Dystonic storm is a neurologic emergency that usually requires management within the intensive care unit..
Dystonia is an involuntary muscle contraction or spasm that may be prolonged and cause abnormal movements and postures.
Features of a dystonic storm:
(1) generalized dystonia (not limited to a specific muscle group or body region)
(2) extreme and forceful muscle contractions
(3) continuous and prolonged
where:
• The pattern might be described as a "status dystonia."
Complications:
(1) fever
(2) pain
(3) rhabdomyolysis with myoglobinuria
(4) exhaustion
(5) renal failure (associated with the myoglobinuria)
(6) dehydration
(7) hypoxemia
The storm may occur spontaneously or it may be precipitated by:
(1) trauma or surgery
(2) infection
(3) fever
(4) drug withdrawal
Management may include intrathecal baclofen or fentanyl. Intractable dystonia may require stereotactic thalamotomy or pallidotomy.
