Prognostic value of myoclonus status in comatose survivors of cardiac arrest

Authors

  • Dr. Eelco F. M. Wijdicks MD,

    Corresponding author
    1. Department of Neurology, Mayo Clinic and Mayo Foundation, Rochester, MN
    2. Department of (Neurology Critical Care Service), Mayo Clinic and Mayo Foundation, Rochester, MN
    • Mayo Clinic, 200 First Street SW, Rochester, MN 55905
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  • Joseph E. Parisi MD,

    1. Division of Anatomic Pathology, Mayo Clinic and Mayo Foundation, Rochester, MN
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  • Frank W. Sharbrough MD

    1. Department of Neurology, Mayo Clinic and Mayo Foundation, Rochester, MN
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Abstract

Generalized myoclonus status is common in comatose patients after cardiac resuscitation, but its prognostic value is uncertain. We studied the clinical, radiologic, and pathologic findings in 107 consecutive patients who remained comatose after cardiac resuscitation. Myoclonus status was present in 40 patients (37%). Features more prevalent in patients with myoclonus status were burst suppression on electroencephalograms, cerebral edema or cerebral infarcts on computed tomography scans, and acute ischemic neuronal change in all cortical laminae. All patients with myoclonus status died. Of 67 patients without myoclonus, 20 awakened. We conclude that myoclonus status in postanoxic coma should be considered an agonal phenomenon that indicates devastating neocortical damage. Its presence in comatose patients after cardiac arrest must strongly influence the decision to withdraw life support.

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