Differential Diagnosis

The differential diagnosis for acute dystonias is:

  • Dislocated mandible
  • Hyperventilation
  • Hypocalcaemia and hypomagnesaemia
  • Primary neurological cause: temporal lobe epilepsy, meningitis, stroke, Wilsons disease
  • Tetanus
  • Toxicity:
    • Strychnine poisoning (spontaneous tonic-clonic contractions as well as extensor thrust provoked by external stimuli)
    • Anti-cholinergic agents (agitation and restlessness)
  • Drug seeking behaviour: there are reports of patients who misuse anticholinergics and present to the ED feigning a dystonic reaction to obtain their drug of abuse.