A case of spinal myoclonus in a patient with elective cesarean section

Abstract

Background: Transient myoclonic involuntary movements, typically referred to as spinal myoclonus (SM), rarely develop in the extremities following neuraxial anesthesia (NA). NA indications in patients with history of SM following NA (SM-NA) are unknown. Case presentation: A 33-year-old woman developed SM-NA after elective cesarean section (CS). Approximately 130 min after spinal anesthesia induction, she began exhibiting involuntary movements, which became most severe after approximately 3 h. The involuntary movements gradually decreased without treatments and disappeared after approximately 5 h. The patient underwent CS on three occasions. The first CS (age, 29 years) was under a combination of spinal and epidural anesthesia. The third CS (age, 35 years) was completed using only spinal anesthesia. There were no neurological events during the postoperative courses for the first and third CS. Conclusions: SM-NA can unexpectedly occur, and history of SM-NA may not be contraindicative for repeated NA.

Transient involuntary movement disorder after spinal anesthesia: A case report

“…Thus, to increase awareness of this atypical movement disorder caused by spinal anesthesia, we believe that it is essential to share our case features with the medical community. In this case, SM-NA occurred in a young man, unlike in previously reported cases in which the patients were young women undergoing cesarean sections[ 4 , 8 , 11 ].…”

“…Therefore, additional case reports on these presentations need to be published to increase awareness and determine the cause of these symptoms. Furthermore, these symptoms are especially rare in men aged < 60 years, as reported in this case[ 4 ]; recently reported cases of SM-NA have mainly involved young women after cesarean sections[ 8 , 11 ]. Therefore, we believe this case to be quite valuable.…”

“…It is essential to distinguish SM-NA from other, more serious problems that require immediate evaluation and treatment, such as epilepsy, electrolyte imbalance, tumor, or infection. This patient’s medication history was also reviewed for the differential diagnosis of neuroleptic-induced extrapyramidal syndromes, although the pedaling movements are unusual in extrapyramidal syndromes[ 8 ]. Furthermore, the patient had no history of use of antipsychotics, such as haloperidol and chlorpromazine.…”

“…However, involuntary myoclonic movement following neuraxial anesthesia is an extremely rare complication[ 3 , 4 ]. Sudden shock-like involuntary muscle contractions that affect a single muscle or multiple muscle groups[ 5 - 7 ] can occur following spinal anesthesia; alternatively, these movements can mimic a pedaling movement[ 8 ]. These symptoms rarely appear in the upper extremities[ 9 , 10 ].…”

Fractura de aguja espinal. Caso reportado durante anestesia raquídea

“…Si la sintomatología persiste durante la manipulación, se recomienda parar y reposicionar la aguja/ catéter. Si bien los síntomas neurológicos a largo plazo son raros, ameritan valoración neurológica con posibles estudios radiológicos y de conducción nerviosa (9,10) . f. Absceso epidural: se trata también de una complicación poco común, pero de carácter serio, pues existe el riesgo potencial de desarrollar una secuela neurológica debilitante permanente o incluso un desenlace fatal.…”