Cervical Dystonia: Torticollis with Dystonic Head Tremor
Cervical dystonia (CD) is often associated with dystonic head tremor. In some cases, the head tremor is much more apparent than the abnormal head posture which may be relatively subtle. Differential diagnosis includes titubation and essential tremor limited to the head and neck. Titubation occurs as a component of midline cerebellar ataxia and is accompanied by cerebellar findings. Essential tremor affecting the head is more jerky and irregular than dystonic tremor, rarely occurs in isolation, and is nearly always associated with postural or action tremor of the upper extremities or voice tremor (see Chap. 25). Dystonic head tremor is often but not always more prominent when the patient attempts to turn the head away from the abnormal head posture.
KeywordsInternal Medicine Differential Diagnosis Essential Tremor Cerebellar Ataxia Cervical Dystonia
5 CD - Torticollis w. dystonic head tremor.mp4 (mp4 7,293kB)
At rest, the patient exhibits 25° of right-sided rotation with continuous, irregular horizontal head tremor. Rotational range of motion is full. There is no postural tremor in the upper extremities.