Disclosures: Michael F. Gallagher, MD: Nothing to disclose

Case Description: A 26-year-old man presented to acute inpatient rehabilitation following a complicated stay at his acute care hospital for high cervical spinal cord injury after a diving accident. After percutaneous gastrostomy (PEG) dislodgement and peritoneal sepsis the patient had a documented fever of 42.1°C (107.8°F) and developed repetitive upper extremity seizure-like activity, both of which resolved. The patient went on to develop general myoclonus most severe in the orofacial and tongue muscles and frequent autonomic storming several days later, without documented cardiac arrest. CT imaging showed no clear evidence of intracranial pathology. EEG showed no seizure activity.

Setting: Acute inpatient rehabilitation

Patient: 26-year-old man with history of hypertension and cervical spinal cord injury, C6 AIS A, ventilator-dependent post-tracheostomy and PEG tube placement

Assessment/Results: The patient was admitted to the spinal cord injury service. He was initiated on a regimen of levetiracetam, clonazepam, propranolol, clonidine, and gabapentin with some improvement in storming but without change to his myoclonus. A trial of facial muscle botulinum toxin improved his myoclonus. At the time of writing the patient was able to communicate with yes/no answers and single-word sentences.

Discussion: Cases of post-anoxic myoclonus have been reported in patients suffering from cardiac arrest, drug overdose, or asthma attack. To the authors’ knowledge this is the first reported case of a Lance-Adams (LAS)-like syndrome in the aftermath of severe hyperthermia. In this patient, the diagnosis of LAS was clinical and radiologic findings were not present; however, the literature indicates that even MRI and EEG findings may not be present in LAS. A combination of medications were able to treat this patient effectively.

Conclusion: There are no reported cases of chronic post-anoxic myoclonus after hyperthermia. This patient also had a case refractory to first-line treatments but responded to facial muscle botulinum, which allowed him to progress further in speech therapy.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/an-unusual-presentation-of-post-anoxic-myoclonus-after-severe-hyperthermia-a-case-report/