The Clinical Course of a Drug-induced Acute Dystonic Reaction in the Emergency Room

Massimo Marano,Vincenzo Di Lazzaro,Gaetano Salomone,Lazzaro Di Biase,Alessandro Di Santo,Annalisa Montiroli

doi:10.5334/tohm.330

Abstract

The Clinical Course of a Drug-induced Acute Dystonic Reaction in the Emergency Room

Highlights

A 23-year-old female with no personal or family history of movement disorders presented to the emergency department complaining of lower facial muscle tightness and mild difficulties in breathing due to a referred sensation of ‘‘swollen neck and tongue.’’ Multiple consultations were performed based on suspicion of anaphylaxis and temporomandibular joint pathology, both of which were excluded by a clinical ear, nose, and throat examination
Psychogenic movement disorders were initially considered due to the outbreak of anxiety, mild grimace, and blepharospasm reported as ‘‘uncontrolled smiling,’’ but this hypothesis was excluded based on the natural clinical progression of painful involuntary facial twitching with forced jaw opening and deviation, torticollis, and carpal spasm with thumb adduction (Video 1)
The reported intake of a dopamine-receptor-blocking-agent, negative family history, and the absence of any other associated neurological sign supported the diagnosis of drug-induced movement disorder (DIMD; i.e., metoclopramide-induced acute dystonia) involving the cranial and neck areas with spread to the upper extremities.[1,3,4]

Summary

Introduction

Psychogenic movement disorders were initially considered due to the outbreak of anxiety, mild grimace, and blepharospasm reported as ‘‘uncontrolled smiling,’’ but this hypothesis was excluded based on the natural clinical progression of painful involuntary facial twitching with forced jaw opening and deviation, torticollis, and carpal spasm with thumb adduction (Video 1).

Results

Conclusion