Spastic torticollis

Introduction Spasmodic torticollis is a localized dystonia involving the neck region, manifested as a paroxysmal involuntary contraction of the neck muscles, causing the head to twist to one side or tilt. It is an extrapyramidal dyskinesia and is an independent organic disease. However, mental factors such as anxiety and reactive depression play a certain role in adjusting the symptoms of the disease. Emotional impulses are even a factor in the accelerated development of the disease. Clinical diagnosis and treatment should be distinguished by careful clinical observation and electromyography.

Cause

(1) Genetic factors: Partial adult dystonia localized seizures are genetically determined. Significant advances have been made in the genetic studies of systemic dystonia, and advances have been made in genetic studies that affect the lower limit of dystonia. In some families, cervical dystonia is seen in about 10% of first- and second-degree relatives, with evidence of autosomal dominant inheritance with reduced penetrance. A study of a family of three patients with spastic torticollis found that the onset of a family was associated with chromosome 18P. The latter two families lack the involvement of the DYT1 locus. This indicates that there are genetic abnormalities in the pathogenesis of cervical muscle dystonia.

(2) Trauma: Trauma has been considered to be the cause of spastic torticollis. It is reported in the literature that 9%-16% of patients have a history of head or neck trauma, usually occurring weeks to months before onset.

(3) Abnormal vestibular function: It has been reported that vestibular-ocular reflex reactivity or asymmetry in patients with spastic torticollis cannot be corrected after treatment with botulinum toxin. Vestibular abnormalities are not primary abnormalities, and other types of localized dystonia (eg, writing sputum, sputum) can also be associated with spastic torticollis. Deafness, dizziness, and ataxia are not characteristic of a spasmodic torticollis. At the same time, many patients have no vestibular reflex abnormalities, and spastic torticollis causes long-term head posture abnormalities.

(4) Others: Short-term or long-term neck vibration stimulation found that there is a significant difference in the head position of the patient. This is due to the change in the sensory stimulation of the surrounding body, which causes the central control of the head and neck to compensate for the twisting and mediating function. The central integration function of nerve impulses is impeded.

an examination

Related inspection

EMG electroencephalography

Check the body

There is a paralysis of the neck muscles, especially the synergistic muscles (a group of muscles that cause a "slanted neck" together). Through the patient's repeated torticollis action, the range of affected muscles and the type of the torticollis can be initially determined. We divide the torticollis into a rotary type, a flexion type, a back type, a side type and a hybrid type.

2. Auxiliary inspection

Electromyography shows the major and minor muscles. CT can show the affected muscles and hypertrophy. Individual patients have abnormal brain CT. In most patients, the organs were functioning normally, and no pathological changes associated with the torticollis were found.

Differential diagnosis

Rickety torticollis

There are pathogenic mental factors, sudden onset, changes in head and neck activity, no regularity, after the suggestion, symptoms can be relieved with emotional stability.

2. Secondary neurological torticollis

Cervical tumors, injuries, osteoarthritis, cervical tuberculosis, etc. can cause this disease. Cervical disc herniation, occipital neuritis, etc., due to stimulation of the neck nerves and muscles, leading to a tonic-necked neck. One-sided semicircular canal caused by irritating torticollis, congenital eye muscle balance disorder caused by ocular torticollis, congenital cervical deformity caused by skeletal torticollis, congenital sternocleidomastoid contracture and cerebellar fourth ventricle tumor The torticollis caused by the early stage has no clonic as an identification, and further examination of the cause of the disease is needed.

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