Objective: Report a case of a patient with cervical dystonia after removal of a posterior fossa meningioma.

Background: Secondary dystonia is a large and diverse group of disorders with many causes including cerebrovascular disease¹, arteriovenous malformation², glioma³, cavernous angioma⁴, meningiomas^5-6 and oligodendrogliomas⁸. Many articles have reported the temporal and anatomic relationship between these tumors and the physiopathology of the dystonia, corroborated by the fact that it improves or resolves after the removal of the culprit lesion^9-10. This report describes a patient with meningioma compressing the left cerebellar hemisphere laterally and brainstem who developed a cervical dystonia after the meningioma was resected.

Method: We report a case of a 49-year-old woman who was initially seen in the clinic with new onset of headaches. It was described as a left sided throbbing pain associated with periorbital pressure. It was accompanied by photophobia, phonophobia, nausea and vomiting. She also described occasional loss of balance associated with the headache, which was triggered by changes in her position such as bending forward. The headache frequently woke her up at night. Neurologic examination demonstrated decreased venous pulsation in the fundoscopy bilaterally. MRI of the brain revealed 5.3 x 4.3 x 3.4 cm enhancing extra-axial mass involving the left posterior cranial fossa causing mass effect on the adjacent cerebellum and brainstem, compatible with meningioma. The patient underwent a left suboccipital craniectomy excision of the tumor. In the postoperative stage, she started to complain about weird posture, rigidity, and contraction of the neck toward the right side consistent with cervical dystonia. After treatment with botulinum toxic, she improved clinically and had an uneventful recovery.

Results: It is generally assumed that dystonia occurs due to a network of disorders involving the direct effect of masses affecting the basal ganglia, thalamus and cortex. Our case provides a new facet for the pathophysiological substrate of dystonia consisting of possible overstimulation of the accessory nucleus located in the brainstem by manipulation of the tissue during the procedure, given the symptoms developed after the surgery.

Conclusion: Cervical dystonia is an expected complication seen after removal of tumors located in the posterior fossa.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/cervical-dystonia-after-resection-of-posterior-fossa-meningioma/