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Acute dystonic reaction — SCE Acute Medicine MCQ

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ModerateAcute Neurological PresentationsAcute dystonic reactionSCE Acute Medicine

A 22-year-old man is assessed on the acute medical unit. He develops painful neck spasm and upward eye deviation after receiving metoclopramide for migraine. Consciousness and observations are normal. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most likely diagnosis?

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Correct answer: D — Acute dystonic reaction

Acute dystonic reaction is the best answer because oculogyric crisis and torticollis after dopamine antagonist exposure indicate an acute dystonic reaction. Posterior circulation stroke is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Treat with anticholinergic medication and avoid the culprit drug.

Reference: https://cks.nice.org.uk/#acute-medicine-order-38-1