Involuntary Craniofacial Lingual Movements in Intensive Care-Acquired Quadriplegia

Abstract

Involuntary craniofacial lingual movements in the setting of flaccid quadriplegia following sepsis-associated encephalopathy are consistent with focal craniofacial brainstem myoclonus and constitutes a new syndrome. Botulinum toxin type A treatment maybe helpful in treatment.

A rare case of undulatory rhythmic lingual myoclonus in a patient with intracranial hemorrhage and diffuse pontine lesion

“…The underlying structural pathology is considered to implicate predominantly the olive with its input connections, as well as the central tegmental tract and the dentate nucleus (the Guillain-Mollaret triangle). The ipsilateral red nucleus projecting to the inferior olivary nucleus and the globus pallidi of the basal ganglia seem to be secondarily involved in the generation of the pattern [3][4][5][6] .…”

“…were accompanied with an underlying structural lesion such as a medullary compression at the craniovertebral junction [2], an Arnold-Chiari malformation [15], a brainstem trauma [3,16,17] or ischemia [18] and even bilateral cortical ischemia [19]. Cartagena [6] reported two rare cases of involuntary craniofacial movements after septic encephalopathy and ICU admission, with the one presenting MRI findings representative of PRES and the other one showing an abnormal sign in the globus pallidi. Our patient's MRI findings were consistent with a brainstem infarction, although not immediately affecting the Guillain-Mollaret triangle.…”