SHM Converge Scientific Abstract ePoster Gallery-Look! It's a Seizure...it's a Stroke...it's a Dystonic Reaction!

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This case describes a 25-year-old man hospitalized for opioid withdrawal who developed episodic abnormal posturing and facial contorting after receiving prochlorperazine for nausea. He initially presented with 5 days of diaphoresis, chills, confusion, nausea, vomiting, dehydration, and anorexia. During the episodes, he remained able to answer questions and follow commands, had marked tachycardia, and had no signs of seizure activity such as clonus, hyperreflexia, or persistent altered mental status. One event resolved after lorazepam, and continuous video EEG later captured a similar spell without epileptiform activity. After a repeat dose of prochlorperazine, he had another episode, leading to the diagnosis of acute dystonic reaction.<br /><br />The report emphasizes that acute dystonic reactions are medication-induced movement disorders most commonly caused by dopamine-blocking agents, including antipsychotics and antiemetics such as prochlorperazine. The mechanism is thought to involve dopamine blockade in the basal ganglia, creating an imbalance between dopamine and acetylcholine. Risk factors include male sex, younger age, and prior dystonic reactions.<br /><br />Clinically, acute dystonia can mimic seizure, stroke, psychogenic nonepileptic seizures, tetanus, anticholinergic toxicity, or neuroleptic malignant syndrome. Common features include sudden involuntary contractions of the face, neck, tongue, or limbs, leading to abnormal postures such as neck twisting, back arching, or eye rolling.<br /><br />Treatment consists of stopping the offending drug and giving an anticholinergic medication such as benztropine or diphenhydramine; benzodiazepines can also help. In this patient, prochlorperazine was discontinued and clonazepam was started, after which symptoms resolved and he was discharged safely with substance use resources. The case highlights the importance of recognizing acute dystonia early to avoid unnecessary testing and treatment.

Asset Subtitle

Evan Raff

Meta Tag

Author List Amy Tierney, Evan Raff, Mukhtar Adem, Spencer Scott, Suzette Laroche

Category Clinical Vignettes

Concept Acute Dystonic Reaction

Concept Anticholinergic Medication

Concept Prochlorperazine

Concept Dopamine Antagonist

Concept Dopamine Blockade

Distinguished Non-Finalist

Presenter Organization University of North Carolina School of Medicine

Presenting Author Evan Raff

Track Adult

Keywords

acute dystonic reaction

prochlorperazine

opioid withdrawal

dopamine blockade

basal ganglia

abnormal posturing

facial contorting

video EEG

benzodiazepines

anticholinergic treatment

Acute Dystonic Reaction

Anticholinergic Medication

Prochlorperazine

Dopamine Antagonist

Dopamine Blockade