A 62-year-old man with diabetes and hypertension with history of left putaminal hemorrhage and right hemiparesis 1.5 years ago presented to our movement disorders clinic with progressive dystonia and spasticity of the right upper and lower limbs for 8 months. The patient noticed that whenever he tried to hold a pen or a spoon with his right hand mainly using the thumb and index finger, he had involuntary opening of his mouth, which subsided on resting the hand. This was described as a jaw-opening oromandibular dystonia (OMD) overflowing from the hand dystonia. Chewing movements made by the patient led to the exacerbation of dystonia in the right hand (Video). Magnetic resonance imaging revealed slitlike encephalomalacic focus with hemosiderin deposition in left basal ganglia denoting sequelae of hemorrhage (Figure). The patient was treated with oral antidystonia treatment with trihexyphenydyl, clonazepam, and baclofen and later with botulinum toxin for the hand dystonia and showed some improvement in symptoms.
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Corresponding Author: Atanu Biswas, MBBS, MD (Medicine), DM (Neurology), Movement Disorders Clinic, Department of Neurology, Institute of Post Graduate Medical Education & Research (IPGME&R) and Bangur Institute of Neurosciences, 52/1A, SN Pandit Street, Bhowanipur, Kolkata, West Bengal 700025, India (firstname.lastname@example.org).
Published Online: March 6, 2023. doi:10.1001/jamaneurol.2023.0058
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:
It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.
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