Involuntary movements in an adolescent: what are the causes?

Area of Science:

• Emergency Medicine
• Clinical Pharmacology
• Neuroscience

Background:

• Involuntary movements present diagnostic challenges in pediatric emergency care.
• Acute dystonia is a potential adverse effect of antipsychotic medications like haloperidol.

Observation:

• A 17-year-old male presented with painful involuntary movements affecting his mouth, lower limbs, and trunk.
• The patient had recently received intravenous haloperidol for acute alcohol intoxication and agitation.
• Concealment of the haloperidol administration complicated the initial diagnosis.

Findings:

• The patient was diagnosed with haloperidol-induced acute dystonia.
• Administration of intravenous biperiden resulted in complete symptom resolution within 15 minutes.

Implications:

• This case underscores the importance of a thorough medication history in diagnosing movement disorders in emergency settings.
• Early recognition and prompt treatment with anticholinergic agents like biperiden are crucial for managing acute dystonia.
• Awareness of haloperidol's potential for inducing dystonia is vital for emergency physicians managing agitated patients.