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NEUROLOGY 1994;44:1374
© 1994 American Academy of Neurology

Dystonia after head trauma

M. S. Lee, MD, PhD, J. O. Rinne, MD, PhD, A. Ceballos-Baumann, MD, P. D. Thompson, MD, PhD and C. D. Marsden, FRS, DSc

University Department of Neurology (Drs. Lee, Rinne, Ceballos-Baumann, Thompson, and Marsden), Institute of Neurology, Queen Square, London, UK; the Department of Neurology (Dr. Lee), Yongdong Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea; and the Department of Neurology (Dr. Rinne), University of Turku, Turku, Finland.

Dystonia is a rare consequence of head trauma. We describe 10 such cases and review 19 similar patients reported in the literature. Twenty-two of the 29 patients suffered head injury during the first or second decade of life. There was a variable delay between the head trauma and the onset of dystonia. In 18 cases with severe head injury, this interval (median, 18 months; range, 1 month to 9 years) was longer than in 11 cases with mild head injury (median, 14 days; range, 3 days to 5 years). In our series, nine of the 10 cases started as a focal dystonia and one as a hemidystonia. The dystonia progressed and spread over several months or years. Two cases remained as focal dystonias, but the others developed segmental, hemi-, multifocal, or generalized dystonia. On brain imaging studies (CT or MRI), the most frequent lesion site was in the contralateral basal ganglia or thalamus, but two cases had normal brain scans. Dysfunction of the lenticulothalamic neuronal circuit seems to be related to the development of dystonia following head trauma.

Address correspondence and reprint requests to Dr. CD. Marsden, University Department of Neurology, Institute of Neurology, Queen Square London WC1N 3BG, UK.

Dr. Rinne was supported by grants from the Medical Research Council of the Academy of Finland and from the Finnish Cultural Foundation.

Received November 5, 1993. Accepted in final form February 11, 1994.






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