Cervical dystonia — SCE Neurology MCQ

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ModerateMovement DisordersCervical dystoniaSCE Neurology

A 48-year-old man presented with painful involuntary neck turning with hypertrophy of sternocleidomastoid. On examination, there was a sensory trick reducing the posture when touching the chin. Initial investigations showed: MRI cervical spine was normal. What is the most likely diagnosis?

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Correct answer: C — Cervical dystonia

Cervical dystonia is the best answer because the vignette describes Cervical dystonia: focal patterned neck posturing with geste antagoniste indicates cervical dystonia. Tardive dyskinesia is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Levodopa-induced dyskinesia and Hemifacial spasm are less appropriate because they would require different localisation, timing or test findings; Functional tremor would fit a different syndrome. Clinical pearl: spastic torticollis from myelopathy would have long-tract signs.

Reference: NICE NG71; Movement Disorder Society consensus criteria