Cervical Dystonia Caused by Chronic Nonunion C2 Fracture: A Case Report.
Shangming Zhang, Jamie Sibel, Majid Dadgar-Kiani and 3 others
PMID 33543096WHAT IT FOUND
A man with neck twisting and swallowing difficulty had an undiagnosed cervical fracture.
Botulinum toxin improved symptoms temporarily, but surgery to fuse the spine resolved the dystonia, pain, and dysphagia completely. This case suggests ruling out structural causes before assuming idiopathic dystonia.
Key findings
01Cervical spine imaging revealed a chronic C2 nonunion fracture with cord compression, which was the underlying cause of the patient's cervical dystonia and dysphagia, rather than the previously assumed herpes encephalitis or idiopathic origin.
02Surgical fusion of the spine led to complete resolution of dysphagia, neck pain, and headache, and restoration of weight loss, with no recurrence of dystonia one year later.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for SLPs
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What it does not show
This is a single case report, so the findings cannot be generalized to all patients with cervical dystonia. The initial history omitted a fall, delaying the identification of the fracture, which underscores the importance of thorough history-taking but does not prove imaging is always necessary. The authors suggest routine cervical imaging for all CD patients based on this single case, which may not be supported by broader evidence.
Declared interests
The authors state that a written informed consent was obtained from the patient for publication. No funding sources or conflicts of interest are explicitly declared in the provided text.
The easy way to misread this
Do not conclude that all patients with cervical dystonia require surgery or routine cervical imaging. This patient had a specific, rare structural cause (chronic fracture) that resolved with fusion. Most cases of cervical dystonia are idiopathic or secondary to other neurological conditions and are managed with botulinum toxin or other therapies without surgical intervention.