Secondary Hemidystonia Following Head Trauma
Head trauma is a well-recognized but infrequent cause of dystonia. Both hemidystonia and torticollis have been identified following head injury: Most patients (70%) are men who have sustained severe head trauma with loss of consciousness. The common presentation is that of acute hemiplegia followed by the delayed appearance of limb dystonia. The amount of delay may not correlate with severity of the initial hemiparesis. Dystonia tends to progress as hemiparesis regresses. The onset of dystonia may occur only days after trauma but sometimes is delayed for as long as 6 years. Delayed onset is usually longer in children where it may occur as a consequence of perinatal brain trauma.
KeywordsBotulinum Toxin Cervical Dystonia Botulinum Toxin Injection Severe Head Trauma Follow Brain Injury
Secondary hemidystonia head trauma.mp4 (MP4 23,958KB)
An irregular and jerky large amplitude tremor is present in the right arm at rest which is worse with action. The patient also exhibits right hemidystonia which is most prominent in the right arm. The abnormal right arm posture is present at rest and becomes worse with action. Right facial pulling and mild right foot dystonia are also present. Mild right rotational torticollis is present together with hypertrophy of right sternocleidomastoid muscle. Gait is normal except for distal tremor in right arm and flexion dystonia at right wrist.