A 36-year-old Caucasian male presents to your office complaining of periodic involuntary deviation of the head to the right, accompanied by muscle pain in his neck. The spells start spontaneously, last 30-40 minutes, and can sometimes be suppressed by placing a hand on the chin. This patient's condition can be best characterized as which of the following?

Question

A 36-year-old Caucasian male presents to your office complaining of periodic involuntary deviation of the head to the right, accompanied by muscle pain in his neck.  The spells start spontaneously, last 30-40 minutes, and can sometimes be suppressed by placing a hand on the chin.  This patient's condition can be best characterized as which of the following?

Quizplus · Accepted Answer

Dystonia is a neurological movement disorder characterized by sustained, involuntary muscle contractions, which force certain parts of the body into abnormal, sometimes painful, movements or postures. These movements may affect a single muscle, a group of muscles, or the entire body. Dystonias may occur without any obvious cause (idiopathic). Focal dystonias involve one muscle or a muscle group. Cervical dystonia, also called spasmodic torticollis, is the most common of the focal dystonias. Blepharospasm is the second most common focal dystonia. It is an involuntary, forcible closure of the eyelids. The initial symptom is often uncontrollable blinking. Later, blepharospasm may cause complete closure of the eyelids. Another common type of focal dystonia is a writer's cramp, which affects the muscles of the hand. (Choice A) Myoclonus is a sudden, brief, sometimes severe (shock-like) muscle contraction. Examples of physiologic myoclonus are hiccups and hypnic jerks (occur when falling asleep). Pathological myoclonus is seen in epilepsy and Creutzfeldt-Jakob disease. (Choice B) On passive extension/flexion of a Parkinsonian limb, the examiner will feel intermittent resistance. This "ratchet-like" resistance to movement is called cogwheel rigidity. (Choice C) Bradykinesia means slow movement. It is also commonly seen in Parkinson disease. (Choice D) Chorea is involuntary muscle activity that "flows" from one muscle group to another. Movements may appear fragmented or jerky, and the patient may display a "dancing" gait (Greek, chorea = dance). Chorea is a feature of Huntington disease. (Choice F) Hemiballism refers to flinging of the limbs (arm and/or leg) on one side of the body. Hemiballism occurs due to contralateral injury in or near the subthalamic nucleus. Educational Objective: Dystonia is a syndrome of prolonged, repetitive muscle contractions. This condition may be the result of impaired function of the basal ganglia. Cervical dystonia (spasmodic torticollis), blepharospasm, and writer's cramp are the most common types of focal dystonia.

A 36-Year-Old Caucasian Male Presents to Your Office Complaining of Periodic