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Journal of the Korean Neurological Association 1997;15(3): 563-575.
말초 외상에 의해 유발된 이상운동증
이명식, 김용덕, 김원찬, 조태영
영동세브란스병원 신경과, 연세뇌 연구소, 연세의대,광혜병원 신경과
Dyskinesias precipiatated by peripheral trauma
M S Lee, Y D Kim, W C Kim, T Y Cho
Department of Neurology, Youngdong Severance Hospital, Yonsei Brain Research Center, Yonsei University College of Medicine, Department of Neurology, Kwang Hey Hospital
We describe 9 patients who developed variable dyskinesias precipitated by peripheral trauma. Three of the 9 developed focal or segmental dystonia, 1 developed painful leg and moving toes syndrome, 1 developed perioral rhythmic twitchings, 1 developed hemifacial spasm, I developed causalgia-dystonia syndrome, and 2 developed psychogenic tremor. Except one who developed spasmodic dysphonia immediately after a v@l cord polypectomy, the others developed dyskinesias from a weak to 24 months after the peripheral trauma. In four dyskinesias spread to involve other parts of the body over a variable period ranging a few months to several years. Five, including two with psychogenic tremor, had persistent pain or sensory changes after the acute insult, but only one had objective evidences of autonomic involvement We suspect that peripheral trauma may precipitate sequential occurrences of reorganization or unmasking of sensorimotor cortex, inactivation of segmental inhibitory interneuron, and disinhibition of pulse generator or reciprocal inhibition, which lead to rhythmic dyskinesia or dystonia. Careful clinical observation is important to make a diagnosis of psychogenic movement disorders after a peripheral trauma, particularly in the patient with a tremor.
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