Painful tonic spasms are brief recurrent episodes of increased muscle tone and abnormal posturing that can affect one or more limbs at a time. They can be extremely debilitating if not identified early.
We describe two cases with different underlying disease entities, in which this was the only initial presenting symptom.
The first case was a 73-year-old guitarist, whose painful tonic spasms cut short his band’s tour and also caused him to sustain a vertebral fracture. MRI whole spine revealed multiple short segments of T2 high signal. He was diagnosed with an acute myelitis and his spasms responded well to carbamazepine.
The second case is a 66-year-old-lady who had months of severe prolonged tonic spasms. Later that year she developed an area postraema syndrome and months later a right optic neuritis. MRIs of the neuroaxis were normal during the initial few years of presentation. A diagnosis of neuromyelitis optica was established once aquaporin-4 antibody was confirmed as positive and her spasms improved spontaneously.
These cases highlight the diagnostic challenge posed by an isolated presentation of painful tonic spasms. Early recognition can aid timely treatment initiation and investigation with aquarporin-4 antibody and MR imaging, to establish the underlying cause.
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