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Orthostatic paroxysmal dystonia
Kapil D Sethi1, Ki Hyeong Lee, Vasanti Deuskar
1Department of Neurology, Medical College of Georgia, Augusta, Georgia 30912, USA. ksethi@neuro.mcg.edu
Insights
A man experienced unexplained jerky movements when standing up, linked to severe carotid artery blockages. This new condition, orthostatic paroxysmal dystonia, may stem from reduced brain blood flow.
Area of Science:
- Neurology
- Vascular Neurology
- Movement Disorders
Background:
- Cerebrovascular disease can manifest in various neurological symptoms.
- Understanding the link between vascular issues and movement disorders is crucial for diagnosis.
Observation:
- A 52-year-old male presented with a 3-year history of paroxysmal hemidystonia.
- Symptoms were consistently triggered by assuming an upright posture after sitting or lying down.
Findings:
- Magnetic Resonance Angiography revealed contralateral internal carotid artery occlusion and near-total ipsilateral internal carotid artery occlusion.
- Subtraction single-proton emission computed tomography indicated reduced contralateral frontoparietal cortex perfusion during dystonic episodes.
- The authors propose the term "orthostatic paroxysmal dystonia" for this clinical presentation.
Implications:
- This case highlights a potential new syndrome linking severe internal carotid artery disease to orthostatic-induced dystonia.
- Further research is warranted to explore the pathophysiology and prevalence of orthostatic paroxysmal dystonia.
- Recognition of this condition can aid in the diagnosis and management of patients with unexplained movement disorders and vascular risk factors.
Abstract:
A 52-year-old man with a history of cerebrovascular disease presented with a 3-year history of paroxysmal hemidystonia precipitated by assuming an upright position after sitting or lying down. MRA showed occlusion of the contralateral internal carotid artery (ICA) and near-total occlusion of the ipsilateral ICA. Subtraction single proton emission computed tomography demonstrated decreased perfusion in the contralateral frontoparietal cortex during the typical dystonic spell. We have coined the term "orthostatic paroxysmal dystonia" for this phenomenon.