Chief Clinical Officer / Medical Director USPhysiatry / PAM Rehab Houston, Texas, United States
Case Diagnosis: Hemidystonia as a Result of Right Pontine Hemorrhagic Stroke
Case Description: Dystonia is a movement disorder characterized by involuntary, repetitive writhing movements. Historically, dystonia is a disorder of the basal ganglia. However, recent studies have reported cases of dystonia associated with brainstem disorders. Although many theories have been proposed, the pathological mechanism of the disorder is uncertain. Furthermore, few effective treatment options have been proposed. This case study reports a case of hemidystonia resulting from acute pontine hemorrhagic stroke successfully treated with pharmacotherapy and intensive inpatient rehabilitation. While the patient progressed in his functionality and mobility during his first admission to inpatient rehab, his condition rapidly declined upon discharge. He presented to our inpatient rehabilitation facility, where baclofen was administered with intensive rehabilitation. Upon discharge, his functionality improved to mostly independent with activities of daily living.
Discussions: Central nervous system lesions are a common cause of secondary hemidystonia. However, most cases of hemidystonia are caused by lesions in the basal ganglia. To our knowledge, the finding of hemidystonia secondary to pontine hemorrhage is unusual. Our patient presented with left-sided weakness and dystonia, supported by pontine hemorrhage noted on CT. In most cases of dystonia, symptoms may progress over a period of months to years. However, our patient experienced the most severe symptoms a few weeks following the stroke. Abnormal movements were more pronounced with movement and less severe at rest- consistent with dystonia.
Conclusions: While no randomized control trials have been executed, this case report indicates that combination of intensive occupational therapy and a GABA-agonist like baclofen may be an appropriate intervention for dystonia of a non-basal ganglia etiology.
