Concussion-Induced Oromandibular Dyskinesia

We present a rare case of concussion-induced chronic oromandibular dyskinesia. The patient is a 51-year-old Caucasian male with complex medical history (including a history of multiple concussions) who presented to the emergency department for suicidal and paranoid ideation. At the time of the visit, the patient was noted to be exhibiting an oromandibular dyskinesia in the form of "teeth-chattering." The first documented episode of his oromandibular dyskinesia dates back to a medical visit in December 2017. During this visit, the patient presented with teeth-chattering and tremors in his legs, hands, and head after a concussive event. Similar symptoms were noted by two different providers during two unrelated appointments one month later in January 2018. These symptoms were not mentioned in his records for four years and three months following the initial onset. They were noted again during an outpatient encounter for insomnia. During these four years, he was treated for a variety of conditions in both inpatient and outpatient settings, including gout, human immunodeficiency virus (HIV), stage four lymphoma, insomnia, and hepatitis C. Curiously, the dyskinesia symptoms reappeared several months after the completion of six cycles of etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin hydrochloride (R-EPOCH) chemotherapy in May 2021. Since reappearing, the symptoms have been worsening and significantly impacting the patient's quality of life. Although concussion-induced dyskinesia has been previously described in the literature, this is to our knowledge the first described case of concussion-induced oromandibular dyskinesia.