Secondary Cervical Dystonia Following Brainstem Hemorrhage
Cervical dystonia (CD), also known as spasmodic torticollis, is the most common form of adult-onset focal dystonia. The vast majority of cases are idiopathic. Secondary cervical dystonia (SCD) is uncommon but can be associated with tardive dystonia, certain heredodegenerative neurologic disorders, vascular or neoplastic brain lesions, and trauma affecting the central or peripheral nervous system. Clues which favor secondary rather than idiopathic CD include fixed postures unaccompanied by involuntary head and neck movements and sensory tricks. Other focal neurologic findings may be present. Secondary cervical dystonia must be distinguished from nondystonic torticollis. Nondystonic torticollis refers to sustained muscle contractions often occurring in response to local neighborhood injuries or other abnormalities possibly as a reflex mechanism or reaction to another problem such as, for example, cervical disc herniation, atlantoaxial fractures or dislocations, cervical spine or spinal cord abnormalities, trochlear nerve palsy, or hemianopia.
KeywordsCervical Spine Cervical Dystonia Sustained Muscle Contraction Cervical Disc Herniation Spasmodic Torticollis
Secondary CD brainstem hemmorhage.mp4 (MP4 6,280KB)
One month after onset of symptoms, the patient displays right-sided torticollis with dynamic head jerks and bilateral upper extremity ataxia. There is hypertrophy of the left sternocleidomastoid muscle and mild right shoulder elevation.