Glycogen Storage Diseases and Myoclonus Open access Peer reviewed

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

Shin Kurosawa, Eri Kameyama, Michiko Kobayashi, Kyoichi Handa and 4 more

JA Clinical Reports | Aug 22, 2026

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A case of an elderly man in his 80 s who was independent in activities of daily living who underwent lumbar laminectomy under general anesthesia and emerged from anesthesia without any issues including neurological symptoms is reported.

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Abstract 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.

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Shin Kurosawa

first | Tohoku Medical and Pharmaceutical University Hospital

Eri Kameyama

middle | Tohoku Medical and Pharmaceutical University Hospital

Michiko Kobayashi

middle | Tohoku Medical and Pharmaceutical University | ORCID 0000-0002-4082-0586

Kyoichi Handa

middle | Tohoku Medical and Pharmaceutical University | ORCID 0000-0003-2180-2865

Akiko Yoshida

middle | Tohoku Medical and Pharmaceutical University Hospital

Kei Nagaya

middle | Tohoku Medical and Pharmaceutical University Hospital

Yosuke Ito

middle | Tohoku Medical and Pharmaceutical University Hospital | ORCID 0000-0003-0840-8214

Marina Sangatsuda

last | Tohoku Medical and Pharmaceutical University Hospital

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@article{Kurosawa2026Perioperative,
  title = {Perioperative transient myoclonic state with asterixis in an elderly patient: a case report},
  author = {Shin Kurosawa and Eri Kameyama and Michiko Kobayashi and Kyoichi Handa and Akiko Yoshida and Kei Nagaya and Yosuke Ito and Marina Sangatsuda},
  journal = {JA Clinical Reports},
  year = {2026},
  doi = {10.1186/s40981-026-00875-3},
  url = {https://doi.org/10.1186/s40981-026-00875-3}
}

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