[Spinal myoclonus in association with brain death].

A 56-year-old, hypertensive man was admitted to our hospital because of confusion. He had been well unit half an hour before admission, when he had suddenly developed left hemiplegia. Although he became deep coma soon after admission, his vital signs were preserved. CT scan revealed a large right putaminal hemorrhage and a ventricular perforation. The condition was too severe for surgical approaches and conservative therapy for brain edema was performed. On the 2nd hospital day, corneal and light reflexes were disappeared and an anisocolia appeared. On the 3rd hospital day, right papilledema appeared. Doll's head-eye movements and ciliospinal reflexes were absent. CT scan demonstrated marked brain edema and collapsed ambient cisterns. Tentorial herniation were suspected. On the 4th hospital day, respiratory arrest occurred and ventilatory assistance began. On the 11th hospital day, electroencephalograms (EEG's) showed electrocerebral silence. EEG's performed next day showed still electrocerebral silence. On the 13th hospital day, brainstem auditory evoked potentials were recorded without any responses. He was thought to be in condition of brain death. On the 17th hospital day, multifocal myoclonus involving lower limbs and abdominal muscles appeared. The myoclonus lasted for about 15 hours occurred on both sides, but was asymmetrical. The myoclonus consisted of intermittent, brief, arrhythmic, stereotype, jerking contractions of the muscles. Sometimes, the contractions were sufficient enough to jump his body over the bed. These symptoms provided the characteristics of spinal myoclonus. Etiologies of spinal myoclonus are varied, but the primary abnormality exists within the spinal cord.(ABSTRACT TRUNCATED AT 250 WORDS)