Characterization of Postanoxic Tonic Eyelid Opening

Alsallom, Faisal; Shaker, Hussam; Newey, Christopher R.; Hantus, Stephen; Punia, Vineet

doi:10.1212/cpj.0000000000000990

Neur Clin Pract

2021

DOI: 10.1212/cpj.0000000000000990

|View full text |Cite

Characterization of Postanoxic Tonic Eyelid Opening

Faisal Alsallom

Hussam Shaker

Christopher R. Newey

et al.

Abstract: BackgroundPost-anoxic myoclonus is a known poor prognostic sign and other post-anoxic spontaneous movements have been reported but poorly described. We aim to describe the electro-clinical phenomenon of post-anoxic eyelid openings in context of its possible prognostic value.MethodsWe collected clinical data on post-cardiac arrest patients with suspicious eyelid movements noted on continuous EEG monitoring. The eyelid movements captured on the video were correlated to the EEG findings and final clinical outcome… Show more

Help me understand this report

Search citation statements

Order By: Relevance

Paper Sections

Select...

Citation Types

Supporting

Mentioning

Contrasting

Year Published

2023

2024

Publication Types

Select...

Article3

Relationship

Self Cite0

Independent3

Authors

Journals

Cited by 3 publications

(2 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Tonic eyelid opening has been described in postanoxic coma time-locked with EEG bursts. 1 The presence of EEG bursts preceding the eyelid opening supports a cortical mechanism. However, partial eyelid openings without EEG bursts (Figure , A) support a subcortical mechanism.…”

mentioning

confidence: 87%

See 1 more Smart Citation

Teaching Video NeuroImage: Postanoxic Tonic Eyelid Opening

Pinero Colon,

Acar,

Garcia Losarcos

et al. 2023

Neurology

View full text Add to dashboard Cite

A 29-year-old man with end-stage renal disease presented with out-of-hospital pulseless electrical activity arrest, requiring multiple rounds of resuscitation. Video-EEG within 24 hours demonstrated a generalized burst suppression pattern (Figure, A). The patient was noted to have repetitive eyelid opening (Video 1) with a duration of 1750.3 ± 710.9 milliseconds. 68.5% of these eyelid openings were time-locked to bursts with a latency of 434.7 ± 213.3 milliseconds. Tonic eyelid opening has been described in postanoxic coma time-locked with EEG bursts.1 The presence of EEG bursts preceding the eyelid opening supports a cortical mechanism. However, partial eyelid openings without EEG bursts (Figure, A) support a subcortical mechanism. Brain MRI demonstrated diffuse anoxic injury with relative sparing of the brainstem (Figure, B and C). The patient was declared brain dead on day 5. This clinical sign is associated with poor prognosis, but the data are limited.1 Generalized EEG burst suppression, however, is reliably associated with poor prognosis after cardiac arrest.2

show abstract

mentioning

confidence: 87%

“…This clinical sign is associated with poor prognosis, but the data are limited. 1 Generalized EEG burst suppression, however, is reliably associated with poor prognosis after cardiac arrest. 2 Author Contributions Y.P.…”

mentioning

confidence: 99%

Teaching Video NeuroImage: Postanoxic Tonic Eyelid Opening

Pinero Colon,

Acar,

Garcia Losarcos

et al. 2023

Neurology

View full text Add to dashboard Cite

show abstract

Myoclonus After Cardiac Arrest: Need for Standardization—A Systematic Review and Research Proposal on Terminology

De Stefano,

Leitinger,

Misirocchi

et al. 2024

Critical Care Medicine

View full text Add to dashboard Cite

Objectives: Although myoclonus less than or equal to 72 hours after cardiac arrest (CA) is often viewed as a single entity, there is considerable heterogeneity in its clinical and electrophysiology characteristics, and its strength of association with outcome. We reviewed definitions, electroencephalogram, and outcome of myoclonus post-CA to assess the need for consensus and the potential role of electroencephalogram for further research. Data Sources: PubMed, Embase, and Cochrane databases. Study Selection: English-language adult (≥ 18 yr) studies from 1966 to May 31, 2024, reporting myoclonus, myoclonic status/status myoclonus (MyS/SM), myoclonic status epilepticus (MSE), and/or early Lance-Adams Syndrome (eLAS) less than or equal to 72 hours post-CA. All study designs were independently screened by two authors. Data Extraction: Data on patients presenting myoclonus, MyS/SM, MSE, and eLAS less than or equal to 72 hours post-CA, along with their definitions, electroencephalogram, and outcomes were extracted. The Newcastle-Ottawa Scale and Cochrane-Risk-of-Bias Assessment tool were used to evaluate study quality (PROSPERO n.CRD42023438107). Data Synthesis: Of 585 identified articles, 119 met the inclusion criteria, revealing substantial heterogeneity in definitions, electroencephalogram, and outcomes. Among 3881 patients, myoclonus was reported in 2659, MyS/SM in 883, MSE in 569, and eLAS in 40. Among patients with a defined outcome, a Cerebral Performance Category (CPC) scale of 1–2 was reported in 9.8% of patients with myoclonus, 5.8% with MyS/SM, 5.7% with MSE, and 82.0% with eLAS. Electroencephalogram was recorded in 2714 patients (69.9%). CPC of 1–2 was observed in 1.6% of patients with suppression/suppression burst (SB)/unreactive (U) electroencephalogram, 11.3% with non-SB/U electroencephalogram and status epilepticus (SE), and 22.3% with non-SB/U electroencephalogram without SE. Conclusions: Heterogeneity in definitions resulted in weak associations with outcomes. We propose to investigate myoclonus by including related electroencephalogram patterns: myoclonus associated with suppression/SB background electroencephalogram, myoclonus with nonsuppression/SB background but SE-electroencephalogram, and myoclonus with nonsuppression/SB background without SE-electroencephalogram. This pragmatic research approach should be validated in future studies.

show abstract

Tonic Eye-Opening Associated with the «Burst-Suppression» Pattern in Patients with Acute Anoxic Brain Injury (Case Series)

Синкин

Broutian

Seliverstova³

et al. 2023

Obŝaâ reanimatologiâ

View full text Add to dashboard Cite

Massive anoxic brain injury caused by cardiac arrest leads to wakefulness suppression up to coma. The prediction of outcome is based on the analysis of the clinical features and the results of instrumental tests. One of the well-known signs of an unfavorable prognosis is involuntary motor activity, which is most commonly represented by myoclonus. In case of their cortical origin, they are accompanied by epileptiform activity in the electroencephalogram (EEG).Material and methods. We present a case series and literature review concerning a very rare fatal sign, non-rhythmic spontaneous eye opening accompanied by a “burst-suppression” pattern (BS) in the EEG. All patients suffered from transient acute hypotension or arrhythmia that required cardiopulmonary resuscitation (CPR) in three cases. A literature search found only 11 publications describing post-anoxic tonic eye-opening (PATEO).Results. The PATEO with BS was observed for less than a day followed by cessation of brain bioelectric activity in all patients. Only two patients exhibited isolated eye-opening and closing, while the rest had axial and limbs myoclonus just after CPR. In one case, eyelid opening was followed by a clonic movement of the head to the right, the EEG bursts were prolonged and had spike-like morphology. Three patients received antiepileptic and sedative therapy. All patients died in 3-43 days after the fatal cardiovascular event.Visual superposition of bursts in EEG and myogram of m. orbicularis oculi demonstrating identical morphology for EEG and myographic bursts was described for the first time. Our cases and literature review confirm that, regardless of the intensive treatment, patients with PATEO have fatal outcomes.Conclusion: The clinical and electrographic PATEO with BS phenomenon always indicates a lethal prognosis. The origin of PATEO is still under discussion. We suggest that it could be caused by disinhibition of subcortical and stem structures during extensive death of cerebral cortical neurons .

show abstract

scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.

Contact Info

customersupport@researchsolutions.com

10624 S. Eastern Ave., Ste. A-614

Henderson, NV 89052, USA

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Blog Terms and Conditions API Terms Privacy Policy Contact Cookie Preferences Do Not Sell or Share My Personal Information

Made with 💙 for researchers

Part of the Research Solutions Family.

Characterization of Postanoxic Tonic Eyelid Opening

Cited by 3 publications

References 30 publications

Teaching Video NeuroImage: Postanoxic Tonic Eyelid Opening

Teaching Video NeuroImage: Postanoxic Tonic Eyelid Opening

Myoclonus After Cardiac Arrest: Need for Standardization—A Systematic Review and Research Proposal on Terminology

Tonic Eye-Opening Associated with the «Burst-Suppression» Pattern in Patients with Acute Anoxic Brain Injury (Case Series)

Contact Info

Product

Resources

About