Tolerance of the Society to Dystonic Patients: Catamnesis of Two Rare Cases of Dystonia

Catamnesis of neurologic patients, especially dystonic patients, features not only the natural history of
certain disorder, but the social status of these cripples. Are they always grata in the country of healthy
people? We report the catamnesis of two dystonic patients, that testify the society to turn them often
into the pariah. Case one concerns with mixed geno – phenotype of generalized dystonia and
Strumpel disease. Strumpel disease and dystonia are inherited disorders with clinical picture of
spastic paraparesis and hyperkinesis respectively. We present a case of a patient born from parents
with these diseases who developed neurologic phenomena uncharacteristic for the classical clinical
picture of his parents’ disorders. Patient V., 12, born from father with generalized dystonia and mother
with Strumpel disease, has flaccid lower paraplegia along with dystonic hyperkinesis in neck and
arms. The flaccid lower paraplegia could be caused by anterior horn lesion. This phenomenon is
unclear because anterior horn lesions were not diagnosed in the proband’s parents. When we got in
touch with his family to check the progress of the treatment, we were terrified to reveal the brutal
murder of his father with generalized dystonia. And when we proceeded to catamnesis of the rest of
studied group of patients, it became clear that such violent outcome seems to be rather the rule than
exception. Case two concerns with cervical dystonia patient with angioma of the frontal lobe and her
terrible death. Structural lesions of CNS, reported to be associated with torticollis, are mostly
restricted to cerebellum, brain stem and basal ganglia. In fact, we know only about two documented
frontal lobe mass lesions – meningiomas, associated with torticollis. Our observation of frontal lobe
cavernous angioma associated with clinical picture of torticollis confirms the role this area could play
in the pathophysiology of involuntary movements. We report a case of patient with torticollis
associated with cavernous angioma of the right frontal lobe and presuppose causative role of
angioma in the development of our patient’s torticollis. These both cases are the observation of very
important neurologic phenomena from one side and the contemporary social attitudes to hyperkinetic
patients from another.