Objective: To describe, for the first time, a patient who developed cervical dystonia with signs and symptoms of a Wallenberg syndrome.

Background: Secondary cervical dystonia is uncommon and it has been suggested that related structural lesions more commonly involve cerebellum, brainstem and cervical spinal cord than basal ganglia or thalamus in this condition. To date, there is only one report of cervical dystonia associated to lateral medullary infarction.

Methods: This 62 year-old male abruptly developed nausea, vomiting and vertigo along with slurred speech, dysphagia, postural instability and incoordination of the left upper and lower limbs. Neurological examination revealed dysarthria, left facial palsy, left Horner’s syndrome, failure of palatal elevation on the left side and left upper and lower limb dysmetria. He displayed abnormal neck posture with a shift to the left and a tilt to the right that was not presented before the onset of the symptoms that prompted the consultation. There was a mild multidireccional torsional nystagmus. Eye movements were otherwise normal with no skew deviation or cyclotorsion of the eyes. There was no history of neuroleptic treatment or family history of dystonia.

Results: Diffusion-weighted imaging and T2-weighted images showed a left lateral medullary infarct with no cerebellar involvement. MR-angiography revealed an absence of flow in the posterior inferior cerebellar artery with no other significant vascular stenosis. Twenty four hour-Holter and echocardiogram did not reveal any abnormalities. Prophylactic treatment with aspirin 300mg a day was started. The patient displayed significant improvement of his symptoms over the following weeks, including resolution of the cervical dystonia.

Conclusions: To our knowledge, this is the first report of cervical dystonia following a lateral medullary infarction associated with signs and symptoms of a Wallenberg syndrome. Cervical dystonia should be differentiated from the head tilt that occurs as part of the ocular tilt reaction triad often seen after medullary infarction, which also includes a skew deviation and cyclotorsion of the eyes. One could argue that disruption of olivocerebellar circuits may play a role in the development of cervical dystonia in these patients.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/cervical-dystonia-associated-to-wallenberg-syndrome/