Cervical dystonia

A man in his 40s was sent to a neurology outpatient clinic for pain in his head and upper limbs that had been present for three years and were made worse by bending forward and while walking. His medical history included fibromyalgia, anxiety, dyslipidemia, gastro-oesophageal reflux disease, and persistent back pain. The patient said these motions began suddenly after a work-related incident where he struck his neck against the bus's steering wheel. His brain and spine were thoroughly MRI to rule out any structural issues. However, his discomfort and stance worsened, forcing him to leave his job as a bus driver.The patient displayed isolated multifocal dystonia during testing, restricted head rotation, and modest chin jerks toward his right shoulder. He intermittently displayed aberrant hand posture with both hands while moving his neck and walking. When the patient lightly stroked the front of his neck, he observed an improvement in his neck posture and stride. The examiner was able to demonstrate the motions' distractibility as well as the sensory trick’s inconsistent behaviour. The patient received education, reassurance, and referrals for physical therapy and a neuropsychological evaluation.1