Dystonia following head trauma: A report of nine patients and review of the literature

Abstract

We report nine patients who developed dystonia following head trauma. The most frequent form was hemidystonia only (six patients). One patient presented with hemidystonia plus torticollis, one with bilateral hemidystonia and one with torticollis only. Seven patients sustained a severe head injury, and two had a mild head injury. At the time of injury, six were younger than 10 years, two were adolescents, and the patient with torticollis only was an adult. Except in the patient with torticollis only, the onset of dystonia varied considerably from months to years. All patients with hemidystonia had posthemiplegic dystonia of delayed onset. Seven out of 8 patients with hemidystonia had lesions involving the contralateral caudate or putamen, as demonstrated by CT and MR. The patient with hemidystonia plus torticollis had no lesion to the basal ganglia, but a contralateral pontomesencephalic lesion. Response to medical treatment was generally poor. Functional stereotactic operations were performed in seven patients. A variety of factors may be responsible for the vascular or nonvascular posttraumatic basal ganglia lesions, which may lead to dystonia. The pathophysiology seems to be more complex than thought previously. We believe that dystonia following head injury is not as rare as is assumed. Awareness of its characteristics and optimized diagnostic procedures will lead to wider recognition of this entity.

Ischemia of the Internal Capsule due to Mild Head Injury in a Child

“…5) [11, 12], and these arteries are functional end arteries. The territory of this branch is thus mechanically vulnerable to ischemia as a result of vascular occlusion or mechanical spasm following arterial disruption, even following mild head injury [1, 3,13,14,15]. In the present case, recurrent episodes of transient but reversible hemiparesis would be consistent with intermittent arterial spasm.…”

A Patients with Hemidystonia and Blepharospasm Following Traumatic Injury

“…Krauss et al reviewed patients with hemidystonia following head trauma, and CT or MRI revealed that all of the patients had contralateral basal ganglia or pontomesencephalic lesions [2]. Secondary blepharospasm is also caused by infarctions in the thalamus [4], striatum [5], and brainstem [6].…”

“…Secondary dystonia is well known subsequent to lesions of the basal ganglia [2], thalamus, or brainstem [3]. Hemidystonia defined as involuntary, sustained posturing of the unilateral arm, leg, and face sometimes occurs following head trauma, with the cause of the contralateral basal ganglia or pontomesencephalic lesions [2].…”

Neurostimulation for traumatic brain injury

“…65,74,134 Posttraumatic dystonia is most commonly found in patients with injuries in the basal ganglia and thalamus. 25,67,75,92 Reduced inhibitory control in basal ganglia-thalamocortical motor loops 4 leading to hyperactivity in frontal motor areas has been suggested to result in dystonia, 23 but the mechanisms of posttraumatic dystonia are complex, as different injury constellations will produce different dystonic symptoms.…”