Working Diagnosis:
The working diagnosis was traumatic spinal myoclonus given negative MRI of the brain and cervical spine, with a normal EEG.

Treatment:
The athlete was treated initially with rest from play during diagnostic work up. He was cleared to return to play without restrictions by Neurology.

Outcome:
The athlete underwent an extensive evaluation with labs, imaging and Neurology consultation. Given his negative results he was allowed to resume training. After the initial two myoclonic episodes he did not have any further episodes to date.

Author's Comments:
The occurrence of myoclonic episodes immediately following trauma during sports in conjunction with negative testing supported the diagnosis of traumatic spinal myoclonus. Traumatic myoclonus is typically seen after an injury to the central nervous system, most often involving the brain (post-traumatic injury) or, less commonly, the spinal cord.

Editor's Comments:
Evaluation for spinal myoclonus should seek to identify the underlying cause as well as localize the lesion within the spinal cord. Traumatic spinal myoclonus presents as involuntary, brief, jerk-like muscle contractions. Spinal myoclonus can be caused by any lesion that affects the spinal cord - including trauma, syringomyelia, myelitis, or malignancy.

A history and physical exam should evaluate the relationship to any trauma, activation pattern (ie rest versus action) and distribution (segmental versus axial). Other neurological signs should be identified and evaluation of myelopathy performed. Imaging of the spinal cord should be performed to identify any structural cord lesions, rule out myelopathy and identify any vertebral injuries in the setting of trauma. Electrophysiologic testing can confirm the diagnosis and subtype of myoclonus. Useful testing modalities include polymyography, EEG-EMG, and somatosensory evoked potentials (SSEP). Laboratory evaluation should be performed if an infectious, inflammatory or neoplastic etiology is considered.

References:
Caviness JN, Brown P. Myoclonus: current concepts and recent advances. Lancet Neurol. 2004 Oct;3(10):598-607. doi: 10.1016/S1474-4422(04)00880-4. PMID: 15380156.

Schupper AJ, McGehrin K, Ravits J, Lee D. Clinical Reasoning: A 22-year-old man presenting with headache and right leg jerks. Neurology. 2018 Nov 6;91(19):891-895. doi: 10.1212/WNL.0000000000006476. PMID: 30397040.

https://open.oregonstate.education/anatomy2e/chapter/spinal-cord/

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