1/6. Spinal myoclonus following combined spinal-epidural anaesthesia for Caesarean section.A nulliparous woman presented with pre-eclampsia at 39 weeks' gestation. A combined spinal-epidural anaesthesia was employed for Caesarean section but the spinal component produced no discernible block, so the epidural was topped up with 20 ml ropivacaine 0.75% without problem and surgery was uneventful. A week after delivery she developed twitching of her legs and opisthotonus, that was initially thought to be eclampsia but was subsequently diagnosed as spinal myoclonus. She was treated with oral carbamazepine and diazepam, with improvement over the next 4 days, and discharged home a week later taking oral carbidopa and levodopa. Her symptoms resolved completely 6 months after the initial event.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/6. Post-operative paraplegia with spinal myoclonus possibly caused by epidural anaesthesia: case report.We report a patient who developed paraplegia following percutaneous nephrolithotresis of the left kidney under epidural anaesthesia. The cause of the paraplegia was unknown, but occlusion of the anterior spinal artery or central arteries and arachnoiditis, possibly due to the epidural anaesthesia, may have taken part in the onset and progression of the paralysis. The patient had spinal myoclonus corresponding to the spinal levels where myelomalacia was found by magnetic resonance (MR) imaging.- - - - - - - - - - ranking = 1.2keywords = anaesthesia (Clic here for more details about this article) |
3/6. myokymia and impaired muscular relaxation with continuous motor unit activity.We have studied two cases of the syndrome of myokymia and impaired muscular relaxation with continuous motor unit activity. Both patients complained of muscle twitching, weakness, stiffness, and hyperhydrosis during their illness. myokymia was present over the entire body in both. On repetitive testing of muscle strength each patient showed initial fatigue followed by increasing strength as he continued his efforts. Both patinets improved on phenytoin therapy at high blood levels. Nerve conduction velocities were decreased. Electromyograms showed continuous electrical activity at rest which persisted during sleep and spinal anaesthesia but was diminished by curare. Intravital staining with methylene blue in one case demonstrated sprouting and beading of motor nerve terminals with multiple innervation of muscle fibres. The neurophysiological and pathological findings in these two cases indicate an abnormality of peripheral nerve in this disorder.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
4/6. Prolonged myoclonic contractions after enflurane anaesthesia - a case report.A healthy young woman underwent arthroscopy of the right knee, for which she was given an enflurane anaesthetic. The anaesthetic was uneventful, but she started to show myoclonic jerky movements involving multiple muscle groups, except those innervated by the cranial nerves, while recovering from the anaesthetic. These jerky movements settled to the left side of her body. It was also associated with significant right frontal and retro-orbital headache. Serial neurological assessments were entirely negative. These symptoms took more than 48 hours to disappear. She recovered from this anaesthetic complication completely. An anaesthetic complication of this nature and duration has not been reported before in association with enflurane.- - - - - - - - - - ranking = 0.8keywords = anaesthesia (Clic here for more details about this article) |
5/6. Prolonged myoclonus and meningism following propofol.The purpose of this report is to describe a new complication of propofol administration. A previously fit patient underwent intravenous anaesthesia with propofol for removal of dental wires. Postoperatively he developed myoclonic jerking of his limbs. On regaining consciousness he complained of an occipital headache, neck stiffness and photophobia, and was found to have nuchal rigidity on examination. These clinical features resolved over the following week. Subsequent investigations failed to explain the aetiology of the symptoms of meningeal irritation, which suggests that propofol was the causative agent. While prolonged myoclonus has been previously described with propofol administration, this is the first report of meningism occurring with its use.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
6/6. Post-traumatic stimulus suppressible myoclonus of peripheral origin.A patient is described who presented with myoclonus of the first dorsal interosseus muscle of the right foot. This myoclonus occurred 18 months after trauma of the cutaneous branch of the deep peroneal nerve on the dorsal aspect of the foot. Tactile stimulation in the dermatome of this nerve, or an anaesthetic block of the deep peroneal nerve stopped the myoclonus. The different innervation between the efferent motor activity responsible for the movements and the sensory afference suppressing it points firmly towards involvement of central connections. However, abolition of the movement by anaesthesia suggests the presence of a peripheral ectopic generator. This finding confirms that focal myoclonus can have its origin in the peripheral nervous system and may be modulated by sensory inputs.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |