Acute Crit Care.  2023 Nov;38(4):509-512. 10.4266/acc.2021.01452.

Myoclonic status epilepticus after severe hyperthermia in a patient with coronavirus disease 2019

• Hill KA
• Peters JJ
• Schaefer SM

• KMID: 2550908
• DOI: http://doi.org/10.4266/acc.2021.01452

Abstract

Myoclonic status epilepticus (MSE) is a sign of severe neurologic injury in cardiac arrest patients. To our knowledge, MSE has not been described as a result of prolonged hyperpyrexia. A 56-yearold man with coronavirus disease 2019 presented with acute respiratory distress syndrome, septic/hypovolemic shock, and presumed community-acquired pneumonia. Five days after presentation, he developed a sustained fever of 42.1°C that did not respond to acetaminophen or ice water gastric lavage. After several hours, he was placed on surface cooling. Three hours after fever resolution, new multifocal myoclonus was noted in the patient’s arms and trunk. Electroencephalography showed midline spikes consistent with MSE, which resolved with 40 mg/kg of levetiracetam. This case demonstrates that severe hyperthermia can cause cortical injury significant enough to trigger MSE and should be treated emergently using the most aggressive measures available. Providers should have a low threshold for electroencephalography in intubated patients with a recent history of hyperpyrexia.

Keyword

brain injury; coronavirus disease 2019; fever; hyperthermia; myoclonus; status epilepticus

Figure

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  Figure 1. Electroencephalogram taken after fever resolution shows midline spikes.

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  Figure 2. (A, B) Brain magnetic resonance imaging taken 12 days after fever resolution did not demonstrate cortical or metabolic injury.

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