Secondary cervical dystonia associated with structural lesions of the central nervous system

Abstract

We tested the hypothesis that structural lesions of the central nervous system (CNS) associated with cervical dystonia more commonly involve the cerebellum and its primary afferent pathways than basal ganglia structures. Cervical dystonia is the most common focal dystonia, the majority of cases are idiopathic, and only a small percentage of patients have a family history of dystonia or other movement disorders. Pathophysiological mechanisms operative in solely or predominantly appendicular dystonias such as writer's cramp and Oppenheim's dystonia, respectively, may not be directly applicable to axial dystonias. The localization of structural lesions of the CNS associated with secondary cervical dystonia may provide some insight into the neural structures potentially involved in primary cervical dystonia. The National Library of Medicine Gateway (from 1960) and a clinical database maintained by the senior author (from 1999) were searched for cases of secondary cervical dystonia associated with structural lesions of the CNS. Search terms included one or more of the following: dystonia, torticollis, cervical, secondary, and symptomatic. Lesion localization and type, patient age, patient gender, head position, occurrence of sensory tricks, and associated neurological findings were tabulated for each case. Structural lesions associated with cervical dystonia were most commonly localized to the brainstem and cerebellum. The remaining cases were equally divided between the cervical spinal cord and basal ganglia. Although inconsistent, head rotation tended to be contralateral to lesion localization. Additional neurological abnormalities were present in the majority of patients with secondary cervical dystonia. The relative paucity of basal ganglia pathology and concentration of lesions in the brainstem, cerebellum, and cervical spinal cord in patients with secondary cervical dystonia suggests that dysfunction of cerebellar afferent pathways may be important to the pathophysiology of primary cervical dystonia.

Spontaneous dyskinesia and familial liability to schizophrenia

“…For example, lesions involving the caudate nucleus, putamen, globus pallidus, subthalamic nucleus, thalamus, and cerebellum have been associated with particular spontaneous dyskinesias in several studies using a variety of methodological techniques (e.g., Antonini et al, 1998;Dooling & Adams, 1975;Kim et al, 2002;Krystkowiak et al, 2000;Krystkowiak et al, 1998;LeDoux & Brady, 2003;Lehericy et al, 1996;Lenz et al, 2002;Lozza et al, 2002;Naumann et al, 1996;Perlmutter et al, 1997). Moreover, an array of structural and functional abnormalities have been observed in several of these regions in individuals with schizophrenia, although substantial variation in findings exists (e.g., Danos et al, 2002;Gunduz et al, 2002;Jernigan et al, 1991;Keshavan et al, 1998;Lang et al, 2001;Marcelis et al, 2003;McCreadie et al, 2002;Menon et al, 2001;Muller et al, 2002;Sigmundsson et al, 2001;Staal et al, 2000;Staal et al, 2001;Young et al, 2000).…”

Dissecting the Links Between Cerebellum and Dystonia

“…In a review of 25 secondary cervical dystonia cases, the most common causes were cerebellar lesions, whereas basal ganglia lesions accounted only for about a quarter of the cases [23]. Posterior fossa tumors are a common causative factor for cervical dystonia [5].…”

Cervical dystonia caused by focal putaminal ischemia

“…Causes differ widely from tardive dystonia secondary to neuroleptic treatment7 to vascular etiologies as stroke8, 9 or subdural hematoma 10. Neoplasms are a known source of secondary dystonia as well: reported cases focused on tumors in children,4, 11, 12, 13, 14, 15 whereas only four cases in adults have been described yet4, 12, 14, 16 (for a complete overview of all identified causes for secondary dystonia see 17). …”