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Old 08-20-2019, 08:36 AM #1
bonyesz bonyesz is offline
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Default Myoclonus-like twitching on all limbs while falling asleep 3 weeks after injury

Hello,

I have searched the forums for something similar but have not found a close enough match, any and all help would be very much appreciated.

Four weeks ago our 13 year old daughter fell backwards while running in a park and hit the back of her head from a standing height into the edge of a stone step.
Fortunately her hair in a braid somewhat dampened the blow but even this way she suffered what appeared to be subarachnoid bleeding above the right cerebellum. Because of the suspicion of bleeding she was transported to a neuro trauma unit. The bleeding was no longer visible on a CT repeated 6 hours after the first one (the radiologist was not sure whether we are looking at real bleeding or an artifact). She was diagnosed having a severe concussion and was released two days later.
About two weeks after her release she was making a fairly good recovery.
The only baffling symptoms started at that point and that is what this post is about.

We first noticed that she trips on her right leg while walking. She describes it as a momentary loss of strength in her calf muscles.
She also complains about her right arm "falling asleep" occasionally in a certain posture.

The bigger concern is the twitching that we started noticing about 10 days ago.
A few minutes after she closes her eyes to fall asleep she starts having twitches on all four limbs in sync, coupled with gasping breathing and contorted facial muscles. This goes on for about 15-20 seconds, then stops and starts again in a minute or two, with 5-6 cycles until she stops and enters a form of sleep. She then awakes a few minutes later and can't go back to sleep for a few hours.
If we wake her up during an episode she describes having very lucid, colorful and lifelike "dreams" , some of them that are set with her real field of vision (her room) in the background.

She had a sleep deprived EEG done a few days ago that included strobe light testing and according to the neurologist there are no signs of seizures, While that's great news, we don't have a diagnosis of what may be going on yet.

Any ideas on what might have going on would be very much appreciated.
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Old 08-20-2019, 08:25 PM #2
Mark in Idaho Mark in Idaho is offline
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These may be a form of hypnagogic jerks. Is she breathing normally when this happens?

I am more concerned about her right side weakness. The location of her impact suggests possible upper neck trauma. This can cause inflammation that can cause nerve dysfunction. Imaging rarely shows these subtle injuries. Using symptoms to track back to the injury is often the solution. Some times, treating the neck as if it is injured with icing, gentle traction, sleeping posture discipline, and such can lead to improvements.

Some gentle spinal manipulation by a chiro or PT or upper cervical specialist may help. No twist the head and pop the neck treatments. They are usually too aggressive.

You don't say what position may lead to the right arm falling asleep. ??

Was there a specific thing that caused her fall? tripping, etc. or could she have experienced a neurological event that caused her to fall? A transient event would not necessarily show up on a CT.
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Old 08-21-2019, 04:39 AM #3
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Thank you for taking the time to respond!
To answer your questions:
During the twitching period there is a change in her breathing: it comes in gasps and becomes more rapid. Our biggest worry is that the episodes are getting longer and the twitching sometimes turns into a cramp for a brief period on her hands. The hands turn inward with the fingers bent. According to the neurologist who briefly looked at the EEG there are no signs of epileptic activity but I have asked for a copy of the EEG and will get a second opinion. (It's a little disheartening that as an engineer at I need to pay more in depth attention to complex machines than a human being gets when hurt - sorry, just venting)
With respect to the neck, she is receiving physical therapy with exercises aimed at getting her neck better. Is it OK to still have pain at the site of the injury a month after the event? The constant pain is gone, but the area is very sensitive to touch. (It's the backmost area of the occipital bone)
The posture is with her palm facing down with the arm raised almost parallel with the ground, with the axis of the upper arm, the forearm and wrist (pointing slightly downward) rotated by about 30 degrees from the fully stretched position. Something like this, with the wrist being the leftmost symbol: /\/
This is important for her because as a musician this is the position of holding her bow.
With respect to what caused the fall, we were not there so I only have a second hand account as our daughter does not remember the exact way she fell. The girl she was running with describes is as her slipping in a puddle. She did lose consciousness for a brief period (a few seconds) after the fall.
Thank you again for your responses!
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Old 08-23-2019, 02:02 AM #4
Mark in Idaho Mark in Idaho is offline
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A numb arm can be from a shoulder or upper back injury.

In my opinion, her PT needs to be very gentle. No heavy exercise or range of motions exercises. A hit like she suffered commonly stresses C-1 to occiput. That takes gentle care and consistent self-discipline to heal. If she is playing a violin with her head twisted to hold her violin, that could be problematic.

Choices to be made.
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