Disclosures: Noel E. Pristas, MD: No financial relationships or conflicts of interest

Case Description: This patient is a high-level wheelchair racer and paralympic hopeful. Wheelchair racing requires prolonged neck extension. This patient initially presented 18 months prior with shoulder abduction weakness. He was found to have central cervical stenosis at C4, C5 on MRI. The patient delayed neurosurgical treatment in favor of conservative management at that time due to his training schedule. On this encounter, he presented for an elective urologic surgical procedure. He required Glidescope intubation with notable cervical extension. In the PACU, the patient began experiencing twitching movements in his pectoral muscles bilaterally. On exam, he was found to have contractions with a rate of approximately 1-2 per second. He was also found to have similar findings in his left deltoid and biceps. His findings were deemed consistent with myoclonus due to his cervical myelopathy. He was initially started on levetiracetam, but experienced dizziness. His symptoms were finally controlled with clonazepam. Neurosurgery will perform decompression and fusion 4 weeks after his discharge from this acute admission.

Setting: Tertiary care pediatric hospital

Patient: 20 year old man with history of caudal regression syndrome and chronic cervical stenosis Assessment/

Results: This patient had known cervical cord compression with previously documented upper extremity weakness and NCS/EMG findings. He experienced hyperextension of his neck during a difficult intubation for a scheduled urologic surgery. Post-operatively, he had myoclonic jerking in previously affected myotomes.

Discussion: There are only a few cases of myoclonus secondary to myelopathy documented in literature. The current recommended treatments, levetiracetam and/or benzodiazepines, were successful in managing the myoclonus in this patient. However, cord decompression is necessary to avoid progression of myelopathic symptoms.

Conclusion: Myoclonus can be a presenting symptom of myelopathy and warrants further investigation, especially in patients with known spinal cord or vertebral pathology.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/acute-on-chronic-cervical-myelopathy-causing-myoclonus-in-a-high-level-wheelchair-athlete-a-case-report/