MRI FINDINGS IN CERVICAL DYSTONIA

Drake D. Duane, M.D.

Arizona Dystonia Institute/Arizona State University

Scottsdale/Tempe, Arizona

MRI abnormalities in cervical dystonia seem uncommon and their relationship with the disorder unclear (Molhol and Factor. Movement Disorders. 1991;6:274-275). Retrospectively, of 212 cervical dystonia (CD) patients evaluated per protocol between 1/88 and 1/92, 59 had head MRI studies. Abnormalities judged by at least two evaluators as beyond expectancy for age occurred in 28 (47%). The 21 F/10 M with normal imaging were younger, had shorter duration of symptoms before study and lower frequency of hypertension than the 19F/9M with abnormalities (Mean 45Y Range (21-71) versus 54Y (26-78); 4.lY (.5-33) versus 8.2Y (.5-31); 19% versus 29%).

The two groups were compared as to: chin direction; CD type; multichannel EMG pattern (38 patients); extranuchal dystonic sites; neuro and cognitive exam; mood; eye color; history of perinatal stress, migraine, trauma, CNS infection or endocrinopathy; serologic autoimmune/endocrine studies; response to Botox treatment; family history movement disorder.

Abnormalities were: two with large left basal ganglia infarcts; 20 with white matter (WM) hyperintensity--isolated left hemisphere 13, isolated right hemisphere two (commonly internal capsule, mid- or frontal centrum), right pontomedullary junction one; two empty sella (neither solitary findings); one marked generalized ventricular dilatation; four asymmetric ventricular dilatation; six age-inappropriate cortical atrophy--one asymmetric; one isolated Arnold Chiari type 1. MRI abnormality increased the likelihood of chin right, extranuchal dystonic site, asymmetric neuro exam, lack of improvement with Botox treatment.

3F/2M had solitary focal WM T2 lesions found both < three years from onset and before age 50. Of these five patients: four had dark eyes, history of trauma and isolated CD; two elevated autoimmune antibody titres; none a family hx of movement disorder. These findings suggest further heterogeneity in the etiology, factors which may influence the expression and/or treatment response of focal dystonia.

Poster presentation, October 18, 1992, American Neurological Association Pro-conference Symposia on Etiology, Pathogenesis and Prevention of Parkinson Disease and Hyporkinetic Movement Disorders, Sponsored by the Movement Disorder Society, Toronto, Ontario, Canada.

Duane DD. MRI findings in cervical dystonia. Movement Disorders, Vll: 300, 1992.

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