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Yun G, Kim E, Do W, Jung YH, Lee HJ, Kim Y. Transient involuntary movement disorder after spinal anesthesia: A case report. World J Clin Cases 2021; 9:7917-7922. [PMID: 34621846 PMCID: PMC8462229 DOI: 10.12998/wjcc.v9.i26.7917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/28/2021] [Accepted: 07/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Spinal anesthesia is commonly used for various surgeries. While many complications occur after induction of spinal anesthesia, involuntary movement is an extremely rare complication.
CASE SUMMARY Herein, we report the case of a 54-year-old healthy male patient who experienced involuntary movements after intrathecal injection of local anesthetics. This patient had undergone metal implant removal surgery in both the lower extremities; 7 h after intrathecal hyperbaric bupivacaine administration, involuntary raising of the left leg began to occur every 2 min. When the movement disorder appeared, the patient was conscious and cooperative. No other specific symptoms were noted in the physical examination conducted immediately after the involuntary leg raising started; moreover, the patient's motor and sensory assessments were normal. The symptom gradually subsided. Twelve hours after the symptom first occurred, its frequency decreased to approximately once every three hours. Two days postoperatively, the symptoms had completely disappeared without intervention.
CONCLUSION Anesthesiologists should be aware that movement disorders can occur after spinal anesthesia and be able to identify the cause, such as electrolyte imbalance or epilepsy, since immediate action may be required for treatment. Furthermore, it is crucial to know that involuntary movement that develop following spinal anesthesia is mostly self-limiting and may not require additional costly examinations.
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Affiliation(s)
- Giyoung Yun
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
- Department of Anesthesia and Pain Medicine, Pusan National University, School of Medicine, Yangsan 50612, South Korea
| | - Eunsoo Kim
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
- Department of Anesthesia and Pain Medicine, Pusan National University, School of Medicine, Yangsan 50612, South Korea
| | - Wangseok Do
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - Young-Hoon Jung
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - Hyun-Ju Lee
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - Yesul Kim
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
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Abstract
Propriospinal myoclonus (PSM) consists of paroxysmal and sudden jerks involving axial flexion trunk and hip muscles, conditioning sudden myoclonias of the trunk and arms/limbs, both spontaneous and triggered by sensory stimulations, emerging in relaxed wakefulness typically during the transition between wake and sleep. Generally, PSM originates from a thoracic myelomere and spreads caudally and rostrally, provoking flexion and/or extension movements, leading to jumps or trunk jerks. They appear triggered by the lying-down position and disappear when the subject stands up. The main consequences are the difficulties in sleep start and the reappearance during the period of wakefulness after sleep onset.
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Affiliation(s)
- Marco Zucconi
- Sleep Disorders Centre, Department of Clinical Neurosciences, San Raffaele Hospital, Via Stamira d'Ancona, 20, Milan 20127, Italy.
| | - Francesca Casoni
- Sleep Disorders Centre, Department of Clinical Neurosciences, San Raffaele Hospital, Via Stamira d'Ancona, 20, Milan 20127, Italy
| | - Andrea Galbiati
- Sleep Disorders Centre, Department of Clinical Neurosciences, San Raffaele Hospital, Via Stamira d'Ancona, 20, Milan 20127, Italy; School of Psychology, Vita-Salute San Raffaele University, Milan, Italy; Division of Neuroscience, Neurologic Unit, Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, IRCCS San Raffaele Hospital, Università Vita-Salute San Raffaele, Milan, Italy
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Silva RM, Morais IG, Almeida AV, Pereira OM, Silva AM, Sá EC. Spinal Myoclonus: Is It An Anesthetic Mystery? ACTA ACUST UNITED AC 2019; 67:108-111. [PMID: 31759616 DOI: 10.1016/j.redar.2019.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/01/2019] [Accepted: 08/28/2019] [Indexed: 10/25/2022]
Abstract
The goal is to present a descriptive study related an unprecedent case of spinal myoclonus (SM) following subarachnoid anesthesia (SA). SM are sudden, brief, involuntary non-generalized spasms that can be an adverse effect of drug administration via neuraxial routes. Female, 67y, ASA II, proposed for hip replacement surgery, with normal preoperative exams. 7min after SA with 10mg of bupivacaine 0,5%, no motor blockade observed, and patient complained of unbearable pain in legs and perineum and bilateral, asymmetrical and arrhythmic myoclonic movements in the lower limbs. The latter solved after 48h of general anesthesia and rocuronium perfusion, amongst other therapeutics. Accordingly, intrathecal bupivacaine appears to be the SM most likely cause, regarding the absence of neurologic and electrolyte disorders, spinal cord direct trauma, drug exchange and normal perioperative examination, imaging and laboratory testing.It is mandatory to always take the patients' anaesthetic histories and recognize, treat and report rare anaesthetic complications.
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Affiliation(s)
- R M Silva
- Departamento de Anestesiología, Centro Hospitalario de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Oporto, Portugal.
| | - I G Morais
- Departamento de Anestesiología, Centro Hospitalario de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Oporto, Portugal
| | - A V Almeida
- Departamento de Anestesiología, Centro Hospitalario de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Oporto, Portugal
| | - O M Pereira
- Departamento de Anestesiología, Centro Hospitalario de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Oporto, Portugal
| | - A M Silva
- Departamento de Anestesiología, Centro Hospitalario de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Oporto, Portugal
| | - E C Sá
- Departamento de Anestesiología, Centro Hospitalario de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Oporto, Portugal
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van der Salm SMA, Erro R, Cordivari C, Edwards MJ, Koelman JHTM, van den Ende T, Bhatia KP, van Rootselaar AF, Brown P, Tijssen MAJ. Propriospinal myoclonus: clinical reappraisal and review of literature. Neurology 2014; 83:1862-70. [PMID: 25305154 DOI: 10.1212/wnl.0000000000000982] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Propriospinal myoclonus (PSM) is a rare disorder with repetitive, usually flexor arrhythmic brief jerks of the trunk, hips, and knees in a fixed pattern. It has a presumed generation in the spinal cord and diagnosis depends on characteristic features at polymyography. Recently, a historical paradigm shift took place as PSM has been reported to be a functional (or psychogenic) movement disorder (FMD) in most patients. This review aims to characterize the clinical features, etiology, electrophysiologic features, and treatment outcomes of PSM. METHODS Re-evaluation of all published PSM cases and systematic scoring of clinical and electrophysiologic characteristics in all published cases since 1991. RESULTS Of the 179 identified patients with PSM (55% male), the mean age at onset was 43 years (range 6-88 years). FMD was diagnosed in 104 (58%) cases. In 12 cases (26% of reported secondary cases, 7% of total cases), a structural spinal cord lesion was found. Clonazepam and botulinum toxin may be effective in reducing jerks. CONCLUSIONS FMD is more frequent than previously assumed. Structural lesions reported to underlie PSM are scarce. Based on our clinical experience and the reviewed literature, we recommend polymyography to assess recruitment variability combined with a Bereitschaftspotential recording in all cases.
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Affiliation(s)
- Sandra M A van der Salm
- From the Department of Neurology and Clinical Neurophysiology (S.M.A.v.d.S., J.H.T.M.K., T.v.d.E., A.-F.v.R.), Academic Medical Center, Amsterdam, the Netherlands; Sobell Department of Motor Neuroscience and Movement Disorders (R.E., C.C., M.J.E., K.P.B.), University College London (UCL) Institute of Neurology, London; Clinical Neurophysiology (R.E., C.C.), National Hospital for Neurology and Neurosurgery, London; Nuffield Department of Clinical Neurosciences (P.B.), University of Oxford, John Radcliffe Hospital, Oxford, UK; and the Department of Neurology (M.A.J.T.), University Medical Center Groningen, University of Groningen, the Netherlands
| | - Roberto Erro
- From the Department of Neurology and Clinical Neurophysiology (S.M.A.v.d.S., J.H.T.M.K., T.v.d.E., A.-F.v.R.), Academic Medical Center, Amsterdam, the Netherlands; Sobell Department of Motor Neuroscience and Movement Disorders (R.E., C.C., M.J.E., K.P.B.), University College London (UCL) Institute of Neurology, London; Clinical Neurophysiology (R.E., C.C.), National Hospital for Neurology and Neurosurgery, London; Nuffield Department of Clinical Neurosciences (P.B.), University of Oxford, John Radcliffe Hospital, Oxford, UK; and the Department of Neurology (M.A.J.T.), University Medical Center Groningen, University of Groningen, the Netherlands
| | - Carla Cordivari
- From the Department of Neurology and Clinical Neurophysiology (S.M.A.v.d.S., J.H.T.M.K., T.v.d.E., A.-F.v.R.), Academic Medical Center, Amsterdam, the Netherlands; Sobell Department of Motor Neuroscience and Movement Disorders (R.E., C.C., M.J.E., K.P.B.), University College London (UCL) Institute of Neurology, London; Clinical Neurophysiology (R.E., C.C.), National Hospital for Neurology and Neurosurgery, London; Nuffield Department of Clinical Neurosciences (P.B.), University of Oxford, John Radcliffe Hospital, Oxford, UK; and the Department of Neurology (M.A.J.T.), University Medical Center Groningen, University of Groningen, the Netherlands
| | - Mark J Edwards
- From the Department of Neurology and Clinical Neurophysiology (S.M.A.v.d.S., J.H.T.M.K., T.v.d.E., A.-F.v.R.), Academic Medical Center, Amsterdam, the Netherlands; Sobell Department of Motor Neuroscience and Movement Disorders (R.E., C.C., M.J.E., K.P.B.), University College London (UCL) Institute of Neurology, London; Clinical Neurophysiology (R.E., C.C.), National Hospital for Neurology and Neurosurgery, London; Nuffield Department of Clinical Neurosciences (P.B.), University of Oxford, John Radcliffe Hospital, Oxford, UK; and the Department of Neurology (M.A.J.T.), University Medical Center Groningen, University of Groningen, the Netherlands
| | - Johannes H T M Koelman
- From the Department of Neurology and Clinical Neurophysiology (S.M.A.v.d.S., J.H.T.M.K., T.v.d.E., A.-F.v.R.), Academic Medical Center, Amsterdam, the Netherlands; Sobell Department of Motor Neuroscience and Movement Disorders (R.E., C.C., M.J.E., K.P.B.), University College London (UCL) Institute of Neurology, London; Clinical Neurophysiology (R.E., C.C.), National Hospital for Neurology and Neurosurgery, London; Nuffield Department of Clinical Neurosciences (P.B.), University of Oxford, John Radcliffe Hospital, Oxford, UK; and the Department of Neurology (M.A.J.T.), University Medical Center Groningen, University of Groningen, the Netherlands
| | - Tom van den Ende
- From the Department of Neurology and Clinical Neurophysiology (S.M.A.v.d.S., J.H.T.M.K., T.v.d.E., A.-F.v.R.), Academic Medical Center, Amsterdam, the Netherlands; Sobell Department of Motor Neuroscience and Movement Disorders (R.E., C.C., M.J.E., K.P.B.), University College London (UCL) Institute of Neurology, London; Clinical Neurophysiology (R.E., C.C.), National Hospital for Neurology and Neurosurgery, London; Nuffield Department of Clinical Neurosciences (P.B.), University of Oxford, John Radcliffe Hospital, Oxford, UK; and the Department of Neurology (M.A.J.T.), University Medical Center Groningen, University of Groningen, the Netherlands
| | - Kailash P Bhatia
- From the Department of Neurology and Clinical Neurophysiology (S.M.A.v.d.S., J.H.T.M.K., T.v.d.E., A.-F.v.R.), Academic Medical Center, Amsterdam, the Netherlands; Sobell Department of Motor Neuroscience and Movement Disorders (R.E., C.C., M.J.E., K.P.B.), University College London (UCL) Institute of Neurology, London; Clinical Neurophysiology (R.E., C.C.), National Hospital for Neurology and Neurosurgery, London; Nuffield Department of Clinical Neurosciences (P.B.), University of Oxford, John Radcliffe Hospital, Oxford, UK; and the Department of Neurology (M.A.J.T.), University Medical Center Groningen, University of Groningen, the Netherlands
| | - Anne-Fleur van Rootselaar
- From the Department of Neurology and Clinical Neurophysiology (S.M.A.v.d.S., J.H.T.M.K., T.v.d.E., A.-F.v.R.), Academic Medical Center, Amsterdam, the Netherlands; Sobell Department of Motor Neuroscience and Movement Disorders (R.E., C.C., M.J.E., K.P.B.), University College London (UCL) Institute of Neurology, London; Clinical Neurophysiology (R.E., C.C.), National Hospital for Neurology and Neurosurgery, London; Nuffield Department of Clinical Neurosciences (P.B.), University of Oxford, John Radcliffe Hospital, Oxford, UK; and the Department of Neurology (M.A.J.T.), University Medical Center Groningen, University of Groningen, the Netherlands
| | - Peter Brown
- From the Department of Neurology and Clinical Neurophysiology (S.M.A.v.d.S., J.H.T.M.K., T.v.d.E., A.-F.v.R.), Academic Medical Center, Amsterdam, the Netherlands; Sobell Department of Motor Neuroscience and Movement Disorders (R.E., C.C., M.J.E., K.P.B.), University College London (UCL) Institute of Neurology, London; Clinical Neurophysiology (R.E., C.C.), National Hospital for Neurology and Neurosurgery, London; Nuffield Department of Clinical Neurosciences (P.B.), University of Oxford, John Radcliffe Hospital, Oxford, UK; and the Department of Neurology (M.A.J.T.), University Medical Center Groningen, University of Groningen, the Netherlands
| | - Marina A J Tijssen
- From the Department of Neurology and Clinical Neurophysiology (S.M.A.v.d.S., J.H.T.M.K., T.v.d.E., A.-F.v.R.), Academic Medical Center, Amsterdam, the Netherlands; Sobell Department of Motor Neuroscience and Movement Disorders (R.E., C.C., M.J.E., K.P.B.), University College London (UCL) Institute of Neurology, London; Clinical Neurophysiology (R.E., C.C.), National Hospital for Neurology and Neurosurgery, London; Nuffield Department of Clinical Neurosciences (P.B.), University of Oxford, John Radcliffe Hospital, Oxford, UK; and the Department of Neurology (M.A.J.T.), University Medical Center Groningen, University of Groningen, the Netherlands.
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