This case report describes a woman who developed involuntary uncoordinated movements of her face and limbs following a spontaneous vaginal delivery, complicated by post-partum haemorrhage. Using systematic assessment with multi-disciplinary team (MDT) input, a differential diagnosis was proposed and relevant investigations were undertaken. Atypical eclamptic or generalised seizure were excluded clinically and neuroimaging ruled out an intracranial vascular event such as stroke or venous sinus thrombosis. Local anaesthetic systemic toxicity was managed empirically with intravenous lipid emulsion and intravenous fluids. A diagnosis of drug-induced dyskinesia was made, most likely secondary to ondansetron, with which dystonias and myoclonus have been described. This woman’s symptoms were transient and resolved within two hours.
This case presented a complex differential diagnosis, highlighting the paucity of guidance available. We propose a diagnostic algorithm to aid identification of acute involuntary movements in pregnancy and the puerperium.