Citation Information :
Seppelt I, Bourne J. Difficulties with neurological prognostication in a young woman with delayed-onset generalised status myoclonus after cardiac arrest due to acute severe asthma. Indian J Crit Care Med 2011; 15 (2):137-139.
Neurological prognostication in cardiac arrest survivors is difficult, especially when the primary etiology is respiratory arrest. Prognostic factors designed to have zero false-positive rates to robustly confirm poor outcome are usually inadequate to rule out poor outcomes (i.e., high specificity and low sensitivity). One of the least understood prognosticators is generalised status myoclonus (GSM), with case reports confusing GSM, isolated myoclonic jerks and post-hypoxic intention myoclonus (Lance Adams syndrome [LAS]). With several prognostic indicators (including status myoclonus) having been validated in the pre-hypothermia era, their current relevance is debatable. New modalities such as brain magnetic resonance imaging (MRI) and continuous electroencephalography are being evaluated. We describe here a pregnant woman resuscitated from a cardiac arrest due to acute severe asthma, and an inability to reach a consensus based on published guidelines, with a brief overview of myoclonus, LAS and the role of MRI brain in assisting prognostication.
Longstreth WT Jr, Diehr P, Inui TS. Prediction of awakening after-of-hospital cardiac arrest. N Engl J Med 1983;308:1378-82.
Lance JW, Adams RD. The syndrome of intention or action myoclonus as a sequel to hypoxic encephalopathy. Brain 1963;86:111-36.
Wijdicks EF, Hijdra A, Young GB, Bassetti CL, Wiebe S. Practice Parameter: Prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2006;67:203-10.
Samaniego EA, Mlynash M, Caulfield AF, Eyngorn I, Wijman CA. Sedation confounds outcome prediction in cardiac arrest survivors treated with hypothermia. Neurocrit Care 2010.
Wijdicks EF, Parisi JE, Sharbrough FW. Prognostic value of myoclonus status in comatose survivors of cardiac arrest. Ann Neurol 1994;35:239-43.
Rossetti AO, Oddo M, Liaudet L, Kaplan PW. Predictors of awakening from postanoxic status epilepticus after therapeutic hypothermia. Neurology 2009;72:744-9.
Harper SJ, Wilkes RG. Posthypoxic myoclonus (the Lance- Adams syndrome) in the intensive care unit. Anaesthesia 1991;46:199-201.
Arnoldus EP, Lammers GJ. Postanoxic coma: Good recovery despite SM. Ann Neurol 1995;38:697.
Topcuoglu MA, Oguz KK, Buyukserbetci G, Bulut E. Prognostic value of magnetic resonance imaging in post-resuscitation encephalopathy. Intern Med 2009;48:1635-45.
Wijdicks EF, Campeau NG, Miller GM. MR imaging in comatose survivors of cardiac resuscitation. AJNR Am J Neuroradiol 2001;22:1561-5.
Arbelaez A, Castillo M, Mukherji SK. Diffusion-weighted MR imaging of global cerebral anoxia. AJNR Am J Neuroradiol 1999;20:999-1007.
Els T, Kassubek J, Kubalek R, Klisch J. Diffusion-weighted MRI during early global cerebral hypoxia: A predictor for clinical outcome? Acta Neurol Scand 2004;110:361-7.