ArticleOxford medical case reports2025
Focal dystonia attributed to secondary Nigrostriatal pathway disruption following brainstem Hemorrhage: a case report.
Article in Oxford medical case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundFocal dystonia is an uncommon movement disorder that may emerge secondary to structural brain lesions. This report presents a rare case of delayed-onset, levodopa-responsive hemidystonia following a brainstem hemorrhage with suspected disruption of the nigrostriatal pathway. CASE REPORT: A 58-year-old man developed sustained dystonic posturing of the left upper and lower limbs one year after suffering a right-sided pontine-midbrain hemorrhage. MRI demonstrated hypointensities in the right substantia nigra and red nucleus, consistent with hemosiderin deposition. Levodopa was initiated at 300 mg/day and titrated to 600 mg/day over 4 weeks, resulting in marked symptomatic improvement. No craniofacial dystonia or parkinsonism was observed. DISCUSSION: Delayed-onset dystonia can arise from secondary degeneration or iron deposition within the nigrostriatal system. This case highlights the importance of advanced imaging and therapeutic trial of dopaminergic agents in post-lesional dystonia. Literature review indicates similar pathophysiological mechanisms in post-stroke dystonia, although levodopa-responsiveness is rarely reported.
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