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Brachial plexus neuropathy (BPN) has been reported in four patients following botulinum toxin A (BTA) treatment of cervical or upper extremity dystonia.1-3 We report a patient with cervical dystonia who developed acute, transient BPN contralateral to the side of cervical BTA injections 10 days following treatment.
Case report. A 55-year old right-handed man developed right-sided rotational torticollis and laterocollis accompanied by right posterior cervical pain without antecedent trauma. He had been diabetic for 12 years without symptomatic peripheral neuropathy. Cervical MRI showed a small midline C5 to C6 disk protrusion. Anticholinergic drugs were unhelpful. Examination 1 year following onset showed right-sided rotational torticollis, laterocollis, and shoulder elevation. Strength and sensation were normal. Tendon reflexes were absent in the left upper extremity and at both ankles. Electromyography showed spasm without denervation in the right splenius capitis, trapezius, levator scapulae, and both sternomastoids. There was no evidence for acute or chronic denervation in the posterior cervical muscles.
Botulinum toxin A (100 U/mL saline without preservative) was injected into the right splenius capitis (90 U), right levator scapulae (40 U), and right sternomastoid (30 U). Cervical dystonia improved and posterior cervical pain disappeared within 2 weeks of injection. Ten days postinjection the patient developed a painless inability …
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