Tarsy D
Department of Neurology, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts 02215, USA.
Mov Disord. 1998 May;13(3):481-5. doi: 10.1002/mds.870130318.
Head, neck, or shoulder trauma is an occasional antecedent event before the appearance of cervical dystonia. A clinically distinctive syndrome of acute-onset posttraumatic cervical dystonia characterized by markedly restricted range of neck motion, absence of phasic involuntary movements, and poor response to treatment has previously been described. Patients with cervical dystonia attending a movement disorder clinic were reviewed for history of trauma before onset of symptoms. Patients with symptom onset within 4 weeks of trauma were compared with patients who developed symptoms between 3 months and 1 year after trauma. Acute-onset cervical dystonia was characterized by markedly reduced cervical mobility; prominent shoulder elevation with trapezius hypertrophy in most patients, absence of involuntary movements, sensory tricks, or activation maneuvers; and poor response to botulinum toxin injection. By contrast, delayed-onset cervical dystonia was clinically indistinguishable from nontraumatic idiopathic cervical dystonia. Acute-onset posttraumatic cervical dystonia is similar to limb dystonia after peripheral trauma and may represent a form of nondystonic muscle spasm similar to torticollis associated with musculoskeletal injuries of the cervical spine and craniocervical junction.
头部、颈部或肩部创伤是颈部肌张力障碍出现之前偶尔发生的先行事件。此前曾描述过一种临床上独特的急性创伤后颈部肌张力障碍综合征，其特征为颈部活动范围明显受限、无阶段性不自主运动且对治疗反应不佳。对在运动障碍诊所就诊的颈部肌张力障碍患者进行了症状出现前创伤史的回顾。将创伤后4周内出现症状的患者与创伤后3个月至1年出现症状的患者进行了比较。急性起病的颈部肌张力障碍的特征为颈部活动度明显降低；大多数患者斜方肌肥大导致肩部明显抬高，无不自主运动、感觉技巧或激发动作；对肉毒毒素注射反应不佳。相比之下，迟发性颈部肌张力障碍在临床上与非创伤性特发性颈部肌张力障碍无法区分。急性创伤后颈部肌张力障碍类似于外周创伤后的肢体肌张力障碍，可能代表一种非肌张力障碍性肌肉痉挛形式，类似于与颈椎和颅颈交界区肌肉骨骼损伤相关的斜颈。
