapy and perform his ADLs independently.

Discussion: The reason for this case report is to highlight a lesser known cause of abnormal movements in the rehabilitation population, as the patient’s myoclonic jerks were initially thought to be muscle spasms.

Conclusion: Lance Adams syndrome presents as myoclonic jerks that can interfere with mobility, ambulation, and ADLs. This diagnosis should be considered in patients with a recent cardiopulmonary resuscitation.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/abnormal-movements-following-cardiopulmonary-resuscitation-a-case-report/