1
|
Zhang Z, Xu C, Wen G, Dong M, Shen X, Gong B, Sun B, Qi M, Tian Y, Liu Y, Yuan W. Postoperative hematoma in cervical spondylosis patient complicated with Huntington's disease: Case report and literature review. SAGE Open Med Case Rep 2023; 11:2050313X221147191. [PMID: 36643711 PMCID: PMC9834929 DOI: 10.1177/2050313x221147191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 12/07/2022] [Indexed: 01/12/2023] Open
Abstract
Hematoma is a life-threatening complication of anterior surgery in cervical spondylosis patients. Herein, we report a cervical spondylosis patient complicated with Huntington's disease, who developed unexpected neck hematoma after anterior cervical discectomy and fusion (ACDF) surgical treatment. During the debridement, we found no noticeable vessel lesions and concluded that the occurrence of postoperative hematoma might be due to the drainage displacement caused by excessive uncontrolled movements of the neck after the operation. The patient recovered well, and further literature review suggests that chorea secondary to Huntington's disease likely increases mechanical stress on the cervical spine, indicating an internal relationship between degenerative cervical spondylosis and Huntington's disease. Cervical spondylotic patients complicated with Huntington's disease can be treated with surgical intervention but need to be immobilized and under close observation.
Collapse
Affiliation(s)
- Zifan Zhang
- Spine Center, Department of
Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai,
China
| | - Chen Xu
- Spine Center, Department of
Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai,
China
| | - Guoqing Wen
- Spine Center, Department of
Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai,
China
| | - Minjie Dong
- Spine Center, Department of
Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai,
China
| | - Xiaolong Shen
- Spine Center, Department of
Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai,
China
| | - Baofeng Gong
- Department of Neurology, Shanghai
Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Baifeng Sun
- Spine Center, Department of
Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai,
China
| | - Min Qi
- Spine Center, Department of
Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai,
China
| | - Ye Tian
- Spine Center, Department of
Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai,
China
| | - Yang Liu
- Spine Center, Department of
Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai,
China
| | - Wen Yuan
- Spine Center, Department of
Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai,
China,Wen Yuan, Spine Center, Department of
Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415th
Fengyang Road, Shanghai 200003, China.
| |
Collapse
|
2
|
van de Zande NA, Massey TH, McLauchlan D, Pryce Roberts A, Zutt R, Wardle M, Payne GC, Clenaghan C, Tijssen MAJ, Rosser AE, Peall KJ. Clinical characterization of dystonia in adult patients with Huntington's disease. Eur J Neurol 2017; 24:1140-1147. [PMID: 28661018 DOI: 10.1111/ene.13349] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 05/22/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Huntington's disease (HD) is an autosomal dominant, neurodegenerative movement disorder, typically characterized by chorea. Dystonia is also recognized as part of the HD motor phenotype, although little work detailing its prevalence, distribution, severity and impact on functional capacity has been published to date. METHODS Patients (>18 years of age) were recruited from the Cardiff (UK) HD clinic, each undergoing a standardized videotaped clinical examination and series of functional assessment questionnaires (Unified Huntington's Disease Rating Scale, Burke-Fahn-Marsden Dystonia Rating Scale and modified version of the Toronto Western Spasmodic Torticollis Rating Scale). The presence and severity of dystonia were scored by four independent neurologists using the Burke-Fahn-Marsden Dystonia Rating Scale and Unified Huntington's Disease Rating Scale. Statistical analysis included Fisher's exact test, Wilcoxon test, anova and calculation of correlation coefficients where appropriate. RESULTS Forty-eight patients [91% (48/53)] demonstrated evidence of dystonia, with the highest prevalence in the left upper limb (n = 44, 83%), right upper limb most severely affected and eyes least affected. Statistically significant positive correlations (P < 0.05) were observed between dystonia severity and increasing HD disease stage and motor disease duration. Deterioration in functional capacity also correlated with increasing dystonia severity. No significant relationship was observed with age at motor symptom onset or CAG repeat length. CONCLUSIONS We report a high prevalence of dystonia in adult patients with HD, with worsening dystonia severity with increasing HD disease stage and motor disease duration. The recognition and management of dystonic symptoms in routine clinical practice will aid overall symptomatic treatment and functional improvement.
Collapse
Affiliation(s)
- N A van de Zande
- Huntington's Disease Research Group, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff, UK
- Faculty of Medical Science, University of Groningen, Groningen, The Netherlands
| | - T H Massey
- Huntington's Disease Research Group, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff, UK
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff, UK
| | - D McLauchlan
- Huntington's Disease Research Group, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff, UK
| | - A Pryce Roberts
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff, UK
| | - R Zutt
- Department of Neurology, University Medical Centre of Groningen, Groningen, The Netherlands
| | - M Wardle
- Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff
- Wales Brain Repair and Intracranial Neurotherapeutics Unit (BRAIN), Cardiff University, Cardiff
| | - G C Payne
- Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff
| | - C Clenaghan
- Huntington's Disease Research Group, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff, UK
| | - M A J Tijssen
- Department of Neurology, University Medical Centre of Groningen, Groningen, The Netherlands
| | - A E Rosser
- Huntington's Disease Research Group, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff, UK
- Wales Brain Repair and Intracranial Neurotherapeutics Unit (BRAIN), Cardiff University, Cardiff
- Cardiff University Brain Repair Group, School of Biosciences, Cardiff, UK
| | - K J Peall
- Huntington's Disease Research Group, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff, UK
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff, UK
- Wales Brain Repair and Intracranial Neurotherapeutics Unit (BRAIN), Cardiff University, Cardiff
| |
Collapse
|
3
|
Andriuta D, Tir M, Godefroy O, Krystkowiak P. Huntington's Disease Revealed by Familial Cervical Dystonia. Mov Disord Clin Pract 2016; 3:415-416. [DOI: 10.1002/mdc3.12311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/23/2015] [Accepted: 11/08/2015] [Indexed: 01/31/2023] Open
Affiliation(s)
- Daniela Andriuta
- Department of Neurology; Amiens University Hospital; Amiens France
| | - Mélissa Tir
- Department of Neurology; Amiens University Hospital; Amiens France
| | - Olivier Godefroy
- Department of Neurology; Amiens University Hospital; Amiens France
| | | |
Collapse
|
4
|
Jiang L, O'Leary C, Kim HA, Parish CL, Massalas J, Waddington JL, Ehrlich ME, Schütz G, Gantois I, Lawrence AJ, Drago J. Motor and behavioral phenotype in conditional mutants with targeted ablation of cortical D1 dopamine receptor-expressing cells. Neurobiol Dis 2015; 76:137-158. [PMID: 25684539 DOI: 10.1016/j.nbd.2015.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 01/14/2015] [Accepted: 02/05/2015] [Indexed: 10/24/2022] Open
Abstract
D1-dopamine receptors (Drd1a) are highly expressed in the deep layers of the cerebral cortex and the striatum. A number of human diseases such as Huntington disease and schizophrenia are known to have cortical pathology involving dopamine receptor expressing neurons. To illuminate their functional role, we exploited a Cre/Lox molecular paradigm to generate Emx-1(tox) MUT mice, a transgenic line in which cortical Drd1a-expressing pyramidal neurons were selectively ablated. Emx-1(tox) MUT mice displayed prominent forelimb dystonia, hyperkinesia, ataxia on rotarod testing, heightened anxiety-like behavior, and age-dependent abnormalities in a test of social interaction. The latter occurred in the context of normal working memory on testing in the Y-maze and for novel object recognition. Some motor and behavioral abnormalities in Emx-1(tox) MUT mice overlapped with those in CamKIIα(tox) MUT transgenic mice, a line in which both striatal and cortical Drd1a-expressing cells were ablated. Although Emx-1(tox) MUT mice had normal striatal anatomy, both Emx-1(tox) MUT and CamKIIα(tox) MUT mice displayed selective neuronal loss in cortical layers V and VI. This study shows that loss of cortical Drd1a-expressing cells is sufficient to produce deficits in multiple motor and behavioral domains, independent of striatal mechanisms. Primary cortical changes in the D1 dopamine receptor compartment are therefore likely to model a number of core clinical features in disorders such as Huntington disease and schizophrenia.
Collapse
Affiliation(s)
- Luning Jiang
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia; St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Claire O'Leary
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia; Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Hyun Ah Kim
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Clare L Parish
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Jim Massalas
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - John L Waddington
- Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Michelle E Ehrlich
- Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA
| | - Günter Schütz
- Deutsches Krebsforschungszentrum, Heidelberg, Germany
| | - Ilse Gantois
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Andrew J Lawrence
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - John Drago
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia; St Vincent's Hospital, Melbourne, Victoria, Australia.
| |
Collapse
|
5
|
Revuelta GJ, Testa C, Greene JG. Writer's cramp: A potential early feature of Huntington's disease. Mov Disord 2010; 25:785-6. [DOI: 10.1002/mds.22883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
6
|
Abstract
Spinocerebellar ataxias are heterogeneous disorders with overlapping clinical features. Spinocerebellar ataxia-6 is a dominantly inherited condition characterized by relatively pure ataxia with a paucity of other manifestations including extrapyramidal findings. We report on two patients with genetically proven SCA-6 who had dystonia. One patient presented initially with dystonia, which remained the most disabling problem. Dystonia may occur in SCA-6 and can be disabling.
Collapse
Affiliation(s)
- Kapil D Sethi
- Medical College of Georgia, Augusta, Georgia 30912, USA.
| | | |
Collapse
|
7
|
Abstract
Parkinsonism and dystonia may coexist in a number of neurodegenerative, genetic, toxic, and metabolic disorders and as a result of structural lesions in the basal ganglia. Parkinson's disease (PD) and the 'Parkinson-plus' syndromes (PPS) account for the majority of patients with the parkinsonism-dystonia combination. Dystonia, particularly when it involves the foot, may be the presenting sign of PD or PPS and these disorders should be suspected when adults present with isolated foot dystonia. Young age, female gender, and long disease duration are risk factors for PD-related dystonia, but dystonia in patients with PD is usually related to levodopa therapy. The mechanism of dystonia in PD is not well understood and the management is often challenging because levodopa and other dopaminergic agents may either improve or worsen dystonia. Other therapeutic strategies include oral medications (baclofen, anticholinergics and benzodiazepines), local injections of botulinum toxin, intrathecal baclofen, and surgical lesions or high frequency stimulation of the thalamus, globus pallidus, or subthalamus.
Collapse
Affiliation(s)
- J Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA.
| | | |
Collapse
|
8
|
Reply. Mov Disord 2001. [DOI: 10.1002/mds.1130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
9
|
Németh AH, Mills KR, Elston JS, Williams A, Dunne E, Hyman NM. Do the same genes predispose to Gilles de la Tourette syndrome and dystonia? Report of a new family and review of the literature. Mov Disord 1999; 14:826-31. [PMID: 10495045 DOI: 10.1002/1531-8257(199909)14:5<826::aid-mds1016>3.0.co;2-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Gilles de la Tourette syndrome (TS) and idiopathic focal torsion dystonia are both movement disorders in which the pathologic process is thought to arise within the basal ganglia. However, despite their possible functional links, they are clinically distinct and are generally considered to have different underlying etiologies. There are several reports in the literature that suggest a relationship between eye winking tics, excessive blinking, and blepharospasm and a report of the coexistence of tics and dystonia. We describe a three-generation family in which TS and dystonias cosegregate. In total, eight patients were affected, five with dystonia and three with TS/facial tics. One of the patients with historic evidence of dystonia subsequently died of motor neuron disease. The identification of this family further strengthens the evidence in favor of an etiologic relationship between some cases of Gilles de la Tourette syndrome and focal dystonia.
Collapse
Affiliation(s)
- A H Németh
- Wellcome Trust Centre for Human Genetics, and Radcliffe Infirmary, Headington, Oxford, England
| | | | | | | | | | | |
Collapse
|
10
|
Abstract
BACKGROUND The prevalence and clinical characteristics of dystonia in Huntington's disease (HD) have not been formally assessed. OBJECTIVES To study (1) the prevalence of dystonia in HD in a clinic population, (2) the clinical features of dystonia, and (3) clinical correlates of dystonia (for example, age, disease duration). METHODS Patients with HD attending the HD Center at the New York State Psychiatric Center were administered the Unified HD Rating Scale and underwent a standardized 5.5-minute videotaped examination. Two neurologists reviewed the videotaped examination and rated the severity and constancy of dystonia, calculating a total dystonia score for each patient. RESULTS Prevalence of dystonia of any severity was 95.2%. Twenty-four of 42 (57.1%) had dystonia in at least one body region that was moderate and present more than half of the time, and seven of 42 (16.7%) had dystonia that was severe and constant. The most prevalent types of dystonia were internal shoulder rotation (64.3%), sustained fist clenching (47.1%), excessive knee flexion (42.9%), and foot inversion (42.9%). In 37 of 42 (88.1%) patients, there were more than two types of dystonia, and in the average patient, three to four types of dystonia. The mean severity was between 1 (mild) and 2 (moderate), and the mean constancy was between 2 (present less than half of the time) and 3 (present more than half of the time). Multivariate linear regression revealed that disease duration (p = 0.0005) and taking an antidopaminergic agent (p = 0.03) were positively associated with the total dystonia score. CONCLUSIONS The majority of patients in this HD clinic exhibited some dystonia. The dystonia was present in several body regions and manifested by a variety of movements and postures not typical of idiopathic torsion dystonia. The dystonia was not bothersome to most patients, and its severity was a function of disease duration and use of an antidopaminergic agent.
Collapse
Affiliation(s)
- E D Louis
- Department of Neurology, the Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | | | | | | |
Collapse
|
11
|
Abstract
Many different disorders have dystonia as the only or primary sign. The list of causes for dystonia increases yearly and now includes three mapped loci for primary torsion dystonia, although other susceptibility genes are suspected. Study of one of these primary torsion dystonia loci (DYT1) has culminated in the cloning of a gene which codes for a novel protein, torsin A. Physiological and positron emission tomography analyses suggest that dystonia results from impaired inhibition at cortical and subcortical levels; these physiological changes may in turn be due to striatal dysfunction and a mismatch or imbalance between the direct and indirect pathways. Future study of normal and mutant torsin A, as well as the identification of other primary torsion dystonia genes, should help elucidate the mechanisms underlying dystonia.
Collapse
Affiliation(s)
- S B Bressman
- Albert Einstein College of Medicine and Beth Israel Medical Center, New York, USA
| |
Collapse
|
12
|
Shan DE, Soong BW, Yeh SI, Cheng CH, Wu ZA. Genetic screening for Huntington's disease in Chinese patients with involuntary movements. Clin Neurol Neurosurg 1997; 99:244-7. [PMID: 9491297 DOI: 10.1016/s0303-8467(97)00102-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The diagnosis of Huntington's disease (HD) can be confirmed by detecting the expanded CAG repeat in the IT15 gene. Besides chorea, patients with HD may present with a variety of bizarre involuntary movements, resulting in confusion in making the diagnosis. Under such conditions, genetic analysis is the final confirmatory test. To determine if any patient with involuntary movements of undetermined etiology might be related to HD, we did genetic analysis on 22 patients and identified three with expanded CAG repeat. We could not obtain family history of HD in these patients due to adoption, early death of parents, or a vague history. All three patients were among the group with generalized chorea, but one had additional marked dystonic posturing. Together with four clinically recognizable HD patients, the relative frequency of HD among the 103 patients with choreiform movements in this hospital is 6.8%.
Collapse
Affiliation(s)
- D E Shan
- Neurological Institute, Veterans General Hospital, Taipei, Taiwan
| | | | | | | | | |
Collapse
|
13
|
Feinstein A. Abnormal movements in a patient with reflex sympathetic dystrophy. Mov Disord 1997; 12:470-1. [PMID: 9159754 DOI: 10.1002/mds.870120338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
|