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Dystonia

Dystonias are sustained or intermittent abnormal repetitive movements or postures due to alterations in muscle tone. The dystonia spasms may affect one (focal, e.g. blepharospasm of eyelid) or more (segmental, e.g. neck—spasmodic torticollis) parts of the body or the whole body (generalised, e.g. oculogyric crisis).

Generalised dystonia Usually drug induced, e.g. levodopa, psychotropics. Treatment: benztropine 1–2 mg IM or IV

Focal dystonias

  • Blepharospasm (uncontrolled blinking)

  • Oromandibular (jaw grinding and grimacing)

  • Meige syndrome (combination of above two)

  • Hemifacial spasms (eye spreading to face): related to facial nerve irritation

  • Cervical dystonia (spasmodic torticollis)

  • Laryngeal or spastic dystonia—strained hoarse voice

  • Hand and forearm cramps (e.g. writer’s, typist’s, golfer’s or pianist’s cramps)

Table D12Dysuria: diagnostic strategy model
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Table D12 Dysuria: diagnostic strategy model

Probability diagnosis

UTI (esp. cystitis) (female)

Urethritis

Urethral syndrome (female), aka painful bladder syndrome

Vaginitis

Serious disorders not to be missed

Neoplasia

  • bladder

  • prostate

  • urethra

Infection

  • gonorrhoea

  • chlamydia

  • genital herpes

Reactive arthritis

Calculi (e.g. bladder)

Pitfalls (often missed)

Menopause syndrome

Adenovirus urethritis

Prostatitis

Foreign bodies in lower urinary tract

Acidic urine

Acute fever

Interstitial cystitis

Urethral caruncle/diverticuli

Vaginal prolapse

Obstruction, e.g. benign prostatic hyperplasia, urethral stricture

Masquerades

Depression

Diabetes

Drugs

UTI
Figure D14

Relative causes of dysuria in women

A 3D pie chart represents relative causes of dysuria in women. The pie chart infers the following data: The two major parts of the pie chart are covered by acute cystitis and urethral syndrome: abacterial cystitis. The second major part is vaginitis. The third major part is postmenopausal atrophic vaginitis. The least part is other causes. The other causes are sexual abuse, trauma/foreign bodies, poor perineal hygiene, allergic reactions, chemical irritants. The chemical irritants are deodorant sanitary pads; contraceptive foams, etc.; vaginal lubricants; vaginal cosmetics; bubble baths, soaps, etc.
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Treatment Injection of purified botulinum A toxin into affected muscle groups—with care. Usually repeated every 3–6 mths.

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