Spasmodic Torticollis

Estimated prevalence of 9 cases per 100,000.

ST, also known as cervical dystonia, is the most common form of focal dystonia.

Peak incidence is in the fifth decade.

Two times more common in females.

80% of cases are sporadic or primary.

20% of cases are secondary to an underlying brain lesion or trauma.

Dysphagia

Aspiration

Consider comorbid neurologic problems such as seizures, cranial nerve palsies, hemiplegia, and so forth.

Difficult pt positioning secondary to sustained muscle contractions

Difficult intubation as a result of poor extension of the cervical spine and diminished mouth opening

ST is defined as twisting of the neck caused by involuntary muscle contractions.

Idiopathic ST is a slowly progressive disease that manifests between the third and fifth decades. Idiopathic ST is likely caused by abn of the basal ganglia circuitry.

Dystonia typically progresses over 3–5 y before it plateaus.

Pain occurs in 75% of pts and contributes to disease disability.

If ST occurs acutely, it is necessary to rule out causes related to trauma, medications (metoclopramide, haldol, phenothiazines), intracranial abnormalities (tumors, AVMs, hemorrhages), and neck pathology (retropharyngeal abscess).

The sternocleidomastoid and trapezius muscles are most commonly involved, but extracervical dystonia may occur in 20% of pts.

Jerking of the head and head tremors are common features.

Head positioning determines the type of torticollis:

• Rotational torticollis: Rotation of the head around the long axis of the neck.

• Anterocollis: Head tilts forward with neck flexion.

• Retrocollis: Head tilts backward with neck extension.

• Laterocollis: Head tilts to one side with the ear pulled toward the shoulder.