acute dystonia
| Painful involuntary muscle contractions. | |
|---|---|
| Etiology | causative medications: metoclopramide, antipsychotics, SSRIs |
| Epidemiology | Risk factors: M>F, young age, alcohol/cocaine misuse |
| Clinical presentation | Various forms - oculogyric crisis, buccolingual crisis, laryngospasm, opisthotonus, torticollis |
| Ddx | - Dislocated mandible, C-spine injury - Hyperventilation - Hypocalcaemia and hypomagnesaemia - Primary neurological cause: temporal lobe epilepsy, meningitis, stroke, Wilsons disease - Neck deep space infections - Tetanus - Toxicity: - Strychnine poisoning (spontaneous tonic-clonic contractions as well as extensor thrust provoked by external stimuli) - Anti-cholinergic agents (agitation and restlessness) |
| Pathogenesis | |
| Investigations | Ca, Mg See below for scary causes of torticollis |
| Management | - 1st line: Procyclidine (anticholinergic) or benztropine → expect symptom free in 30 min - benzodiazepines - treatment needs to continue 48h afterward to prevent relapse! - meds rv of causative medication - non-traumatic, non-infective torticollis may respond to analgesia |
Torticollis - underlying causes
- CNS infection
- SAH (meningism)
- Tetanus
- neck abscess eg Retropharyngeal abscess
- Trauma
- suspect if neck pain, torticollis and injury
- Grisel syndrome = atlantoaxial rotatory subluxation following inflammatory or ENT procedures
- more likely in children with lax ligaments e.g. Down syndrome