Krishnaiengar Suparna R, Cruz-Saavedra Luis, Lavu Venkat Srikar, Bautista Ramon E
Neurology, University of Florida College of Medicine - Jacksonville, Jacksonville, USA.
Neurology, University of Florida, Gainesville, USA.
Cureus. 2024 May 19;16(5):e60621. doi: 10.7759/cureus.60621. eCollection 2024 May.
Lance-Adams syndrome (LAS) is a rare clinical presentation of hypoxic-ischemic brain injury typically occurring in the setting of cardiac arrest. It is rare for it to be associated with respiratory failure. The advent of the COVID-19 pandemic heralded a new cause of respiratory failure, and not much is known about the occurrence of Lance-Adams syndrome in the context of COVID-19 pneumonia. A 23-year-old male was brought to the emergency department (ED) after being found unconscious at home. He had prominent generalized myoclonus in the context of COVID-19 pneumonia and a possible clonazepam overdose. Magnetic resonance imaging (MRI) of the brain with and without contrast revealed findings suggestive of hypoxic-ischemic brain injury. A diagnosis of LAS was made based on electroencephalography (EEG). As LAS typically carries a relatively favorable prognosis, aggressive treatment was pursued. This resulted in a fairly good outcome, although he had to be maintained on several antiseizure medications. Our case is a rare occurrence of Lance-Adams syndrome in the setting of respiratory failure and COVID-19 pneumonia in the absence of cardiac arrest. It is critical to distinguish myoclonic status epilepticus (MSE) from Lance-Adams syndrome due to the difference in prognosis. Our case can provide future direction for studies in a larger cohort of patients to see if LAS is frequently associated with respiratory failure secondary to COVID-19 pneumonia in the absence of cardiac arrest. It is important to consider Lance-Adams syndrome as one of the emerging neurological complications of COVID-19 pneumonia.
兰斯-亚当斯综合征（LAS）是缺氧缺血性脑损伤的一种罕见临床表现，通常发生在心脏骤停的情况下。它很少与呼吸衰竭相关。新型冠状病毒肺炎（COVID-19）大流行的出现预示着呼吸衰竭的一个新病因，而关于COVID-19肺炎背景下兰斯-亚当斯综合征的发生情况知之甚少。一名23岁男性在家中被发现昏迷后被送往急诊科（ED）。他在COVID-19肺炎的背景下出现明显的全身性肌阵挛，且可能存在氯硝西泮过量。头颅磁共振成像（MRI）平扫及增强检查结果提示缺氧缺血性脑损伤。基于脑电图（EEG）做出了兰斯-亚当斯综合征的诊断。由于兰斯-亚当斯综合征通常预后相对良好，因此采取了积极的治疗措施。尽管他必须持续服用几种抗癫痫药物，但最终取得了相当不错的结果。我们的病例是在无心脏骤停的情况下，呼吸衰竭和COVID-19肺炎背景下罕见的兰斯-亚当斯综合征病例。由于预后不同，区分肌阵挛性癫痫持续状态（MSE）和兰斯-亚当斯综合征至关重要。我们的病例可为更大规模患者队列的研究提供未来方向，以观察在无心脏骤停的情况下，兰斯-亚当斯综合征是否经常与COVID-19肺炎继发的呼吸衰竭相关。将兰斯-亚当斯综合征视为COVID-19肺炎新出现的神经并发症之一很重要。
