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Figure: Cerebral MRI of patient 2 at the end of the first month and two months later. Initial MRI performed at the end of the first month: (A) Axial diffusion-weighted sequence at b1000 shows no signal abnormality; (B) Coronal fluid-attenuated inversion recovery (FLAIR) sequence shows bilateral cortical and subcortical asymmetric hypersignals in the temporal and frontal lobes; (C) Sagittal T1-weighted sequence shows cortical and subcortical hyposignals in the parietal, occipital and frontal regions in the regions where hypersignals are located on the T2 weighted sequence (see D); (D) Axial T2-weighted sequence shows bilateral cortical and subcortical asymmetric hypersignals in the right frontal and both parietal lobes. Follow-up MRI performed two months later: (E) Axial T2-weighted sequence shows, in spite of movement artefacts, an almost complete disappearance of the hypersignal abnormalities compared to the first MRI (D). Better images could not be acquired due to patient’s movement.(JPEG 94 kb)
VIDEO 1 On day 12, before the treatment with levetiracetam began, the patient presented wide myoclonus of the four limbs and trunks. Sitting down in his bed was impossible for him. Absent at rest, myoclonus became apparent during movements while trying to reach the physician’s hand. On day 16, 3 days after the treatment began, the neurological status had mildly improved. There was less myoclonus but voluntary movements were still difficult; the patient was unable to pick up the hammer on the table. On day 19, after 7 days of treatment, the patient was able to sit in the chair. Myoclonus had almost disappeared and he could perform precise voluntary movements (3GP 690 kb)
VIDEO 2 On day 20, before the treatment with levetiracetam began, the patient presented wide myoclonus of the limbs and the head that were triggered by external stimuli. She did not obey commands. On day 22, 2 days after the treatment began, myoclonus was less intense. She was able to obey commands and sit in the chair. Two months after intensive care unit discharge, she had preserved mental function and obeyed commands. There were no abnormal movements at rest, but during voluntary movements, she presented residual myoclonus of the lower limbs that did not allow walking (3GP 388 kb)
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Venot, M., Weiss, N., Espinoza, S. et al. Improvement of early diagnosed post-anoxic myoclonus with levetiracetam. Intensive Care Med 37, 177–179 (2011). https://doi.org/10.1007/s00134-010-2055-6
- Cardiac Arrest
- Valproic Acid