BİR MULTİFOKAL DİSTONİ OLGUSU | Arastirmax - Scientific Publication Index
BİR MULTİFOKAL DİSTONİ OLGUSU
A PATIENT WITH MULTIFOCAL DYSTONIA
Aim: Diagnosed with multifocal dystonia, the subjects without trauma, exposure to toxic sub¬stances, metabolic diseases or the history of chronic drug use were aimed to be discussed in light of literature. Case Report: A 62- year-old man was recruited to our clinic with the complaints of the pain on the right half of the neck, tenderness, contractions on both hands, more definite on the right. In his history, it was determined that the pain on the right half of the neck had been present for two years and the complaint of contraction on the right hand had just started after the right neck pain, and that contraction on the left hand had existed for one year. On his physical examination,a mass which could palpably be felt, in size of 1x1 cm, of neatly framed and tender was observed on the right half of the neck. On the neurologic examination, dystonia existed on both hands, more marked on the right, and tonus had increased on both upper extremities in the nature of rigidity. On the cervical MRI, definite protrusion on C5-6, left paramedian protrusion on C5-6, C6-7 and cord impression on C5-6 were present. Conclusion: What makes our case remarkable is timely correla¬tion between pain on right half of neck and beginning of dystonia on right upper extremity. Chronic pain could lead to movement disorder in the form of dystonia by disinhibitation of the silent spinal cord central pattern generator by causing hyperexitability of spinal interneurons.
Amaç: Travma, toksik maddeye maruziyet, metabolik hastalık ya da kronik ilaç kullanım öyküsü olmayan multifokal distonili hastanın literatür ışığında tartışılması amaçlandı. Olgu Sunumu: Altmış iki yaşında erkek hasta boynun sağ yarısında ağrı, hassasiyet, sağda belirgin her iki elde kasılma şikayetleri ile servisimize yatırıldı. Öyküde boynun sağ yarısındaki ağrının iki yıldır mevcut olduğu ve bu ağrının hemen ardından sağ elde kasılma şikayetinin başladığı, bir yıldır da sol elde kasılma şikayetinin mevcut olduğu tespit edildi. Genel fizik muayenede boynun sağ yarısında dokunmakla hassas 1x1 cm ebadında düzgün sınırlı ele gelen kitle gözlendi. Nörolojik muayenede sağda daha belirgin her iki elde distoni mevcuttu, tonus her iki üst ekstremitede rjidite şeklinde artmıştı. Servikal MRG'de C5-6'da belirgin C5-6, C6-7'de sol paramedial protrüzyon, C5-6 seviyesinde kord basısı mev¬cuttu. Sonuç: Olgumuzu asıl ilgi çekici kılan boyun sağ yarısındaki ağrı ve sağ üst ekstremitedeki dis-toninin ortaya çıkışı arasındaki zamansal korelasyondur. Kronik ağrı, spinal internöronların hiperek-sitabilitesine neden olarak sessiz durumdaki spinal kordun santral pattern jeneratörünün disinhibis-yonu ile distoni şeklinde hareket bozukluğuna yol açabilir.
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