A Case of Lance-Adams Syndrome Post Life-Threatening Bronchial Asthma

Abstract

Lance-Adams syndrome (LAS) is a rare complication that occurs after successful cardiopulmonary resuscitation, in which myoclonus appears rapidly upon recovery from the severe hypoxic event. To date, <150 cases have been reported. The author reports a case of a 43-year-old male who presented with cardiorespiratory collapse as a result of life-threatening bronchial asthma that required 10 minutes of cardiopulmonary resuscitation. He was intubated and haemodynamically supported with inotropes for 4 days. Post-extubation, he developed progressively worsening action myoclonus involving limbs, trunk, and speech. His mini-mental state examination (MMSE) was 16/30. All his metabolic, infective, and neuroimaging screenings, including CT and MRI of the brain, were normal. He was diagnosed with LAS due to the classical onset and semiology. Clonazepam and sodium valproate were started, with piracetam added later. He showed marked functional improvement after the treatment. He was able to walk with walking-frame and MMSE improved to 26/30; however, minimal dysarthria persisted. Early and accurate diagnosis is of paramount importance for disability limitation; however, management of LAS can be challenging as high-quality, evidence-based treatment has not been established. This case highlights the importance of retaining high clinical suspicion in diagnosing LAS. Given its typical history and presentation, the diagnosis can be made confidently.