Facial myokymia in brain death

European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies
G SaposnikR Saizar

Abstract

Brain death (BD) is the irreversible loss of all functions of the brain and brainstem. Spontaneous and reflex movements of the limbs have been described in this condition. However, facial myokymia (FM) in BD has not been previously reported. The origin of that motor phenomenon in alive patients is still uncertain, since supranuclear, nuclear and peripheral mechanisms have been proposed. We describe the presence of FM in a patient who fulfilled the criteria for BD. A 40-year-old-man had right-sided weakness and impaired consciousness. After 14 h admission, he fulfilled the criteria for BD. A CT scan of the head showed a large putaminal hemorrhage. The EEG was isoelectric. At that time, fine spontaneous twitches of the left cheek were noticed. They consisted of repetitive and rhythmic movements in groups of 3-5 lasting for < 5 s. These movements appeared every 2-10 min during 6 h. Spinal reflexes have been described in BD. The presence of any movements other than the recognized reflexes may question this diagnosis and limit organ procurement for transplantation. The recognition of FM as an accepted movement in BD patients has practical and legal implications.

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Citations

Apr 22, 2009·The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques·Gustavo SaposnikG Bryan Young
Feb 7, 2016·Practical Neurology·E John CameronDavid P Breen
May 1, 2001·European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies·G SaposnikJ Bueri
Mar 5, 2005·The American Journal of Medicine·Gustavo SaposnikJosé A Bueri
Jun 23, 2018·Journal of Intensive Care Medicine·Anne L Dalle Ave, James L Bernat
Oct 8, 2020·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Ariane Lewis, David Greer
Feb 2, 2021·Der Nervenarzt·R W C JanzenF Erbguth

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