Convulsive-like movements in brainstem stroke

Background: Involuntary convulsive-like movements sometimes occur in patien ts with brainstem strokes. These movements vary in nature, frequency, and t rigger, including fasciculation-like, shivering, jerky, tonic-clonic, and i ntermittent shaking movements. Some are interpreted as decerebrate postures or seizures. It is important to recognize this type of motor phenomenon si nce it may be a diagnostic clue for early diagnosis and treatment of brains tem strokes. Design: Case report and review of the literature Observation: A 72-year-old-man presented with impaired consciousness and je rks of the upper limbs mimicking seizures. These episodes consisted of brie f clonic contractions of the proximal and distal upper extremities. They we re observed in paroxysms lasting for 3 to 5 seconds. Magnetic resonance ima ging showed large midpontine infarction. Magnetic resonance angiography rev ealed the absence of basilar artery blood now. No seizure discharges were o bserved in the electroencephalogram. Anticoagulation with intravenous hepar in was started. Two days after admission, the patient had a cardiac arrest and died. We review the frequency and nature of convulsive-like movements i n brainstem stroke in the literature. Conclusion: Movements associated with brainstem lesions are not easily diff erentiated from convulsions. Unexpected onset and inexperience of the obser vers limit the characterization of this phenomenon. Convulsive-like movemen ts in brainstem stroke may occur more frequently than reported. Early detec tion of this motor phenomenon may hav e practical implications.