Harada Taku, Yamasato Kazushi, Nakanishi Toshiyuki, Nakai Mori
Department of General Medicine, Nerima Hikarigaoka Hospital, Tokyo, Japan.
Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Tochigi, Japan.
Eur J Case Rep Intern Med. 2024 Jan 10;11(2):004254. doi: 10.12890/2024_004254. eCollection 2024.
Transient myoclonic (TM) state in older adults is a neurological condition characterised by short-lived, repetitive myoclonus without consciousness disturbance. First reported in 1992, it predominantly affects older individuals with chronic diseases. Despite its clear symptomatology, TM often remains under-recognised, leading to potential misdiagnoses.
We report a case of a 68-year-old woman with a history of chronic heart failure who developed TM during hospitalisation following medication adjustment for acute heart failure. The patient, who had no history of intracranial disease or epilepsy, experienced acute involuntary movements of the face and limbs three days after diuretic adjustment. She responded well to intravenous diazepam and oral clonazepam, with no recurrence of symptoms post-treatment.
TM presents with bilateral, irregular, and repetitive myoclonus, mostly affecting the head, neck and upper extremities. Diagnosis is clinical, based on symptomatology and normal laboratory results. This case underscores the importance of recognising TM in differential diagnosis, especially in older patients in the acute or recovery phase of infection, or with medication changes. The potential role of fluid volume changes in TM pathophysiology in patients with underlying conditions such as hypertension or chronic heart failure is also highlighted. This case emphasises the need for heightened awareness and knowledge of TM among healthcare professionals.
TM, though rare, requires awareness among clinicians for accurate diagnosis and management. It is crucial to avoid misdiagnosis and unnecessary interventions, and to provide appropriate information during care transitions, particularly in older adults with chronic conditions.
Transient myoclonic (TM) state is a rare neurological condition in older adults, characterised by brief and repetitive myoclonus, primarily affecting the head, neck and upper extremities.The distinctive clinical diagnostic feature is myoclonus occurring without disturbances in consciousness, without amnesia or paralysis, while retaining the ability to perform directed movements. This condition can manifest at rest, may worsen with posture or movement, and tends to improve during sleep.Management strategies include ensuring smooth care transitions, avoiding misdiagnosis and educating patients and families about the risk of recurrence.
老年人短暂性肌阵挛（TM）状态是一种神经系统疾病，其特征为短暂的、重复性肌阵挛，且无意识障碍。1992年首次报道，主要影响患有慢性疾病的老年人。尽管其症状明显，但TM常未得到充分认识，导致可能的误诊。
我们报告一例68岁女性，有慢性心力衰竭病史，在因急性心力衰竭调整药物治疗住院期间发生了TM。该患者无颅内疾病或癫痫病史，在利尿剂调整三天后出现面部和四肢急性不自主运动。她对静脉注射地西泮和口服氯硝西泮反应良好，治疗后症状未复发。
TM表现为双侧、不规则且重复性肌阵挛，主要影响头部、颈部和上肢。诊断基于临床症状和正常实验室检查结果。该病例强调了在鉴别诊断中识别TM的重要性，尤其是在处于感染急性期或恢复期或有药物变化的老年患者中。还强调了在患有高血压或慢性心力衰竭等基础疾病的患者中，血容量变化在TM病理生理中的潜在作用。该病例强调了医护人员提高对TM的认识和了解的必要性。
TM虽罕见，但临床医生需提高认识以进行准确诊断和管理。避免误诊和不必要的干预，并在护理过渡期间提供适当信息至关重要，尤其是对于患有慢性疾病的老年人。
短暂性肌阵挛（TM）状态是老年人中一种罕见的神经系统疾病，其特征为短暂且重复性肌阵挛，主要影响头部、颈部和上肢。独特的临床诊断特征是肌阵挛发作时无意识障碍、无失忆或瘫痪，同时保留执行定向运动的能力。这种情况可在休息时出现，可能因姿势或运动而加重，且在睡眠中往往会改善。管理策略包括确保护理过渡顺利、避免误诊以及对患者及其家属进行复发风险教育。
