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Academia Mexicana de Neurología, A.C.

2006, Number 5

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Rev Mex Neuroci 2006; 7 (5)

Differential diagnosis among parkinsonian and dystonic camptocormia

Martínez HR, Cantú-Martínez L, Martínez-Ramírez D, González HC, Venegas-Moniet P

Language: English
References: 28
Page: 375-379
PDF size: 110.27 Kb.


ABSTRACT

Background: Camptocormia is characterized by a marked thoracolumbar spine flexion that disappears in resting position. A clinical analysis among a patient with parkinsonian camptocormia and a case with dystonic camptocormia is described. Methods: Among our cohort of 140 patients with Parkinson disease we found one patient with camptocormia. The diagnosis was performed when the patient exhibited a flexion (› 45°) of thoracolumbar spine increasing during walking and disappearing in recumbent position. This patient was compared to a patient showing a severe lateral flexion of the spine that was diagnosed as dystonic camptocormia. Both cases had complete neurological examination, UPDRS, and head, cervical and thoracic magnetic resonance imaging. Clinical manifestations and response to treatment are described. Results: A 46 years-old male patient started with right lateral flexion of his trunk, head drop and laterocolis 3 years before evaluation, no extrapyramidal signs were observed. He received thioridazine for 2 years at the age of 40. MRI showed a normal brain, cervical lordosis and thoracic kyphosis. A moderate improvement with botulinum toxin was observed. A 72 years-old Parkinsonian male developed forward flexion (› 45°) in the last year that increased during walking. Head and spine MRI were normal. He showed improvement on his extrapyramidal signs and posture after levodopa treatment. Discussion: Patient with dystonic camptocormia showed a lateral flexion of the trunk associated to dystonic posture of the neck, head drop, absence of extrapyramidal signs and moderate response to botulinum toxin injection. On the other hand, the patient with Parkinsonian camptocormia showed severe forward flexion of the trunk, extrapyramidal signs, absence of head drop and improvement in his posture with levodopa treatment. Since the pathogenesis of camptocormia is unknown and the etiologies are multiple, there is no accepted form of treatment. Conclusion: Differential diagnosis of camptocormia subtype may be useful for an accurate classification and for an appropriate treatment.


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