YULETIDE TREMOR, TWITCHES AND TUNES

ABSTRACT

A 53 year old fit and well female was admitted to hospital with rapidly evolving progressive generalised stimulus sensitive myoclonus, axial rigidity and encephomyelitis over five days, two weeks after confirmed diagnosis of SARS-COV-2 infection. On admission to hospital she had generalised myoclonus involving face, voice, trunk, proximal and distal limbs augmented with tactile and auditory stimulus and voluntary movements. A few days later she developed significant axial rigidity, ocular bobbing and encephalitis as well as a myoclonic storm requiring intubation and ventilation. MRI Brain with contrast and CSF exami-nation were unremarkable and an EEG showed no epileptiform discharges. She was started on high dose intravenous steroids followed by 5 courses of plasma exchange. Her COVID serology was positive and other investigations including Glycine, GAD, amphiphysin and DPPX antibodies were negative. She demonstrated significant improvement and was discharged home a week after plasma exchange with the view to wean off steroids over six weeks. This case demonstrates a patient presenting with a rapidly evolving stimulus sensitive myoclonic storm with rigidity and encephalomyelitis two weeks after SARS-COV2 infection, which responded well to prompt immunomodulatory treatment.