P 122 Stimulus-responsive myoclonic jerks of both levator palpebrae muscles in a comatose survivor of cardiopulmonary resuscitation may pretended awareness

Abstract

Comatose survivors of cardiopulmonary resuscitation (CPR), who develop myoclonus within 1–2 days after CPR, usually have a poor prognosis. Typically, such myoclonus occurs or increases on sensory stimuli like touching the patient or acoustic stimuli. Myclonic jerks mainly occur in the muscles of the face, shoulder girdle and diaphragm. Sometimes, such jerks may be restricted to one muscle like the diaphragm leading to hiccups. We report one comatose survivor of CPR with stimulus-sensitive myoclonus, which was restricted to both levator palpebrae muscles leading to eye opening on acoustic stimulation and by doing so pretending awareness. A 76-year-old female survivor of CPR opened her eyes on acoustic or sensory stimuli followed by a short period of blinking, which pretended awareness. EEG documented polymorph spike-slow waves after acoustic stimuli and was otherwise flat. Eye opening and blinking were coupled to spike-slow waves discharges and interpreted as restricted myoclonus of the levator palpebare muscles. This was a transient phenomenon for 24 h, and after another day, the patient was brain dead. Early myoclonus in comatose survivors of a CPR usually indicate a poor prognosis, although recent data indicate, that patients with focal myoclonus may have a better prognosis than those with more generalized myoclonus. Bouwes et al. (2012) reported a good outcome in 8 of 48 patients with focal myoclonus compared to 1 of 31 with generalized myoclonus. As shown by our patient, focal or restricted stimulus-sensitive myoclonus may pretend awareness and causes diagnostic problems, which can be solved by EEG.