A 35-year-old man presents with a 5-year history of progressive dystonia that began in his left foot. Over the past year, dystonia has developed in his left leg, and more recently in his right arm and neck. He works as a software engineer and reports chronic occupational stress. He denies medication use, drug exposure, or family history of movement disorders. Neurologic examination reveals sustained muscle contractions causing abnormal postures and repetitive twisting movements; there is no weakness, sensory loss, hyperreflexia, or pyramidal signs. Brain MRI, serum ceruloplasmin, 24-hour urine copper, and serum prolactin are all normal. Levodopa challenge test shows no response. Which of the following is the most likely diagnosis?

  1. A)Dopa-responsive dystonia (DRD)
  2. B)Secondary dystonia from occult spinal cord pathology
  3. C)Functional neurologic disorder
  4. D)Primary idiopathic dystoniaGABARITO
  5. E)Drug-induced dystonia from unrecognized antipsychotic exposure

Explicação

Primary idiopathic dystonia is characterized by progressive onset of dystonia in adulthood (typically 20s-40s) with a descending or segmental pattern of spread (foot → leg → arm/neck), normal neuroimaging, normal labs, and absence of secondary causes. This pat... Ver explicação completa e trilha adaptativa →

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