J Electrodiagn Neuromuscul Dis.  2024 Apr;26(1):14-17. 10.18214/jend.2023.00157.

Successful Management of an Acute Dystonic Reaction Induced by an Anesthetic Agent

• Park JY
• Yoon JA
• Shin YB

• KMID: 2554779
• DOI: http://doi.org/10.18214/jend.2023.00157

Abstract

Acute dystonic reactions (ADRs) are movement abnormalities characterized by involuntary muscle contractions that typically manifest after exposure to a triggering agent, such as a medication. The specific muscle groups affected determine the type of reaction. For instance, an oculogyric crisis primarily affects the ocular muscles, while oromandibular dystonia involves jaw opening and tongue protrusion. We present the rare case of a 68-year-old man with amyotrophic lateral sclerosis who was successfully treated for an ADR. The patient was admitted with loss of consciousness due to respiratory failure. Tracheostomy was promptly performed under sedation with multiple general anesthetic agents. Immediately after tracheostomy, the patient communicated via eye-blinking without any notable abnormalities, just as before the procedure. However, the following day, he became unresponsive to verbal cues and exhibited a decreased level of consciousness, accompanied by tongue dyskinesia, deviation of both eyes to the left, and loss of visual tracking. The patient’s vital signs remained stable. Brain imaging and an electroencephalogram revealed no abnormalities. Treatment with midazolam produced initial improvement; however, due to a significant side effect of hypotension, the treatment was switched to oral diazepam. The patient’s condition gradually improved, and the medication was eventually discontinued without further ADR episodes.

Keyword

Dystonic disorders; Amyotrophic lateral sclerosis; Anesthesia, general; Oculogyric crisis