Abstract
Introduction: Status Dystonicus (SD) is a life-threatening rare movement disorder characterized by episodes of frequent or continuous severe generalized dystonic spasms. It’s considered a underdiagnosed entity and it treatment remains a challenge. Case report: A 44-years old woman was admitted with a 6-hour history of loss of consciousness and generalized stiffness. She had a previous hospitalization 7 months ago due a stroke in the left MCA site. At neurological examination, she was in GCS 10, with generalized dystonia affecting neck and the four limbs and global hyperreflexia, with no clonus. A MRI showed hyperintense lesions in T2, FLAIR and DWI sequences compatible with acute ischemic stroke affecting cortex and white matter in both frontal lobes, right parietal and temporal lobes, and bilateral striatal nuclei involvement. On arteriography, intracranial stenosis of the right carotid bifurcation was observed. Also, there was a previous pencil-like occlusion of the left internal carotid and a partial filling of left A2 site by anterior communicating artery. She evolved with significant improvement of SD after sedation with Midazolam. Levodopa-Benzerazide and Baclofen were added and intermittent midazolam dosege mantained for 3 days. After 7 days from ictus, dystonia began to improve, followed by normalization of creatine kinase levels. Discussion: Post-stroke dystonia is the second most frequent movement disorder related with ischemia and rarely are presented as generalized dystonia. The main lesion site is Lenticular Nucleus, especially Putamen. There is no agreement in literature about specific SD first line therapy, however, Levodopa-Benzerazide, Baclofen and Midazolan can be used.Figure: hyperintense lesions in FLAIR and DWI sequences compatible with acute ischemic stroke, affecting cortex and white matter in both frontal lobes, right insula, parietal and temporal lobes. Also, there is a bilateral striatal nuclei involvement, notably on the right side.
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