Spasmodic Torticollis








ICD-10 CODE G24.8



The Clinical Syndrome


Spasmodic torticollis is a rare condition characterized by involuntary movement of the head. It is classified as a focal or segmental dystonia and occurs in approximately 3 in 10,000 people. It begins in early adult life. The three varieties of spasmodic torticollis are as follows:




  • Tonic, which involves involuntary turning of the head to one side



  • Clonic, which involves involuntary shaking of the head



  • Tonic/clonic, which involves both types of involuntary movement



Spasmodic torticollis also can be subclassified based on the specific movement of the head: (1) rotation, which involves the turning of the head to the side; (2) laterocollis, which involves the leaning of the head against the shoulder; (3) retrocollis, which involves the leaning of the head toward the back; and (4) anterocollis, which involves the leaning of the head toward the chest. The disease occurs more commonly in women and often is initially diagnosed as a hysterical reaction or tic.


Thought to be due to dysfunction centrally, rather than a disease of the affected muscles, spasmodic torticollis often begins as a subtle involuntary movement of the head. Early in the disease, the dystonia is often intermittent. As the disease progresses, the symptoms become more severe and harder for the patient to hide. The dystonic movements may become more sustained and associated with constant, aching pain in the affected muscles. The pain often becomes the primary reason for the patient to seek medical attention, with the patient almost indifferent to the dystonic movements. The dystonia often disappears with sleep and becomes less pronounced on first awakening, with the dystonic movements and pain worsening as the day progresses. Spontaneous recovery has been reported, but, overall, treatment is difficult and of limited success.




Signs and Symptoms


A patient with spasmodic torticollis exhibits involuntary, dystonic movements of the head. In extreme cases, the dystonia is continuous and the laterocollis so marked that the patient’s ear rests on the ipsilateral shoulder ( Figs. 22.1 and 22.2 ). Pain may be a predominant feature of the syndrome, and spasms of the cervical paraspinous musculature, the strap muscles of the neck, and the sternocleidomastoid are often present. Hypertrophy of the affected muscles may occur occasionally. Other than the dystonic movements, the neurological examination is normal. As mentioned previously, the patient may seem indifferent to the abnormal head movements or position. Touching the opposite side of the face or chin often causes the dystonia to cease momentarily.




Fig. 22.1


The dystonia of spasmodic torticollis causes significant pain and functional disability.



Fig. 22.2


Anterocollis, Right Laterocaput and Laterocollis

From Le Goff F, Duparc F, Lefaucheur R, et al. Clavicle fracture mimicking dropped-head syndrome in a patient with multiple system atrophy. Parkinsonism Relat Disord . 2017;35:98–99, fig. 1A. ISSN 1353-8020, doi-org.easyaccess2.lib.cuhk.edu.hk/10.1016/j.parkreldis.2016.11.008 . www.sciencedirect.com.easyaccess2.lib.cuhk.edu.hk/science/article/pii/S1353802016304394 .




Signs and Symptoms


A patient with spasmodic torticollis exhibits involuntary, dystonic movements of the head. In extreme cases, the dystonia is continuous and the laterocollis so marked that the patient’s ear rests on the ipsilateral shoulder ( Figs. 22.1 and 22.2 ). Pain may be a predominant feature of the syndrome, and spasms of the cervical paraspinous musculature, the strap muscles of the neck, and the sternocleidomastoid are often present. Hypertrophy of the affected muscles may occur occasionally. Other than the dystonic movements, the neurological examination is normal. As mentioned previously, the patient may seem indifferent to the abnormal head movements or position. Touching the opposite side of the face or chin often causes the dystonia to cease momentarily.


Feb 9, 2020 | Posted by in PAIN MEDICINE | Comments Off on Spasmodic Torticollis
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