Early onset dystonia following traumatic brain injury

Dystonia, a movement disorder resulting from dysfunction of the basal ganglia and thalamus, has not been described during the acute post-traumatic period after severe traumatic brain injury. We reported three patients who developed early onset dystonia after sustaining severe closed head injuries. The first patient went on to complete resolution of the dystonia; the second patient improved and had minimal residual dystonia that did not limit function; and the third patient became frankly agitated at which time the dystonic features became difficult to track. In contrast, delayed onset dystonia after traumatic brain injury has been reported to be relatively persistent. All of our patients also presented with autonomic instability. Because injuries that cause damage to the basal ganglia and thalamus may also affect the nearby hypothalamus, both dystonic posturing and autonomic instability may result.