Dystonia as a Presenting Feature of Acute Ischemic Stroke: A Case Report and Literature Review

Casul, Yoram A. Roman; Humbert, M.; Farooqui, Amreen; Shukla, Aparna Wagle; Nagaraja, Nandakumar

doi:10.7759/cureus.17272

Cited by 3 publications

(2 citation statements)

References 18 publications

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“…Spasticity is defined as velocity-dependent hypertonia and tendon jerk hyperreflexia, resulting from stretch reflex excitability ( 1 , 2 ). In contrast, dystonia involves involuntary muscle contractions, often leading to abnormal posturing and twisting movements ( 3 ). There are different types of dystonia, including focal dystonia such as blepharospasm, oromandibular dystonia, spasmodic dysphonia, torticollis, and writer’s cramp ( 4 , 5 ).…”

Section: Introductionmentioning

confidence: 99%

Case report: Intrathecal baclofen therapy improved gait pattern in a stroke patient with spastic dystonia

Kim,

Lee,

Lee

et al. 2024

Front. Neurol.

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BackgroundIntrathecal baclofen (ITB) therapy, a viable alternative for unsuitable candidates of conventional spasticity medications, is a preferred method of administration over the oral route. Owing to its enhanced bioavailability, ITB ensures a more effective delivery at the target site.ObjectiveThere is a lack of conclusive evidence regarding the use of ITB treatment in managing ambulatory patients with spastic dystonia. Before ITB pump implantation, patients commonly undergo an ITB bolus injection trial to rule out potential adverse reactions and verify the therapeutic effects on hypertonic issues. In this report, we highlight a case of spastic dystonia, particularly focusing on an ambulatory patient who demonstrated significant improvement in both the modified Ashworth scale (MAS) score and gait pattern following the ITB injection trial.Case reportThis case report outlines the medical history of a 67-year-old male diagnosed with left-side hemiplegia and spastic dystonia, resulting from his second episode of intracranial hemorrhage in the right thalamus. An ITB injection trial was initiated because the patient was not suitable for continued botulinum toxin injections and oral medications. This was due to the persistent occurrence of spastic dystonia in both the upper and lower extremities. The patient underwent a four-day ITB injection trial with progressively increasing doses, resulting in improved MAS scores and gait parameters, including cadence, step length, step time, stride length, and stride time were increased. Particularly, kinematic gait analysis demonstrates a substantial improvement of increased knee flexion in the swing phase in stiff knee gait pattern. These findings indicated a gradual reduction in spasticity-related symptoms, signifying the positive effect of the ITB injection trial. The patient eventually received an ITB pump implantation.ConclusionIn this post-stroke patient with spastic dystonia, ITB therapy has demonstrated effective and substantial management of spasticity, along with improvement in gait patterns.

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Section: Introductionmentioning

confidence: 99%

Case report: Intrathecal baclofen therapy improved gait pattern in a stroke patient with spastic dystonia

Kim,

Lee,

Lee

et al. 2024

Front. Neurol.

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“…However, it is also possible that PSMDs are underrecognized 1 . Although previous studies have highlighted the clinical spectrum, phenomenology, and neuroimaging findings of PSMDs, there are many important knowledge gaps and controversies 2‐6 . In this article, we aim to highlight these gaps and to resolve the controversies with the proposal of a tentative roadmap to advance knowledge and optimize the care of these patients.…”

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confidence: 99%

Gaps, Controversies, and Proposed Roadmap for Research in Poststroke Movement Disorders

et al. 2022

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Poststroke movement disorders (PSMDs) are a common cause of secondary movement disorders. Although prior studies have highlighted the clinical spectrum and phenomenology of PSMDs, there are many knowledge gaps worth addressing. Some of the most important include lack of clinical definitions, variable stroke symptom latencies, and lack of biomarkers for vulnerability for or resilience against developing PSMDs. Collectively, the association between stroke localization and phenomenology is less than 30%, and the long‐term clinical prognosis and treatment responses are highly variable. After summarizing the accumulated evidence regarding the phenomenology, pathophysiology, neuroimaging, and treatment of PSMDs, highlighting the many gaps and controversies including diagnostic challenges, we propose a roadmap for future research to fill these gaps and resolve the related controversies. More research is warranted concerning the phenomenology, classification, diagnostic criteria, and pathophysiology of PSMDs. Further, there is an urgent need for treatment guidelines for the management of PSMDs. © 2022 International Parkinson and Movement Disorder Society.

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Truncal dystonia with isolated middle cerebral artery ischemia: A case report of revascularization therapy for dystonia

Matsumoto

Yamamoto

Fujita

et al. 2022

Surgical Neurology International

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Background: Dystonia is a rare movement disorder with some cases being difficult to treat. Although dystonia can occur as a symptom of moyamoya disease, few studies have reported truncal dystonia occurring with middle cerebral artery (MCA) stenosis. Here, we report a case of truncal dystonia with MCA occlusion. Case Description: The patient was a 48-year-old female clerical worker who lived alone. An abnormal cervical posture initially appeared 7 years before (right flexion). Symptoms improved with medication and botulinum toxin injection. Five years before this report, her symptoms worsened, so the dose of oral medication was increased and botulinum treatment was performed, but the symptoms did not improve. The patient showed decreased cerebral blood flow (CBF) in the cortical areas but not in the basal ganglia. We performed superficial temporal artery-MCA bypass surgery because we believed that the dystonia was due to right MCA stenosis. The patient’s symptoms improved immediately after surgery, except for her mild cervical backbend. Seven months after the surgery, the patient’s involuntary movements showed further improvement, and symptoms have not worsened even after 2 years. Conclusion: Revascularization therapy improved CBF and truncal dystonia and could be a viable treatment option for dystonia with ischemia in the MCA region. Extensive cerebral ischemia can result in cortical inhibition loss or over-adapted cerebral plasticity and cause dystonia. Revascularization therapy may be useful for patients with dystonia and decreased CBF in the MCA region.

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Dystonia as a Presenting Feature of Acute Ischemic Stroke: A Case Report and Literature Review

Cited by 3 publications

References 18 publications

Case report: Intrathecal baclofen therapy improved gait pattern in a stroke patient with spastic dystonia

Case report: Intrathecal baclofen therapy improved gait pattern in a stroke patient with spastic dystonia

Gaps, Controversies, and Proposed Roadmap for Research in Poststroke Movement Disorders

Truncal dystonia with isolated middle cerebral artery ischemia: A case report of revascularization therapy for dystonia

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