Classification
Spasmodic torticollis is a form of focal dystonia, a neuromuscular disorder that consists of sustained muscle contractions causing repetitive and twisting movements and abnormal postures in a single body region. There are two main ways to categorize spasmodic torticollis: age of onset, and cause. The disorder is categorized as early onset if the patient is diagnosed before the age of 27, and late onset thereafter. The causes are categorized as either primary (idiopathic) or secondary (symptomatic). Spasmodic torticollis can be further categorized by the direction and rotation of head movement. Primary
Primary spasmodic torticollis is defined as having no other abnormality other than dystonic movement and occasional tremor in the neck. This type of spasmodic torticollis is usually inherited. Studies have shown that the DYT7 locus on chromosome 18p in a German family and the DYT13 locus on chromosome 1p36 in an Italian family is associated with spasmodic torticollis. The inheritance for both loci is autosomal dominant. These loci are all autosomal dominantly inherited with reduced penetrance. Although these loci have been found, it is still not clear the extent of influence the loci have on spasmodic torticollis. Secondary
When other conditions lead to spasmodic torticollis, it is said that the spasmodic torticollis is secondary. A variety of conditions can cause brain injury, from external factors to diseases.
Expectations should be managed so that patients understand the unfortunate inevitability of the disorder; however, they should also be assured that most cases of anagen effluvium are reversible and they will grow hair once chemotherapy is ceased. Patients should be instructed to avoid chemical trauma to the hair. This includes hot appliances, bleach, or color treatments in the time leading up to and during chemotherapy. If possible, patients should be given resources to obtain hairpieces or protective scarves before hair loss and educated on the benefits such garments offer, including cold protection in addition to the aesthetic component. Differential Diagnosis
The differential diagnosis for anagen effluvium includes other nonscarring alopecias such as telogen effluvium, trichotillomania, and androgenetic alopecia. These entities can be distinguished by history, hair pull test, and trichoscopy. A thorough review of systems should be completed to exclude other causes of hair loss such as nutritional deficiencies, metabolic and endocrine disorders, and infections. See also
Telogen effluvium
Noncicatricial alopecia
List of cutaneous conditions

References


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