Neurodegeneration with Brain Iron Accumulation: Two Additional Cases with Dystonic Opisthotonus

  • Sahil Mehta
  • Vivek Lal


Background: Specific phenomenology and pattern of involvement in movement disorders point toward a probable clinical diagnosis. For example, forehead chorea usually suggests Huntington’s disease; feeding dystonia suggests neuroacanthocytosis and risus sardonicus is commonly seen in Wilson’s disease. Dystonic opisthotonus has been described as a characteristic feature of neurodegeneration with brain iron accumulation (NBIA) related to PANK2 and PLA2G6 mutations.

Case report: We describe two additional patients in their 30s with severe extensor truncal dystonia causing opisthotonic posturing in whom evaluation revealed the diagnosis of NBIA confirmed by genetic testing.

Discussion: Dystonic opisthotonus may be more common in NBIA than it is reported and its presence especially in a young patient should alert the neurologists to a possibility of probable NBIA.

Keywords: Opisthotonus, dystonia, neurodegeneration with brain iron accumulation, secondary, phenomenology, genetics, botulinum toxin

Citation: Mehta S, Lal V. Neurodegeneration with brain iron accumulation: Two additional cases with dystonic opisthotonus. Tremor Other Hyperkinet Mov. 2019; 9. doi: 10.7916/tohm.v0.683