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23 - Dystonia
- from Section 1 - Differential Diagnosis of Abnormal Symptoms and Signs
- Edited by Alan B. Ettinger, Albert Einstein College of Medicine, New York, Deborah M. Weisbrot, State University of New York, Stony Brook
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- Book:
- Neurologic Differential Diagnosis
- Published online:
- 05 June 2014
- Print publication:
- 17 April 2014, pp 158-163
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Contributors
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- By Lenard A. Adler, Pinky Agarwal, Rehan Ahmed, Jagga Rao Alluri, Fawaz Al-Mufti, Samuel Alperin, Michael Amoashiy, Michael Andary, David J. Anschel, Padmaja Aradhya, Vandana Aspen, Esther Baldinger, Jee Bang, George D. Baquis, John J. Barry, Jason J. S. Barton, Julius Bazan, Amanda R. Bedford, Marlene Behrmann, Lourdes Bello-Espinosa, Ajay Berdia, Alan R. Berger, Mark Beyer, Don C. Bienfang, Kevin M. Biglan, Thomas M. Boes, Paul W. Brazis, Jonathan L. Brisman, Jeffrey A. Brown, Scott E. Brown, Ryan R. Byrne, Rina Caprarella, Casey A. Chamberlain, Wan-Tsu W. Chang, Grace M. Charles, Jasvinder Chawla, David Clark, Todd J. Cohen, Joe Colombo, Howard Crystal, Vladimir Dadashev, Sarita B. Dave, Jean Robert Desrouleaux, Richard L. Doty, Robert Duarte, Jeffrey S. Durmer, Christyn M. Edmundson, Eric R. Eggenberger, Steven Ender, Noam Epstein, Alberto J. Espay, Alan B. Ettinger, Niloofar (Nelly) Faghani, Amtul Farheen, Edward Firouztale, Rod Foroozan, Anne L. Foundas, David Elliot Friedman, Deborah I. Friedman, Steven J. Frucht, Oded Gerber, Tal Gilboa, Martin Gizzi, Teneille G. Gofton, Louis J. Goodrich, Malcolm H. Gottesman, Varda Gross-Tsur, Deepak Grover, David A. Gudis, John J. Halperin, Maxim D. Hammer, Andrew R. Harrison, L. Anne Hayman, Galen V. Henderson, Steven Herskovitz, Caitlin Hoffman, Laryssa A. Huryn, Andres M. Kanner, Gary P. Kaplan, Bashar Katirji, Kenneth R. Kaufman, Annie Killoran, Nina Kirz, Gad E. Klein, Danielle G. Koby, Christopher P. Kogut, W. Curt LaFrance, Patrick J.M. Lavin, Susan W. Law, James L. Levenson, Richard B. Lipton, Glenn Lopate, Daniel J. Luciano, Reema Maindiratta, Robert M. Mallery, Georgios Manousakis, Alan Mazurek, Luis J. Mejico, Dragana Micic, Ali Mokhtarzadeh, Walter J. Molofsky, Heather E. Moss, Mark L. Moster, Manpreet Multani, Siddhartha Nadkarni, George C. Newman, Rolla Nuoman, Paul A. Nyquist, Gaia Donata Oggioni, Odi Oguh, Denis Ostrovskiy, Kristina Y. Pao, Juwen Park, Anastas F. Pass, Victoria S. Pelak, Jeffrey Peterson, John Pile-Spellman, Misha L. Pless, Gregory M. Pontone, Aparna M. Prabhu, Michael T. Pulley, Philip Ragone, Prajwal Rajappa, Venkat Ramani, Sindhu Ramchandren, Ritesh A. Ramdhani, Ramses Ribot, Heidi D. Riney, Diana Rojas-Soto, Michael Ronthal, Daniel M. Rosenbaum, David B. Rosenfield, Durga Roy, Michael J. Ruckenstein, Max C. Rudansky, Eva Sahay, Friedhelm Sandbrink, Jade S. Schiffman, Angela Scicutella, Maroun T. Semaan, Robert C. Sergott, Aashit K. Shah, David M. Shaw, Amit M. Shelat, Claire A. Sheldon, Anant M. Shenoy, Yelizaveta Sher, Jessica A. Shields, Tanya Simuni, Rajpaul Singh, Eric E. Smouha, David Solomon, Mehri Songhorian, Steven A. Sparr, Egilius L. H. Spierings, Eve G. Spratt, Beth Stein, S.H. Subramony, Rosa Ana Tang, Cara Tannenbaum, Hakan Tekeli, Amanda J. Thompson, Michael J. Thorpy, Matthew J. Thurtell, Pedro J. Torrico, Ira M. Turner, Scott Uretsky, Ruth H. Walker, Deborah M. Weisbrot, Michael A. Williams, Jacques Winter, Randall J. Wright, Jay Elliot Yasen, Shicong Ye, G. Bryan Young, Huiying Yu, Ryan J. Zehnder
- Edited by Alan B. Ettinger, Albert Einstein College of Medicine, New York, Deborah M. Weisbrot, State University of New York, Stony Brook
-
- Book:
- Neurologic Differential Diagnosis
- Published online:
- 05 June 2014
- Print publication:
- 17 April 2014, pp xi-xx
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Chapter 27 - Movement disorders emergencies
- from Section V - Systemic complications of movement disorders
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- By Ritesh A. Ramdhani, Movement Disorders Division, Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA, Steven J. Frucht, Movement Disorders Division, Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA
- Edited by Werner Poewe, Joseph Jankovic, Baylor College of Medicine, Texas
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- Book:
- Movement Disorders in Neurologic and Systemic Disease
- Published online:
- 05 April 2014
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- 20 February 2014, pp 419-441
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Summary
Introduction
A movement disorder emergency is defined as any movement disorder that evolves or clinically worsens over hours to days. It can occur with hypokinetic as well as hyperkinetic conditions. The systemic and neurological sequelae can originate from the inherent disease process, excessive movements, or a combination of both. Failure to recognize and efficiently manage these patients carries a significant risk of morbidity and mortality.
We review the six major categories of movement disorder emergencies: parkinsonism, dystonia, chorea, myoclonus, tics, and emergencies associated with deep brain stimulation.
Acute parkinsonism
Acute parkinsonism, or non-neurodegenerative parkinsonism, develops suddenly over hours to days. Unlike idiopathic Parkinson’s disease (PD), symptoms are usually symmetric, with prominent bradykinesia and rigidity. Dopamine-blocking medications are the most common precipitants. Consideration of rarer etiologies such as toxins and chemotherapy, structural lesions, and rapid dystonia-parkinsonism, viral encephalitis, and neuroleptic malignant syndrome is predicated in the clinical context (Table 27.1).
Drug-induced parkinsonism
Drug-induced parkinsonism (DIP) is commonly caused by medications that affect dopamine efficacy either by blocking its receptors or depleting its stores (i.e. neuroleptics, antiemetics). As many as 60 percent of patients develop symptoms within one month of initiating these medications, and 90 percent by the third month (Quinn 1995). Its incidence increases with age and it tends to have a bimodal distribution, with an initial peak in adolescence and a second peak after the sixth decade (Susatia and Fernandez 2009). Women are twice as likely as men to be affected, and the risk of developing it correlates with the potency of the drug (Ayd 1961).