Objective: To study the clinical features and neuroimaging findings of patients with post stroke dystonia and dystonic tremor.

Background: Post stroke dystonia is a known entity but dystonic tremor has rarely being described following stroke.

Method: It was a prospective study performed at our tertiary care center. The clinical details and imaging characteristics of patients with post stroke dystonia were noted and further analyzed.Patients were further classified into two groups: dystonia (without tremor) and dystonic tremor (DT) (dystonia with tremor in dystonic body segment).

Results: We evaluated 65 patients of post stroke dystonia of which 21 (32.31%) patients had DT whereas 44 (67.69%) patients had dystonia without tremor. The distribution of dystonia in patients having dystonia without tremor in the descending order was hemidystonia in 17 (38.64%), focal dystonia in 16 (36.36%), segmental dystonia in 9 (20.45%) and multifocal in 2 (4.55%) patients, whereas DT group had hemidystonia in 13 (61.90%) patients, focal dystonia in 7 (33.33%) and generalized dystonia in one (4.76%) patient. Overall, ischemic lesions were seen in 48 (73.85%) patients and hemorrhagic lesions were seen in 17 (26.15%) patients. In the dystonia without tremor group, there were 36 (81.82%) patients with ischemic lesions and 8 (18.18%) patients with hemorrhagic lesions. In the DT group, 12 (57.14%) patients had ischemic lesions and 9 (42.86%) patients had hemorrhagic lesions. Only 2 (11.76%) patients of hemidystonia without tremor had hemorrhagic lesions whereas 7 (53.84%) patients of hemidystonia with tremor had hemorrhagic lesions (P value = 0.012). Thalamic lesions were seen in 4 (9%) patients of hemidystonia without tremor and 7 (33.33%) patients of hemidystonia with tremor (P value = 0.037).

Conclusion: In our post stroke dystonia cohort, 32.31% (21/65) had dystonic tremor. Overall ischemic lesions were more common in patients of dystonia without tremor than patients of dystonic tremor. Hemorrhagic lesions were more frequent in patients of hemidystonia with tremor than hemidystonia without tremor (P value = 0.012). Patients of hemidystonia with tremor had more of thalamic involvement when compared to patients of hemidystonia without tremor (P value = 0.037). Thus, we conclude that dystonic tremor is an important phenomenology of post stroke movement disorders and is not rare, as described in the previous studies.1, 2

References: 1) Alarcón F, Zijlmans JC, Dueñas G, Cevallos N. Post-stroke movement disorders: report of 56 patients. J Neurol Neurosurg Psychiatry. 2004;75(11):1568-74. 2) Gupta N, Pandey S: Post-Thalamic Stroke Movement Disorders: A Systematic Review. Eur Neurol 2018;79:303-314. doi: 10.1159/000490070

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MDS Abstracts - https://www.mdsabstracts.org/abstract/post-stroke-dystonia-and-dystonic-tremor-clinical-features-and-neuroimaging-findings/