Cervical dystonia in a case of longstanding secondary progressive multiple sclerosis

A 50-year-old woman with longstanding secondary progressive multiple sclerosis (MS) presented with a 3-year history of cervical dystonia. She was diagnosed with MS after the onset of diplopia and cerebellar syndrome in 1991. She started to present with neck dystonic posture in 2014, with slow progressive worsening and functional impairment. At that time, a 1.5 T brain magnetic resonance imaging (MRI) showed several bilateral confluent lesions in the frontoparietal subcortical and periventricular white matter associated with a lesion in the left posterior putamen, without any cerebellar abnormalities. In addition, a 1.5 T cervical spine MRI revealed a slightly swollen and non-homogeneous appearance of the C1-C5 spinal cord segments without contrast enhancement. Neurological examination showed the presence of sustained dystonic posture of the neck, characterized by moderate rightlaterocollis/laterocaput, mild retrocollis and moderate right shoulder elevation.