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  • Focal dystonia
  • Dystonia
  • Spasmodic torticollis
  • Anterocollis
  • Retrocollois
  • Laterocollis

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  • 333.83 Spasmodic torticollis

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  • G24.3 Spasmodic torticollis

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Description

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  • Dystonia is a condition that is characterized by involuntary intermittent or prolonged muscular contractions, such as twisting or repetitive movements, which may cause abnormal postures and movements
  • Dystonia may be generalized or focal
  • Cervical dystonia (CD) is the most common focal dystonia
  • Cervical dystonia is commonly referred to as spasmodic torticollis, which may be misleading
    • Spasmodic describes movements that are intermittent or clonic and tremulous, though some patients with CD present with prolonged contractions
    • Torticollis implies rotary impairment, though patients with CD often present with combined postures associated with flexion, extension, and side-bending
  • Further classification may be based upon head position or movement2

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Essentials of Diagnosis

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  • Traditional classification is based upon etiology
    • Primary (idiopathic)
    • Secondary (of known cause)
  • Current classification describes each person based upon the following characteristics
    • Age of onset
    • Distribution of symptoms

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General Considerations

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Demographics

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Signs and Symptoms

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  • Common to patients with primary and secondary CD
    • Pain
    • Enlargement of the neck muscles
    • Shoulder elevation on affected side
    • Ipsilateral head tilt and contralateral head rotation
    • Head tremor or spasmotic jerking
    • Tremors of the arm
    • Possible difficulty swallowing
  • Unique to patients with post-traumatic CD
    • Marked limitation in range of motion
    • Lack of improvement after sleep
    • Lack of Geste antagoniste, also known as sensory tricks, are physical positioning, such as touching the chin, which have been shown to temporarily reduce dystonia5

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Functional Implications

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  • Postural control abnormalities
  • Greater reliance on vision for maintaining postural stability1
  • Reduced ability to perform activities of daily living involving head or neck movements
  • Difficulty sleeping
  • Reduced psychosocial functioning

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Possible Contributing Causes

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  • Primary cervical dystonia
    • Idiopathic cause
  • Secondary cervical dystonia
    • Drugs
      • Neuroleptics
      • Dopamine agonists
      • Anticonvulsants
      • Antimalarial drugs
    • Environmental toxins
      • Manganese
      • Carbon monoxide
      • Methanol
    • CNS lesions
      • Intramedullary lesions of the cervical cord
      • Focal brain lesions, such as vascular malformation, tumor, ...

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