spasmodic torticollis

Burrell College of Osteopathic Medicine
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TexasTriathlete

TexasTriathlete

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Okay, I just watched this thing on the discovery health website called "mystery diagnosis", in which the pt had spasmodic torticollis. I actually guessed this about two seconds after they showed/described the pt's symptoms, and I was shocked when I was right, because people with only one year of med school under their belts don't know ****. I will be the first to admit that.

This patient went to his PCP a few times, another doc that his job sent him to, the ER, a neurologist that I think was consulted on his case (and he was admitted to neurology, and stayed in the hospital for a month!), and finally, he went to another neurologist who figured it out.

So why was I able to guess this immediately? I am on the very low end of the medical hierarchy right now, but we were lectured on it in OMM a few times, but also, we got it in neuro, from an MD neurosurgeon, so I don't think it is an osteopathic-only thing.

Is this something that not many people knew about until recently? This happened in the 80's. Its not like the symptoms are obscure. You can't turn your f-ing head. I am just curious as to how this was such a "mystery diagnosis"
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How did they treat the patient? I know that OMT, especially ME, is pretty effective for torticollis, laterocollis, etc. I wonder if it is effective for spasmodic torticollis.
 
I actually had spasmodic torticollis a few years ago! I woke up one morning and my neck was just hurting like crazy. Any time I tried to turn my head the muscles on one side of my neck would to into intense spasms and it made even the simplest of tasks extremely difficult. I went to the urgent care thinking that maybe I had strained the muscles in my neck during the night or something. The doctor just kind of talked with me about my schooling and told me to come back in a few days if it wasn't better. Two days later it still wasn't much better so I went back and saw another doctor. Right off the bat he told me I had spasmodic torticollis and gave me the proper meds to help take care of the problem. He referred me to physical therapy but I never went and seemed to recover just fine. So in my case it took just two doctors to figure out what was wrong with me. I'm glad it wasn't like the case that you saw on "mystery diagnosis".
 
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I work at a neurology clinic and research lab and we get patients with cervical dystonia (aka spasmodic torticollis) all the time. It's sometimes misdiagnosed as arthritis, stiff neck, or wryneck. They usually treat it with botox injections. I believe the patients come in every couple of months to get the injections, its a very quick visit.

What other diagnosis did the first few physicians come up with?
 
All kinds of **** from a pulled muscle to "torticollis", which is what baffled me a little bit, because later, the neurologist came up with "cervical dystonia", which is spasmodic torticollis.

They treated it with botox injections, which were still in clinical trials at the time. This was the late-80's.

I just thought it was weird that something a guy like me could get on the first guess would be a "mystery diagnosis", and that there were numerous docs getting it wrong. I am always wrong about crap like this, because all I know is what I've heard in my most recent lectures. So if someone has a headache, my first thought is "what kind of brain tumor is it?" or "subarachnoid hemorrhage".

The only reason I remember torticollis is because I thought it was an awesome word.
 
TexasTriathlete said:
Okay, I just watched this thing on the discovery health website called "mystery diagnosis", in which the pt had spasmodic torticollis. I actually guessed this about two seconds after they showed/described the pt's symptoms, and I was shocked when I was right, because people with only one year of med school under their belts don't know ****. I will be the first to admit that.

This patient went to his PCP a few times, another doc that his job sent him to, the ER, a neurologist that I think was consulted on his case (and he was admitted to neurology, and stayed in the hospital for a month!), and finally, he went to another neurologist who figured it out.

So why was I able to guess this immediately? I am on the very low end of the medical hierarchy right now, but we were lectured on it in OMM a few times, but also, we got it in neuro, from an MD neurosurgeon, so I don't think it is an osteopathic-only thing.

Is this something that not many people knew about until recently? This happened in the 80's. Its not like the symptoms are obscure. You can't turn your f-ing head. I am just curious as to how this was such a "mystery diagnosis"
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Torticollis (both spasmodic and congenital) was mentioned a couple weeks ago in anatomy lecture, and the first thing I thought of was that episode of Mystery Diagnosis. I saw that episode years ago, and never even remembered the name of the condition, but we were going over the sternocleidomastoid and the professor just mentioned it as sort of a clinical correlation, and my mind went straight to that episode.
I remember thinking, "Um, I've only been in med school for a week, but could it have really been that hard for DOCTORS to figure that case out?" Didn't seem too complicated to me...

And it doesn't seem to be anything new, since we were shown photos of patients with spasmodic torticollis, and those photos looked like they were taken sometime between that late 1800's and the early 1900's. I think congenital torticollis was also more common back then because during birth, doctors would pull babies out with a giant pair of forceps.

And I agree, torticollis is a pretty cool word. 😀
 
TexasTriathlete said:
Okay, I just watched this thing on the discovery health website called "mystery diagnosis", in which the pt had spasmodic torticollis. I actually guessed this about two seconds after they showed/described the pt's symptoms, and I was shocked when I was right, because people with only one year of med school under their belts don't know ****. I will be the first to admit that.

This patient went to his PCP a few times, another doc that his job sent him to, the ER, a neurologist that I think was consulted on his case (and he was admitted to neurology, and stayed in the hospital for a month!), and finally, he went to another neurologist who figured it out.

So why was I able to guess this immediately? I am on the very low end of the medical hierarchy right now, but we were lectured on it in OMM a few times, but also, we got it in neuro, from an MD neurosurgeon, so I don't think it is an osteopathic-only thing.

Is this something that not many people knew about until recently? This happened in the 80's. Its not like the symptoms are obscure. You can't turn your f-ing head. I am just curious as to how this was such a "mystery diagnosis"
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This is a great example of why knowing your stuff well is important; patients' (and health-providing entities') time and financial resources are efficiently spent.
 
There should be an episode of mystery diagnosis about some guy who presents to the ED with chest pain every day, but it always resolves with a sack lunch. then they admit him to cardiology and nobody can figure out what is causing this chest pain. They could make it an ongoing series, as this patient is tested over and over for different things, but nobody can figure out what it is
 
I watch that show all the time. One time - as a dumb pre-med - I guessed Klinefelter's syndrome on a guy after like 9 seconds and was right. I also saw a DO on the show once ... good day.
 
You guys have Ninja skills.....
 
So - my paramedic buddies and I watch "diagnosis x" all the time...

I recently saw an episode where the pt. presented with painful neck/back spasms, and after 2 days, a large, gangrenous lac was discovered between the toes of his foot. So, we immediately thought tetanus. BUT - it was "stiffman's syndrome." Take that!

We were right on another one though. A kid presents with vague GI discomfort, no fever, borderline BP. Abd. is non-pulsatile. They can't figure out what it is. We guess it is a abd. bleed, most likely venous in origin. Sure enough, a later CT scan and exploratory surgery showed hemoperitoneum and a tear to the hepatic portal vein. Ahaha!

Oh, I do agree that torticollis is an awesome word. I'll have to bust that out one day to an ED RN.
 
JaggerPlate said:
I watch that show all the time. One time - as a dumb pre-med - I guessed Klinefelter's syndrome on a guy after like 9 seconds and was right. I also saw a DO on the show once ... good day.
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I guessed pheochromocytoma in the first two minutes of an episode, simply because my physiology professor mentioned it as an example of when the endocrine system goes ape****.

Klinefelters, thats XXY?
 
TexasTriathlete said:
There should be an episode of mystery diagnosis about some guy who presents to the ED with chest pain every day, but it always resolves with a sack lunch. then they admit him to cardiology and nobody can figure out what is causing this chest pain. They could make it an ongoing series, as this patient is tested over and over for different things, but nobody can figure out what it is
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lol.
 
TexasTriathlete said:
There should be an episode of mystery diagnosis about some guy who presents to the ED with chest pain every day, but it always resolves with a sack lunch. then they admit him to cardiology and nobody can figure out what is causing this chest pain. They could make it an ongoing series, as this patient is tested over and over for different things, but nobody can figure out what it is
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Haha, that would be called "Real World: Any Academic Medical Center"
 
This medical condition is caused by an abnormality of signals coming from the brain that cause the muscles to stay contracted and not relax.
 
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