Table 1 Review of brain stem lesions causing secondary cervical dystonia
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 mid-pons thalamus | 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 Trihexyphenidyl Cyclobenzaprine primidone Amitriptyline Carbamazepine | 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 Dysarthria 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 medication | Did not improve | |
10 | 67 years, F | Right laterocollis (severe) Anterocollis Right shoulder moderate elevation and anterior displacement Left rotation (mild) | Multiple lesions in pons and caudal midbrain | Ischemic infarctions | Dysarthria Hyperreflexia 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 Retrocollis | Central pons Left posterior thalamus Left occipital lobe | Multiple infarction | Right homonymous hemianopsia Anomia 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 l-Tryptophan l-Hydroxytryptophan Trihexyphenidyl | Did not improve |
14 | 42 years, M | Right laterocollis Left rotation | Left dorsolateral pons Left middle cerebellar peduncle | Posttraumatic hemorrhage | Oculomotor disturbances Dysarthria 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 Blepharospasm | 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 craniotomy | 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 Epiphora | 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 Dysarthria Right body sensory disturbance Left athetoid movement | A few days | None | Spontaneous improvement in a few weeks |