Abstract
BackgroundSecondary cervical dystonia is induced by organic brain lesions involving the basal ganglia, thalamus, cerebellum, and brain stem. It is extremely rare to see cervical dystonia induced by a medullary lesion.Case presentationWe report a case of an 86-year-old Japanese woman who developed cervical dystonia following lateral medullary infarction. She developed sudden-onset left upper and lower extremity weakness, right-side numbness, and dysarthria. Brain magnetic resonance imaging revealed an acute ischemic lesion involving the left lateral and dorsal medullae. A few days after her stroke, she complained of a taut sensation in her left neck and body, and cervico-shoulder dystonia toward the contralateral side subsequently appeared. Within a few weeks, it disappeared spontaneously, but her hemiplegia remained residual.ConclusionsTo date, to the best of our knowledge, there has been only one reported case of cervical dystonia associated with a single medullary lesion. It is interesting to note the similarities in the clinical characteristics of the previously reported case and our patient: the involvement of the dorsal and caudal parts of the medullary and associated ipsilateral hemiplegia. The present case may support the speculation that the lateral and caudal regions of the medulla may be the anatomical sites responsible for inducing cervical dystonia.
Highlights
Secondary cervical dystonia is induced by organic brain lesions involving the basal ganglia, thalamus, cerebellum, and brain stem
To date, to the best of our knowledge, there has been only one reported case of cervical dystonia associated with a single medullary lesion
It is interesting to note the similarities in the clinical characteristics of the previously reported case and our patient: the involvement of the dorsal and caudal parts of the medullary and associated ipsilateral hemiplegia
Summary
It remains uncertain whether cervical dystonia is more likely to be complicated by Opalski’s syndrome, this type of cervical dystonia might be overlooked in patients with acute stroke, those with hemiparesis. We believe this case report contributes to recognizing the possible relationship between caudal medullary lesions and cervical dystonia, as well as facilitates the accumulation of similar cases for better understanding of secondary dystonia. Left hemiparesis Left body sensory disturbance (pain, touch, temperature) Left paretic sternocleidomastoid muscle Left decreased deep sensation Left neck pain 10 days. Oculomotor disturbances Dysarthria Flaccid tetraparesis and ataxia Left hemidystonia. Left hemiplegia Dysarthria Right body sensory disturbance Left athetoid movement
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