Status spasticus and psoas muscle edema due to anti-GAD antibody associated stiff-man syndrome

Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine
Boby Varkey Maramattom

Abstract

Severe muscle rigidity and spasms are uncommon causes of Intensive Care Unit (ICU) admissions. Stiff-man syndrome (SMS) is a rare disorder characterized by continuous muscle spasms, axial muscle rigidity, "tin soldier gait," and continuous motor unit activity on electromyography. There are three clinical variants of SMS; stiff-limb syndrome, classical SMS, and paraneoplastic encephalomyelitis with rigidity and myoclonus. Three types of antibodies have been associated with SMS; however, anti-glutamic acid decarboxylase (GAD) antibodies are the most frequent and are seen in the idiopathic type of SMS. The spasms of SMS can be very disabling and severe enough to cause muscle ruptures and skeletal fractures. We present a case of anti-GAD positive SMS with "status spasticus" causing bilateral psoas myoedema and rhabdomyolysis due to repeated axial muscle jerking in a 64-year-old man and discuss the differential diagnosis of a "jerking patient in the ICU."

References

Feb 3, 2004·Annals of Neurology·Gabor C PetzoldPietro De Camilli
Mar 17, 2010·Neurology India·Bobby Varkey Maramattom
Jun 16, 2012·Arquivos de neuro-psiquiatria·Renato P MunhozHélio A G Teive
Jun 22, 2014·Brain : a Journal of Neurology·Alexander Carvajal-GonzálezAngela Vincent

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Citations

May 1, 2018·PM & R : the Journal of Injury, Function, and Rehabilitation·Seung-Wook NoDu Hwan Kim
Jul 20, 2016·Neurocritical Care·Vincent JachietEtienne de Montmollin

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