More Severe Presentations
Patients usually only present to EDs with more severe forms of dystonia. Patients may appear agitated, with sweating and tachycardia.
Examples of such acute dystonias include:
Fig.4 Oculogyric crisis
Initial symptoms include:
- Agitation
- Restlessness
- Fatigue
- Fixed stare
This phase is followed by a more extreme and sustained spasm of extra-orbital muscles resulting most commonly in upward deviation of the eyes.
Additionally, the eyes may adduct. Abduction and downward gaze are less common.
Buccolingual crisis
Buccolingual crisis may include:
- Trismus (an inability to open the mouth normally)
- Risus sardonicus a highly-characteristic, abnormal sustained grimace
- Dysarthria (difficulties with articulation and speech)
- Dysphagia (difficulties with swallowing)
- Grimacing
- Tongue protrusion or sensation of the tongue feeling swollen
The image shows risus sardonicus.
Trunk involvement
Fig.5
The image shows acute dystonia involving the trunk (opisthotonus).
Laryngospasm
Fig.6
Laryngospasm presents as stridor, and although rare, is potentially life threatening.
The image shows acute dystonia involving the larynx.
Learning Bite
Dystonias can involve any muscle group but most commonly involve the muscles of the head, neck and trunk. (Evidence Grade 2B)