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    1. The document discusses factors that are important to consider when evaluating patients with posthypoxic myoclonus, including obtaining a thorough history, examination, and testing. 2. Key factors that provide prognostic information include cortical activity on examination, reaction to pain, lab tests such as NSE and S100B, and EEG findings. Older tests like SSEP need to be interpreted cautiously. 3. There are two types of posthypoxic myoclonus - those with coma and myoclonus indicating a worse prognosis, and awake patients with action-induced myoclonus which is more common among resuscitation survivors and indicates a better prognosis.

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    Posthypoxic Myoclonus

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    Posthypoxic Myoclonus – Early and Late _ Neurology Journal

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    1. The document discusses factors that are important to consider when evaluating patients with posthypoxic myoclonus, including obtaining a thorough history, examination, and testing. 2. Key factors that provide prognostic information include cortical activity on examination, reaction to pain, lab tests such as NSE and S100B, and EEG findings. Older tests like SSEP need to be interpreted cautiously. 3. There are two types of posthypoxic myoclonus - those with coma and myoclonus indicating a worse prognosis, and awake patients with action-induced myoclonus which is more common among resuscitation survivors and indicates a better prognosis.

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    2 views1 page

    Posthypoxic Myoclonus - Early and Late - Neurology Journal

    Uploaded by

    Stacey Woods
    1. The document discusses factors that are important to consider when evaluating patients with posthypoxic myoclonus, including obtaining a thorough history, examination, and testing. 2. Key factors that provide prognostic information include cortical activity on examination, reaction to pain, lab tests such as NSE and S100B, and EEG findings. Older tests like SSEP need to be interpreted cautiously. 3. There are two types of posthypoxic myoclonus - those with coma and myoclonus indicating a worse prognosis, and awake patients with action-induced myoclonus which is more common among resuscitation survivors and indicates a better prognosis.

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    of 1

    10/8/2014

    Posthypoxic myoclonus early and late | Neurology Journal

    Posthypoxic myoclonus early and late


    We spoke about hypoxic encephalopathy a few times already. The problem of prognosis for early posthypoxic patients is in
    my view quite simple t0 solve:
    1. Make sure that you are dealing with posthypoxia rather than something else (do an exam, imaging [at least CT],
    perhaps an EEG).
    2. Use as much information as possible.
    3.
    History
    Time to (any) resuscitation
    Initial rhythm
    Time of resuscitation may use the total epi dose instead
    Epidemiology: as always, age, CHD and diabetes are bad
    Exam
    If he shows any cortical activity, the prognosis cannot be too bad, so dont bother with additional
    tests.
    Especially look out for reaction to (severe) pain, remembering that brainstem activity is necessary
    but not sufficient to get a meaningful outcome
    Tests
    Remember that most of the old tests (say SSEP) have been developed in old age. They didnt know
    anything about hypothermia, temperature management and so on. So beware of old data. Always
    request new studies to be done.
    Labs: NSE, S100B (I like those; they have been evaluated in recent times)
    EEG: probably not good for prognosis (except if zero EEG or burst suppression)
    SSEP, AEP: This is just as good as testing for reactions to pain, but easier to make objective. Never
    been evaluated for hypothermic patients.
    MRI: nice to have for rule-out of structural disease (such as stroke), yet not good for (early)
    prognosis. After 2 weeks it might be fine, but then we all know the outcome.
    Posthypoxic status: again, this used to portend a bad prognosis, but nowadays the false positive rate
    is to high (might be about 7-10%).
    But really we want to deal with posthypoxic myoclonus here you have to distinguish the pt with coma + myoclonus vs. the
    (more or less) awake recovering patient with post-hypoxic (nearly always action induced) myoclonus. The latter used to be
    taught as rare, but probably is quite common among resuscitation survivors. As for treatment, I recommend
    Levetiracetam (piracetam is probably no better)
    Valproate
    Lacosamid
    Zonisamid

    http://jneuro.wordpress.com/2012/06/25/posthypoxic-myoclonus-early-and-late/

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