Neurocritical Care

, Volume 16, Issue 1, pp 139–144 | Cite as

Involuntary Craniofacial Lingual Movements in Intensive Care-Acquired Quadriplegia

  • A. M. CartagenaEmail author
  • M. Jog
  • G. B. Young
Practical Pearl



The syndrome of involuntary craniofacial lingual movements in the setting of acute intensive care-acquired quadriplegia (critical illness neuromyopathy) following sepsis-associated encephalopathy has not been previously described. We suggest a localization and treatment for this disabling condition.


Three patients (2 female) from our center were quadriplegic from critical illness neuromyopathy when they developed involuntary craniofacial lingual movements following sepsis-associated encephalopathy.


Extensive investigations failed to identify an etiology for the abnormal movements. Movements were of large amplitude, of moderate speed, and semi-rhythmic in the jaw, tongue, and palate, persistent and extremely bothersome to all patients. Injection with Botulinum toxin type A was very beneficial.


Involuntary craniofacial lingual movements in the setting of flaccid quadriplegia following sepsis-associated encephalopathy are consistent with focal craniofacial brainstem myoclonus and constitutes a new syndrome. Botulinum toxin type A treatment maybe helpful in treatment.


Myoclonus Critical illness neuromyopathy Sepsis Neurocritical care 

Supplementary material

Video 1: Case 1. The patient is affected with ICU-acquired quadriplegia and is exhibiting debilitating involuntary cranio-facial lingual movements; before injection of botulinum toxin A. (WMV 1957 kb)

Video 2: Case 1. The patient after injection of botulinum toxin A; showing much less involuntary cranio-facial lingual movements and able to follow simple commands. (WMV 2992 kb)


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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of Clinical Neurological Sciences, Schulich School of MedicineThe University of Western OntarioLondonCanada
  2. 2.NPF Centre of Excellence, Movement Disorders Program, Schulich School of MedicineThe University of Western OntarioLondonCanada

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