Perioperative transient myoclonic state with asterixis in an elderly patient: a case report

Background Transient myoclonic state with asterixis (TMA) is characterized by repetitive, short-lived myoclonus without impaired consciousness disturbance. Herein, we report a case of an elderly man who developed TMA perioperatively. Case presentation A man in his 80 s who was independent in activities of daily living underwent lumbar laminectomy under general anesthesia. Post-operatively, he emerged from anesthesia without any issues including neurological symptoms. On the night of postoperative day (POD) 1, he remained conscious, but developed acute dysarthria, finger tremor, and involuntary tremulous movements involving the face, neck, tongue, and bilateral upper extremities. Routine laboratory investigations and brain magnetic resonance imaging showed no abnormalities. He was diagnosed with TMA and responded well to oral clonazepam. Conclusions TMA should be recognized in the differential diagnosis of acute onset involuntary movements, particularly in patients after general anesthesia. Increased awareness of this condition is important to avoid misdiagnosis and unnecessary interventions and ensure appropriate management.