An 18-Year-Old Woman Who Attacked a Policeman With a Knife: Our Memorable Lesson on Treatable Causes of Dystonia
This chapter discusses the case of an 18-year-old woman, who had dystonia. She was sent to a psychiatric facility. She received low doses of haloperidol and a tricyclic antidepressant and after 2 weeks developed drooling, twisting of the neck to the right, and trouble walking. At that point, the psychiatrist consulted the movement disorders neurologist. She had drooling and cervical dystonia with laterocollis to the right with a mild rotational component. She presented an interesting diagnostic and treatment challenge. At the outset, the differential diagnosis consisted of primary psychiatric disorder and a possibility of drug-induced movement disorder versus a spontaneous movement disorder with psychiatric manifestations as seen in Wilson’s disease (WD). Her tests confirmed the diagnosis of WD, and she was treated with Penicillamine with the knowledge that it can cause further drop in platelets. Over the next several months, her eye movement became normal and the cervical dystonia disappeared.