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Convulsive-like Movements in Brainstem Stroke
Gustavo Saposnik, MD;
Louis R. Caplan, MD
Arch Neurol. 2001;58:654-657.
Background Involuntary convulsive-like movements sometimes occur in patients with
brainstem strokes. These movements vary in nature, frequency, and trigger,
including fasciculation-like, shivering, jerky, tonic-clonic, and intermittent
shaking movements. Some are interpreted as decerebrate postures or seizures.
It is important to recognize this type of motor phenomenon since it may be
a diagnostic clue for early diagnosis and treatment of brainstem strokes.
Design Case report and review of the literature.
Observation A 72-year-old-man presented with impaired consciousness and jerks of
the upper limbs mimicking seizures. These episodes consisted of brief clonic
contractions of the proximal and distal upper extremities. They were observed
in paroxysms lasting for 3 to 5 seconds. Magnetic resonance imaging showed
large midpontine infarction. Magnetic resonance angiography revealed the absence
of basilar artery blood flow. No seizure discharges were observed in the electroencephalogram.
Anticoagulation with intravenous heparin was started. Two days after admission,
the patient had a cardiac arrest and died. We review the frequency and nature
of convulsive-like movements in brainstem stroke in the literature.
Conclusions Movements associated with brainstem lesions are not easily differentiated
from convulsions. Unexpected onset and inexperience of the observers limit
the characterization of this phenomenon. Convulsive-like movements in brainstem
stroke may occur more frequently than reported. Early detection of this motor
phenomenon may have practical implications.
From the Stroke Unit, Department of Neurology, Ramos Mejía Hospital,
Buenos Aires University, Buenos Aires, Argentina (Dr Saposnik); and the Stroke
Unit, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard
Medical School, Boston, Mass (Dr Caplan).
Corresponding author and reprints: Gustavo Saposnik, MD, Charcas
4431 4 "10," Buenos Aires C1425BMN, Argentina (e-mail: gsaposnik{at}intramed.net.ar).
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