Summary
Definition
History and exam
Key diagnostic factors
- involuntary twisting or deviation of the neck
- neck pain
- presence of sensory trick
- abnormal head posture
- otherwise normal neurologic exam
Other diagnostic factors
- head tremor
- insidious onset
- headache
- asymmetrical hypertrophy of neck muscles
- normal range of motion (ROM) of neck (early in course)
Risk factors
- female sex
- middle age (40 to 59 years)
- white ancestry
- family history of acquired torticollis
- exposure to dopamine-blocking drugs
- history of trauma
Diagnostic investigations
1st investigations to order
- clinical diagnosis
Investigations to consider
- cervical x-rays
- CT or MRI of the brain
- CT or MRI of the neck
- DYT-1 gene
- serum ceruloplasmin, urinary copper excretion
- electromyography
Treatment algorithm
without pain or functional impairment
with functional impairment or pain or diminished quality of life
refractory to therapy with botulinum toxin
Contributors
Authors
David B. Sommer, MD, MPH
Neurologist and Movement Disorder Specialist
Reliant Medical Group
Worcester
MA
Disclosures
DBS declares that he has no competing interests.
Acknowledgements
Dr David B. Sommer would like to gratefully acknowledge Dr Mark A. Stacy, a previous contributor to this topic.
Disclosures
MAS has received speaking honoraria and consulting fees from Allergan, the manufacturer of Botox; he has received research grant support from Ipsen, manufacturer of Dysport, and Merz, manufacturer of Xeomin; he is an author of a reference cited in this topic. Duke University has received funding from Allergan for a continuing medical education program.
Peer reviewers
Allison Brashear, MD
Professor and Chair
Department of Neurology
Wake Forest University Baptist Medical Center
Winston Salem
NC
Disclosures
AB declares interests in Allergan; she is an author of a reference cited in this topic.
Robert Werner, MD
Professor
Chief of PM&R
Ann Arbor VA Medical Center
Ann Arbor
MI
Disclosures
RW declares that he has no competing interests.
Differentials
- Arthritis of cervical spine
- Neck mass
- Cerebral mass, lesion or infarct
More DifferentialsGuidelines
- Practice guideline update summary: botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache
- EFNS guidelines on diagnosis and treatment of primary dystonias
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