Objective: to present a patient who developed delayed secondary cervical dystonia after anterior medullary hemorrhage and ipsilateral cerebellar stroke.

Background: Postroke dystonia is mostly associated with the lesions of the basal ganglia, thalamus, pons and cerebral hemispheres, and extremely rarely with lesions in the cerebellum and brain stem.

Method: Emergency CT findings were consistent with acute medullary hemorrhage as elonged area extending from the lower edge of the pons distally to the right in the area of the medulla oblongata 7x9x20 mm. At admission, CT did not showed ischemic lesion. However, brain CT perforemed after one month revealed an ischemic lesion in the right cerebellar lobe, while the medullar hemorrhage was completely resorbed.

Results: On admission, neurological examination revealed contralateral, left-sided hemiplegia, left-sided nystagmus. After 11 months, the patient experienced sustained, involuntary contraction of the neck musles with abnormal posturing and movements of the head, so the head was rotated to the right and down and coarse back-and-forth dystonic tremor. Therapy with clonazepam 1.5 mg daily and baklofen 15 mg daily had no effect. After the aplication of botulinum toxin, his symptoms improved significantly, although he had residual neurologic sequelae, such as contralateral left-sided hemiplegia.

Conclusion: Although brain stem and/or cerebellar stroke is common, dystonia has been rarely associated with focal cerebellar and medullary lesions. This type of dystonia may be a nonspecific phenomenon of the cerebellar and/or brain stem injury. It can be speculated that the damage od the olivocerebellar pathway could causes abnormal output of Purkinje cells potentially leding to dystonia

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MDS Abstracts - https://www.mdsabstracts.org/abstract/cervical-dystonia-after-cerebellar-stroke-and-medullary-hemorrhage/