Abstract Details

Title Spontaneous Eye Opening and Tonic Posturing Reflex in a Child with Severe Hypoxic Ischemic Encephalopathy

Topic Critical Care/Emergency Neurology/Trauma

Presentation(s) P06 - (-)

Poster/Presentation
Number 239

Objective

Background BACKGROUND: Comatose patients with severe HIE enter a vegetative state in which responses are limited to primitive postural and reflex movements.This case report defines a patient who had a spontaneous bilateral eye opening reflex with extension of lower extremities and flexion of upper extremities.

Design/Methods DESIGN/METHODS: Case report.

Results RESULTS: A 22 month old boy with complex partial seizures who was intubated and mechanically ventilated secondary to a prolonged partial status epilepticus and cardiopulmonary arrest.Initial CT brain revealed edema within the left occipital lobe extending to the left temporal and parietal lobe. Continuous EEG monitoring during the first 24 hours of hospitalization revealed continuous background slowing without normal organization, frequent intermittent 5-6 Hz activity over the frontal region with no clear ictal evolution, and intermittent sleep and awake cycles throughout the night. Approximately,72 hours later, he started to have episodes of intermittent spontaneous reflex opening of both eyes associated with flexion of bilateral upper extremities at the elbow, extension posturing of bilateral lower extremities, and irregular breathing.Each episode lasted for a few seconds, and occurred multiple times per day, occasionally in clusters. Few episodes were also associated with elevated blood pressure and tachycardia. No clear stimulus could be identified. Continuous EEG monitoring throughout that day was iso-electric including during these reflex episodes.MRI of the brain revealed a diffusely infarcted brain.Brainstem Auditory Evoked Response(BAER)study revealed a delay in inter-peak latency suggesting delayed conduction from the Pons to midbrain.

Conclusions CONCLUSIONS: Eye opening reflex seen in this patient does not belong to Doll's eye phenomenon.To the best of our knowledge, this has not been reported in the pediatric population to date.It may be a manifestation of a decerebrate response in diffuse cerebral damage.

Authors/Disclosures
Savitra M. Bandari, MD (JFK Neuroscience Institute) PRESENTER	Dr. Bandari has nothing to disclose.
Aravindhan Veerapandiyan, MD (Arkansas Childrens Hospital/UAMS)	Dr. Veerapandiyan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen, Novartis,Edgewise Therapeutics, Pfizer, PTC Therapeutics, Sarepta Therapeutics, Inc., UCB Pharma, Catalyst, Entrada, Lupin, Percheron, ITF. Dr. Veerapandiyan has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for MedLink Neurology. Dr. Veerapandiyan has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Muscle and Nerve. The institution of Dr. Veerapandiyan has received research support from AMO Pharma, Capricor Therapeutics, Edgewise Therapeutics, FibroGen, Muscular Dystrophy Association, Novartis, Parent Project Muscular Dystrophy, Pfizer, RegenxBio, SolodBio and Sarepta Therapeutics. Dr. Veerapandiyan has received personal compensation in the range of $5,000-$9,999 for serving as a MD with PPMD, MDA.
Jayoung Pak, MD (NJMS Rutgers)	No disclosure on file
Appaji Rayi, MD, FAAN (Charleston Area Medical Center)	Dr. Rayi has nothing to disclose.
	No disclosure on file

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