Diaphragmatic flutter (myoclonus) is a rare condition  characterised by high-frequency, involuntary contractions of the diaphragmatic muscles. It is often accompanied by contractions of accessory respiratory muscles and is then known as respiratory myoclonus. 

In this paper, we present a case report of a 61-year-old patient seeking medical help for difficulties lasting about a month in terms of respiratory muscle contractions with dyspnoe and epigastric pain. Clinical examination showed clonic twitching of the rectus abdominis muscle and tonic spasm of the diaphragm. 

MRI scans of the brain showed subacute bleeding of cavernoma in the Guillain-Mollaret (myoclonic) triangle. Guillain-Mollaret triangle is an important feedback circuit of the brainstem and deep cerebellar nuclei which is responsible for modulating spinal cord motor activity.

In this case we reported that diaphragmatic myoclonus was successfully treated by injecting botulinum toxin A  under needle electromyography (EMG) guidance.

Keywords: diaphragmatic myoclonus, cavernoma, Giullain-Mollaret triangle, the dentato-rubro-olivary tract

Martin Daniš has completed his University medical studies in 2018 in Comenius University in Bratislava. Since then he has been working at the department of Neurology in Faculty Hospital of Trnava.