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Table 1 Review of brain stem lesions causing secondary cervical dystonia

From: Cervico-shoulder dystonia following lateral medullary infarction: a case report and review of the literature

Case report number First author, year [reference] Age, sex Dystonia features Brain lesion Cause or pathogenesis of lesion Other clinical features noted Onset from diagnosis Treatment for dystonia Cervical dystonia outcome
1 Boisen, 1979 [5] 32 years, F Right rotation Midline between cerebellar tonsils and medullaris Ependymoma None NA NA NA
2 Plant et al., 1989 [6] 30 years, F Left rotation Large lesion: right mesencephalon to lower edge of thalamus
Small lesion: right cerebellar hemisphere
Multiple sclerosis Gait ataxia
Left hemisensory disturbance (pain, temperature)
1 year None Persisted at 1 year
3 Krauss et al., 1992 [7] 4 years, M Right laterocollis
Left rotation
Diffuse lesion: paramedian and lateral pontomesencephalic tegmentum
Diffuse axonal injury Facial palsy
Right hemidystonia
Ipsilateral hemiparesis
Right intention tremor
6 months Thalamotomy Marked improvement
4 Caress et al., 1996 [8] 4 years, M Left rotation Right cerebellum
Right medulla
Right pons
Cervical spinal cord
Cerebellar gangliocytoma Gait ataxia NA Subtotal resection Improvement
5 Krauss et al., 1997 [9] 42 years, M Left laterocollis Left cerebellopontine angle Schwannomas Left progressive hearing loss
Head jerking toward the left
Shrugging of the left shoulder
NA Operation
botulinum toxin
Once mild improved, but with recurrenceand did not improve on any medication but botulinum toxin
6 13 years, F Right rotation Left cerebellopontine angle Schwannomas Cerebellar ataxia
Decreased hand dexterity
Slightly slurred speech
Mild left spinal accessory nerve palsy
NA Shunting procedure for obstructive hydrocephalus Relieved after 1 year
7 52 years, F Left laterocollis
Left rotation
Left cerebellopontine angle Meningioma Head horizontal oscillation toward the left 6 years Botulinum toxin
Cyclobenzaprine primidone
Improved but limited effect
8 LeDoux et al., 2003 [2] 55 years, M Left rotation
Abnormal contraction of right sternocleidomastoid muscle
Right central pons Spontaneous hemorrhage Left hemiparesis
Bilateral abducens palsy
24 hours None 4–6 weeks after hypertrophy of the right sternocleidomastoid muscle
9 42 years, F Left rotation
Right laterocollis
Right shoulder elevation (mild)
Left cerebellopontine angle Arachnoid cyst None At diagnosis Botulinum toxin
Did not improve
10 67 years, F Right laterocollis (severe)
Right shoulder moderate elevation and anterior displacement
Left rotation (mild)
Multiple lesions in pons and caudal midbrain Ischemic infarctions Dysarthria
Impaired conjugate
Mild right hemiparesis
Right hand parkinsonian-type resting tremor
Right arm action tremor
Spastic and ataxic gait
Several days Levodopa/carbidopa
Botulinum toxin
Did not improve with levodopa
Moderately improved by botulinum toxin
11 72 years, M Left rotation
Central pons
Left posterior thalamus
Left occipital lobe
Multiple infarction Right homonymous hemianopsia
Right hemihypesthesia
1 day NA NA because of death
12 Kajimoto et al., 2004 [10] 84 years, F Right laterocollis Left lateral caudal medulla Ischemic infarction Left hemiparesis
Left body sensory disturbance (pain, touch, temperature)
Left paretic sternocleidomastoid muscle
Left decreased deep sensation
Left neck pain
10 days None Gradually improved after several weeks
13 Loher et al., 2009 [11] 31 years, M Right laterocollis
Left rotation
Tegmental and tectal pons
Right mesencephalon
Spontaneous hemorrhage Right sixth and seventh nerve palsies
Left hemidystonia and athetoid movements
Orofacial dystonia
Right head jerky tremor
3 months Propranolol
Did not improve
14 42 years, M Right laterocollis
Left rotation
Left dorsolateral pons
Left middle cerebellar peduncle
Posttraumatic hemorrhage Oculomotor disturbances
Flaccid tetraparesis and ataxia
Left hemidystonia
14 months None Did not improve
15 56 years, M Right laterocollis
Left rotation
Left dorsolateral pons
Left middle cerebellar peduncle
Spontaneous hemorrhage Fifth and seventh nerve palsies
Gaze palsy (upward and horizontal)
Left hemidystonia
1 month None Gradually improved
16 Agrawal et al., 2009 [12] 9 years, F Right laterocollis Left midbrain and pons Cavernous hemangioma hemorrhage Left cerebellar signs At diagnosis Left retromastoid Suboccipital
Significant improvement at 8 months
17 DeBenedictis et al., 2010 [13] 15 months, F Left laterocollis Left brachium pontis
(displacement of pons)
Tumor (low-grade astrocytoma suspected) Left eye tearing
Extreme photophobia
At diagnosis None Resolved in 1 year
18 Our patient 86 years, F Right laterocollis
Left shoulder elevation
Left dorsal lower lateral medulla Ischemic infarction Left hemiplegia
Right body sensory disturbance
Left athetoid movement
A few days None Spontaneous improvement in a few weeks
  1. NA Not available