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BMJ Case Reports 2017; doi:10.1136/bcr-2017-220334
  • Unusual presentation of more common disease/injury
  • CASE REPORT

Progressive delayed hemidystonia following clinically mild traumatic brain injury

  1. Haresh Bharote1
  1. 1Department of Neurology, BYL Nair Charitable Hospital, Mumbai, India
  2. 2Department of Neurology, Topiwala National Medical College, Mumbai, India
  1. Correspondence to Dr Swaleha N Nadaf, ameli786{at}yahoo.com
  • Accepted 28 November 2017
  • Published 28 December 2017

Summary

A 16-year-old boy presented with progressive left hemidystonia over 3 years. The possibilities of symptomatic hemidystonia due to focal lesions such as infarct (vasculitis), tumours, tuberculoma, arteriovenous malformations or heredodegenerative disorders such as Wilson disease were considered. Imaging showed a peculiar scar involving right basifrontal region extending upto anterior, centromedian and dorsomedial nuclei of thalamus due to blowout fracture of roof of orbit. This scar was responsible for progressive left hemidystonia. On probing the history, it was revealed that patient had sustained a mild traumatic brain injury (mTBI) 3 years ago. Burke-Fahn-Marsden dystonia severity rating scale showed improvement from 19 to 6 after treatment with tablet trihexyphenidyl 16 mg and clonazepam 1 mg. A linear scar reaching upto thalamus due to blowout fracture of roof of orbit following clinically mTBI is unique. Delayed, progressive hemidystonia has been reported following severe head injury, however is less common following clinically mTBI.

Footnotes

  • Contributors SNN involved in patient evaluation and examination, planning and preparing a concept, review of literature, acquisition of the data, and preparation of manuscript, analysis and interpretation of data, acted as corresponding author. RTC: patient evaluation and examination, helping prepare a concept, assessment of manuscript, interpreting the data, supervised work, manuscript evaluation, help in editing the manuscript, assessment of all the images and videos, help understanding the learning points. KVK: review of manuscript, manuscript evaluation, supervised work, editing the videos and images, assessing the learning points. HB helped to evaluate and edit the manuscript, assessing the learning points, proofreading.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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