COMPARISON OF ACUTE-ONSET AND DELAYED-ONSET POSTTRAUMATIC CERVICAL DYSTONIA

Head, neck, or shoulder trauma is an occasional antecedent event befor e the appearance of cervical dystonia. A clinically distinctive syndro me of acute-onset posttraumatic cervical dystonia characterized by mar kedly restricted range of neck motion, absence of phasic involuntary m ovements, and poor response to treatment has previously been described . Patients with cervical dystonia attending a movement disorder clinic were reviewed for history of trauma before onset of symptoms. Patient s with symptom onset within 4 weeks of trauma were compared with patie nts who developed symptoms between 3 months and 1 year after trauma. A cute-onset cervical dystonia was characterized by markedly reduced cer vical mobility; prominent shoulder elevation with trapezius hypertroph y in most patients, absence of involuntary movements, sensory tricks, or activation maneuvers; and poor response to botulinum toxin injectio n. By contrast, delayed-onset cervical dystonia was clinically indisti nguishable from nontraumatic idiopathic cervical dystonia. Acute-onset posttraumatic cervical dystonia is similar to limb dystonia after per ipheral trauma and may represent a form of nondystonic muscle spasm si milar to torticollis associated with musculoskeletal injuries of the c ervical spine and craniocervical junction.