Segmental dystonia after radical neck dissection and radiotherapy: a case report
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LETTER TO THE EDITOR
Segmental dystonia after radical neck dissection and radiotherapy: a case report Francesca Di Biasio 1
&
Ottavia Baldi 2 & Laura Avanzino 1,3 & Roberta Marchese 1
Received: 19 May 2020 / Accepted: 3 October 2020 # Fondazione Società Italiana di Neurologia 2020
Dear Editor in Chief, Although cervical dystonia (CD) is well known as the most common form of adult onset focal dystonia [1], little is known about the acquired conditions which are still not well determined. Some possible risk factors have been identified in peripheral trauma, head injury, drug side effects, neurological diseases, infections, and several others [2]. Beside these controversial geneses of secondary dystonia, there are also some oncologic treatments as radiotherapy, chemotherapy, and related procedures [3] to account for.
Case report We report the case of a 68-year-old male with a history of segmental dystonia, characterized by neck lateral deviation to the right, dystonic tremor and abnormal twisting movements and postures of the right arm. Clinical examination revealed no other focal neurological signs. Patient’s history started in 2012, when he noted swollen cervical lymph nodes on the right side, interpreted as possible secondary localization of a squamous cell carcinoma of unknown origin. Total body computed tomography examinations demonstrated enlarged lymph nodes in the patient’s neck; however, the primary cancer was not detected over the years. He underwent a fist removal of some lymph nodes, without complications. After several years, in 2016, new lymph nodes appeared in the same * Francesca Di Biasio [email protected] 1
IRCCS Policlinico San Martino, Genoa, Italy
2
Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
3
Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Genoa, Italy
side, leading the patient to undergo a radical neck dissection (RND), a historical standard technique that involves removal of all ipsilateral cervical lymph nodes from levels I through V, as well as other extra nodal structures as spinal accessory nerve and internal jugular vein [4]. After the surgery, the patient was able to lift and abduct his right arm, and his shoulder did not exhibit any drooping. Histological examinations of the resected material demonstrated the presence of metastatic lymph nodes. Postoperative radiation therapy was prescribed. After 3 months, a mild rotation of the head to the right appeared, and a month later dystonic tremor with irregular amplitudes and variable frequencies was visible. The patient tolerated the new neurological condition, taking advance of his unintentional sensory trick, touching the chin, until May 2018, when he developed numbness, and tingling in the right hand. Nerve conduction studies revealed a possible carpal tunnel syndrome, so he underwent surgery without any improvement. Among the sensory symptoms, he also developed a right-hand dystonia, and onl
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