Lance-Adams Syndrome Following Cardiac Arrest: A Case Report

Case Diagnosis: Lance-Adams Syndrome secondary to cardiac with anoxic brain injury in the setting of opioid overdose

Case Description or Program Description: A 46 year old male with a medical history of anxiety, depression, and substance abuse developed myoclonus limiting his ability to walk. One month prior he went into cardiac arrest from opioid overdose leading to an anoxic brain injury. Other than mild folate deficiency, metabolic workup was unremarkable. MRI imaging ruled out structural causes and he was diagnosed with Lance-Adams syndrome. EEG showed myoclonic seizures and he was started on levetiracetam and valproic acid. Benzodiazepines were later added to decrease episodes of myoclonus.

Setting: Acute inpatient rehabilitation

Assessment/Results: Myoclonus improved with the start of anti epileptic medications and benzodiazepines. Levetiracetam and valproic acid doses were increased to better control myoclonic episodes. When he arrived at rehab his mobility functional ability score was 41 and at discharge was 62. When he arrived to rehab his overall functional ability score was 74 and at discharge was 103. He was discharged ambulating over 70 meters using a rolling walker.

Discussion (relevance): Lance-Adams syndrome is a rare syndrome that can occur in patients who have had cerebral hypoxia, most commonly seen after cardiopulmonary resuscitation. In the weeks to months following the hypoxic episode patients with Lance-Adams syndrome will develop myoclonus, particularly action myoclonus. Diagnosis is made predominantly based on the patient's history which would include a cerebral hypoxic event and the patient's symptoms. EEG is often obtained to assess cortical activity and assess for epileptic discharges. As seen with this patient, action myoclonus can lead to severe impairments in ambulation.

Conclusions: Lance-Adams syndrome is a rare syndrome that causes action myoclonus which can lead to impairments in mobility and activities of daily living. Early diagnosis is important for medication initiation and adjustment of dosing for better symptom control.