Re: Dystonia-Causalgia Syndrome...Q's?

Posted By Cathy on January 01, 1999 at 23:21:36:

In Reply to: Re: Dystonia-Causalgia Syndrome...Q's? posted by CCF Neurology MD - AY on January 01, 1999 at 21:06:32:






: : I read something in an earlier post and am wondering if I could get further information about it.  Dystonia-Causalgia Syndrome.  I did a search and could find nothing on it.  What are the causes, symptoms, treatments, etc...
Thank you for providing a wonderful service.




: Thanks for your question.  The following is a clinical review on the subject
: of dystonia-causalgia (I also included the abstract of the article).  The
: complete article can be found in any good university library:
The causalgia-dystonia syndrome.
: Brain 1993 Aug;116 ( Pt 4):843-51
: Bhatia KP; Bhatt MH; Marsden CD
: University Department of Clinical Neurology, Institute of Neurology, London, UK.
"We report 18 patients (16 women and two men) with causalgia and dystonia, triggered by peripheral injuries in 15 cases and occurring spontaneously in three. The injury
: was often trivial, and did not cause overt peripheral nerve lesions. The mean age at presentation was 28.5 years. None had a family history of dystonia. The leg was
: affected initially in 12 patients, the arm in the remaining six cases. All had burning pain, allodynia and hyperpathia, along with vasomotor, sudomotor and trophic changes.
: All developed dystonic muscle spasms in the affected part. Dystonia always appeared at the same time or after the causalgia. The spasms were typically sustained,
: producing a 'fixed' dystonic posture, in contrast to the mobile spasms characteristics of idiopathic torsion dystonia. There was spread of the causalgia and of the dystonia
: from its initial site both in the affected limb and to other extremities, the latter in hemiplegic, transverse and triplegic distribution. All investigations were normal. All modes of
: conventional treatment failed to relieve either the pain or the dystonia, but two patients recovered spontaneously. At present it is impossible to decide whether this
: distressing syndrome is a true functional disorder of the central nervous system, or is of psychogenic origin. "

: I hope this information is helpful.  Best of luck.
This information is provided for general medical education purposes only.
: Please consult your doctor regarding diagnostic and treatment options.




Thanks for your question.  The diagnosis of psychogenic/"stress-induced" neurological symptoms is always one of EXCLUSION, that is, one eliminates all the reasonable organic/structural/physiological causes before reaching that tentative conclusion.  It is also one diagnosis that is most readily discarded whenever new information is made available to the physician.  As with all symptom evaluation in any area of medicine, the associated symptoms and features of the medical history are greatly helpful in the complete evaluation of each clinical case.  Because each situation is so dependent on each individual patient, one should not compile a "hard list" of so-called "red flags" for a diagnosis of psychogenically-cause symptoms.
I hope this information is helpful.  Happy New Year.