RESUMEN
Lance-Adams syndrome (LAS), or chronic post-hypoxic myoclonus, is a myoclonic disorder following acute cerebral hypoxia after successful cardiopulmonary resuscitation (CPR). LAS is distinct from acute post-hypoxic myoclonus (acute PHM), presenting with myoclonic jerks and cerebellar ataxia after regaining consciousness. However, the overlap at the onset complicates differentiation and may lead to the withdrawal of life-sustaining measures, especially in sedated ICU patients. The presented case involves a 77-year-old male diagnosed with LAS post-CPR. Despite the presence of early myoclonic jerks EEG, laboratory testing, and neuroimaging showed no definitive proof of irreversible neurological damage. Once diagnosed, treatment involved sequential antiseizure medications and physical therapy when the patient achieved full consciousness. However, the patient ultimately faced severe disabilities and was unable to recover. This case report emphasizes the importance of limiting sedation, comprehensive clinical examination, and the use of complementary tests when no definitive proof of irreversible neurological damage is present after acute cerebral hypoxia. While LAS has a better vital prognosis than acute PHM, it is associated with poor neurofunctional recovery and chronic disability in most cases. Further research is essential for evidence-based management.
RESUMEN
EN: We report the use of mechanical venous thrombectomy in 2 cases of cerebral venous sinus thrombosis in which the usual first-choice treatment with systemic anticoagulants was contraindicated. Our aim is to present this treatment as an alternative to consider when anticoagulants therapy is too risky or is contraindicated in critically ill patients.
ES: Se presentan 2 casos de trombosis venosa cerebral (TVC) aguda tratados mediante trombectomía mecánica venosa (TMV) en los que la anticoagulación sistémica, considerada como la primera línea terapéutica, estaba contraindicada. El objetivo de la presente nota clínica es mostrar esta técnica como tratamiento alternativo en pacientes críticos en los que la anticoagulación supone un riesgo excesivamente elevado o está contraindicada.
Asunto(s)
Trombosis de los Senos Intracraneales/cirugía , Trombectomía/métodos , Adulto , Anticoagulantes/uso terapéutico , Lesiones Traumáticas del Encéfalo/complicaciones , Terapia Combinada , Angiografía por Tomografía Computarizada , Contraindicaciones de los Medicamentos , Humanos , Hipertensión Intracraneal/complicaciones , Imagen por Resonancia Magnética , Masculino , Neuroimagen , Convulsiones/etiología , Trombosis de los Senos Intracraneales/diagnóstico por imagen , Trombosis de los Senos Intracraneales/tratamiento farmacológico , Trombosis de los Senos Intracraneales/etiología , Fracturas Craneales/complicaciones , Hemorragia Subaracnoidea/complicaciones , Adulto JovenRESUMEN
Se presentan 2 casos de trombosis venosa cerebral (TVC) aguda tratados mediante trombectomía mecánica venosa (TMV) en los que la anticoagulación sistémica, considerada como la primera línea terapéutica, estaba contraindicada. El objetivo de la presente nota clínica es mostrar esta técnica como tratamiento alternativo en pacientes críticos en los que la anticoagulación supone un riesgo excesivamente elevado o está contraindicada (AU)
We report the use of mechanical venous thrombectomy in 2 cases of cerebral venous sinus thrombosis in which the usual first-choice treatment with systemic anticoagulants was contraindicated. Our aim is to present this treatment as an alternative to consider when anticoagulants therapy is too risky or is contraindicated in critically ill patients (AU)
Asunto(s)
Humanos , Masculino , Adulto , Persona de Mediana Edad , Trombosis Intracraneal/cirugía , Trombectomía/métodos , Cuidados Críticos/métodos , Lesiones Traumáticas del Encéfalo/diagnóstico por imagen , Unidades de Cuidados Intensivos/organización & administración , Unidades de Cuidados Intensivos/normasRESUMEN
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