Cervical Dystonia

Aka: Cervical Dystonia

1. Epidemiology
   1. Prevalence: 9 per 100,000
   2. Average Age of onset: 40 years
   3. Gender predominance: Women account for 65% of cases
2. Definition
   1. Movement Disorder
   2. Involuntary neck and Shoulder muscle contractions
   3. Head twists into aberrant position
3. Symptoms
   1. Pain (93%)
   2. Difficult reading, driving, watching television
   3. Withdrawal from social interactions
   4. Abnormal Posture (83%)
   5. Head jerks or neck spasms (62%)
4. Types
   1. Torticollis (neck rotation)
   2. Laterocollis (lateral neck bending)
   3. Retrocollis (neck extension)
   4. Anterocollis (neck flexion)
5. Causes
   1. Primary or idiopathic cervical Torticollis
      1. Hereditary
         1. Autosomal Dominant
         2. X-linked recessive
      2. Sporadic
   2. Secondary or symptomatic cervical Torticollis
      1. Cervical Lymphadenopathy
         1. Streptococcal Pharyngitis
      2. Hereditary neurologic syndromes
      3. Environmental causes
         1. Neck Trauma (e.g. Whiplash)
         2. Medications
         3. Toxins
         4. Perinatal cerebral injury
      4. Parkinsonism
      5. Psychogenic Dystonia
6. Labs
   1. Quick Strep Test
7. Management
   1. Physical Therapy
   2. Botulin Toxin Type-A (local injection)
   3. Systemic Medications
      1. Anticholinergics
      2. Muscle relaxants