In anoxic coma, myoclonic status epilepticus and other nonreactive epileptiform patterns are considered as signs of poor prognosis. We report the case of a good recovery in a prolonged comatose myoclonic status epilepticus (MSE) after a cardiac arrest (CA) treated with mild therapeutic hypothermia (TH) in a patient who had undergone a bone marrow transplantation for Hodgkin’s lymphoma. This case emphasizes the opportunity of performing an electroencephalogram (EEG) in the acute period after an hypoxic-ischemic insult and underlines the diagnostic difficulties between MSE and Lance-Adams syndrome, which classically occurs after the patient has regained consciousness, but can also begin while the patient is still comatose or sedated. Major problems in prognostication for postarrest comatose patients will also be pointed out. 1. Introduction Postanoxic status epilepticus, particularly myoclonic status, is traditionally considered a marker of unfavorable outcome. Overall, the prognosis is extremely poor, with only a fraction of patients surviving hospital discharge and often even then reporting severe neurological or cognitive deficits [1–4]. With the advent of therapeutic hypothermia, an improvement in outcome was described in comatose survivors. In particular, some authors reported cases of patients with early post-anoxic MSE who presented a good recovery [5–7]. There are also a handful of case reports that mention early myoclonus in patients who regained consciousness and had a good neurological outcome after cardiorespiratory arrest [8–12]. These findings stress the importance of considering a combination of prognostic features before making any outcome prediction, with also bearing in mind the confounding effects of several factors, including but not limited to hypothermia and sedatives. We describe the case of a patient who had undergone a bone marrow transplantation and had a good recovery after a prolonged post-anoxic MSE. Our case aims to demonstrate the possibility of reasonable neurological recovery despite early onset of myoclonic status even when very serious comorbidity is present. The diagnostic difficulties between MSE and Lance-Adams syndrome are also underlined. 2. Case Report A 52-year-old man was diagnosed with Hodgkin’s lymphoma in March 2009. He was treated with radiotherapy, five cycles of chemotherapy, and then underwent autologous bone marrow transplantation, all of which did not prove beneficial in terms of remission. Finally, in March 2010 an allogenic transplantation was performed, obtaining a good hematologic response.
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