Neurology and Neurophysiopathology, Ospedale Sandro Pertini, Via Monti Tiburtini 385, 00157, Rome, Italy.
Neurol Sci. 2013 Oct;34(10):1815-7. doi: 10.1007/s10072-013-1299-7. Epub 2013 Jan 24.
We describe a 58-year-old woman who underwent hysteroscopic myomectomy to treat a large submucosal leiomyoma. A hypotonic glycine solution was instilled to distend the uterus. At one hour after the distending medium infusion started for hysteroscopic resection an electrolytic imbalance developed. One hour later myoclonus developed predominantly involving the bilateral sternocleidomastoidei and abdominal muscles. The patient was alert and cooperative; jerks were spontaneous and triggered by sensory stimuli. The electroencephalographic and brain computed tomography was normal. The clinical characteristics of her myoclonus resemble reticular reflex myoclonus, a form of subcortical myoclonus originating from the lower brainstem reticular formation. Given her severe hyponatremia we conjecture that she had symptomatic metabolic myoclonus caused by electrolytic disturbance. The case report we present underlines the need to detect in time and promptly treat neurological symptoms such as myoclonus suggesting resorption syndrome, an uncommon event complicating transcervical hysteroscopic surgery and urologic procedures.
我们描述了一位 58 岁的女性，她接受了宫腔镜子宫肌瘤切除术以治疗大型黏膜下子宫肌瘤。向子宫内注入低张甘氨酸溶液以扩张子宫。在宫腔镜切除术中开始输注扩张介质后 1 小时，发生电解质失衡。1 小时后，出现以双侧胸锁乳突肌和腹肌为主的肌阵挛。患者意识清醒，合作；抽搐是自发性的，并由感觉刺激触发。脑电图和脑计算机断层扫描正常。她的肌阵挛的临床特征类似于网状反射性肌阵挛，这是一种起源于下脑干网状结构的皮质下肌阵挛。鉴于她严重的低钠血症，我们推测她患有症状性代谢性肌阵挛，由电解质紊乱引起。我们报告的病例强调了需要及时发现并迅速治疗提示吸收综合征的神经症状，如肌阵挛，这是一种不常见的并发症，会使经宫颈宫腔镜手术和泌尿科手术复杂化。
