Contrast induced spinal myoclonus after percutaneous coronary intervention

• Published in: Journal of cardiology cases 2017-09, Vol.16 (3), p.97-100
• Main Authors: Abela, Lauren, Magri Gatt, Kurt, Farrugia, James, Mallia, Maria
• Format: Article
• Language: English
• Subjects: Angiography; Contrast; Myoclonus; Segmental; Spinal
• ISSN: 1878-5409; 1878-5409
• DOI: 10.1016/j.jccase.2017.05.012

We present a case of a 77-year-old man diagnosed with contrast-induced spinal myoclonus following primary percutaneous coronary intervention. After being admitted with a diagnosis of anteroseptal myocardial infarction, he underwent primary percutaneous coronary intervention to the left anterior descending artery and was prescribed aspirin, clopidogrel, and intravenous heparin. The following day he developed non-intentional irregular jerky movements confined to the truncal area. In view of rhythmic jerking confined to muscles innervated by a restricted segment of the spinal cord, resistance to supra-spinal influences and voluntary action, and no preceding electroencephalography activity in the contralateral sensorimotor cortex, a diagnosis of spinal myoclonus was made. Spinal myoclonus is a rare entity in which myoclonic movements occur in muscles originating from few (segmental), or many adjacent spinal motor roots (propriospinal). Structural lesions are found in the majority of cases but the actual pathophysiology is still unknown. Contrast-induced spinal myoclonus is an even rarer phenomenon with few published reports. We describe postulated mechanisms and the management of this phenomenon.