Status dystonicus: a diagnosis delayed

Abstract

Status dystonicus, also known as the dystonic storm or dystonic crisis, is rare but may prove fatal due to respiratory and bulbar complications. In adults, the condition is rare and possibly under-reported. The lack of awareness of this condition among emergency and acute physicians may lead to an incorrect or delayed diagnosis, which should be avoided. We report a case of a 23-year-old man with athetoid cerebral palsy who presented to a district general hospital with uncontrolled dystonic movements, which were diagnosed as status dystonicus. This was successfully treated with intravenous clonidine, with full recovery returning to baseline functional state.

Keywords: epilepsy and seizures; movement disorders (other than parkinsons).

Figure 1

Axial T2 fluid-attenuated inversion recovery MRI of the patient at the level of the centrum semiovale, showing global brain atrophy, more prominent at the frontoparietal regions, with compensatory hydrocephalus.

Figure 2

Portable electroencephalogram trace of the patient, performed at the intensive care unit showing diffuse low-voltage beta rhythm with well-organised background activity.