Primary craniocervical dystonia presenting as a respiratory emergency

Abstract

The craniocervical region is frequently affected by dystonia. Facial, lingual, masticatory, and laryngeal muscle involvement is reported in >75% of cases with primary focal/segmental dystonia.1 Symptoms in these cases appear gradually, and there is sufficient time for the patients to seek proper medical attention. Acute dystonic reactions are often secondary to dopaminergic receptor antagonism. Acute laryngeal dystonia has been identified as a life-threatening side effect of classic antipsychotics.2 Herein we describe a patient with primary craniocervical dystonia who presented as a respiratory emergency. A previously healthy 52-year-old man was diagnosed with possible mild asthma after mild breathing difficulties of subacute onset. Following this diagnosis, he was prescribed standard antiasthmatic medication with no success and was scheduled for a detailed workup. About 2 months later, while at rest, he suddenly developed extreme difficulty breathing and was rushed to the emergency department where a tracheostomy was performed due to upper airway obstruction. There was no definite …