Summary
Definition
History and exam
Key diagnostic factors
- torção ou desvio involuntário do pescoço
- dor cervical
- presença de truque sensorial
- postura anormal da cabeça
- restante do exame neurológico normal
Other diagnostic factors
- tremor da cabeça
- início insidioso
- cefaleia
- hipertrofia assimétrica dos músculos do pescoço
- amplitude de movimentos (ADM) normal do pescoço (no início da evolução)
Risk factors
- sexo feminino
- meia idade (40 a 59 anos)
- ascendência branca
- história familiar de torcicolo adquirido
- exposição a medicamentos bloqueadores da dopamina
- história de trauma
Diagnostic investigations
1st investigations to order
- diagnóstico clínico
Investigations to consider
- radiografias cervicais
- TC ou RNM cranioencefálica
- TC ou RNM do pescoço
- gene DYT-1
- ceruloplasmina sérica, excreção urinária de cobre
- eletromiografia
Treatment algorithm
indolor ou sem comprometimento funcional
com comprometimento funcional, dor ou diminuição da qualidade de vida
refratário à terapia com toxina botulínica
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 programme.
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.
References
Key articles
Stacy M. Epidemiology, clinical presentation, and diagnosis of cervical dystonia. Neurol Clin. 2008 May;26(suppl 1):23-42. Abstract
Singer C, Velickovic M. Cervical dystonia: etiology and pathophysiology. Neurol Clin. 2008 May;26(suppl 1):9-22. Abstract
Colosimo C, Suppa A, Fabbrini G, et al. Craniocervical dystonia: clinical and pathophysiological features. Eur J Neurol. 2010 Jul;17(suppl 1):15-21. Abstract
Rodrigues FB, Duarte GS, Marques RE, et al. Botulinum toxin type A therapy for cervical dystonia. Cochrane Database Syst Rev. 2020 Nov 12;11:CD003633.Full text Abstract
Dashtipour K, Lew M. Cervical dystonia. In: Stacy MA, ed. Handbook of dystonia. New York, NY: Informa Healthcare; 2007:137-53.
Jankovic J, Leder S, Warner D, et al. Cervical dystonia: clinical findings and associated movement disorders. Neurology. 1991 Jul;41(7):1088-91. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Artrite da coluna cervical
- Massa cervical
- Massa, lesão ou infarto cerebral
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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