Challenge case! Listen to this 12 minute Radiolab podcast and see whether and how fast you can make the diagnosis. The picture below provides a clue. The next paragraph has the answer, so don’t read it until you’re ready.
This is a great emergency neurology pearl for our newish residents: When you give a patient an anti-dopaminergic drug, such as prochlorperazine to treat nausea or migraine or haloperidol to treat agitated psychosis, there’s a small chance of provoking an acute dystonic reaction. These have varied manifestations, including the relatively benign blepharospasm, blepharospasm plus oromandibular dystonia (Meige’s syndrome–shown above) and the very scary laryngospasm. Oculogyric crises, torticollis, and opisthotonos are other classics. Treatment is with an anticholinergic: diphenhydramine 50 mg IV or benztropine 1 to 2 mg IV.