Dystonic storm: a practical clinical and video review

Table 1 Differential diagnosis of dystonic storm

Entity	Age	Trigger	Time course	Movement disorder phenomenology	Other neuro signs	Altered mental status	Autonomic instability
Dystonic storm	P	+/−	Hours-Days	Dystonia +/− chorea	−	−	+
Choreic storm	P-YA	+/−	Hours-Days	Chorea	−	−	−
Oculogyric crisis	All	+++	Acute	Dystonia	Oculogyria	−	+/−
Neuroleptic malignant syndrome	A	+++	Days-Weeks	Parkinsonism	−	+	+
Serotonin syndrome	All	+++	Hours-Days	Myoclonus	−	+	+
Lethal catatonia	All	+/−	Hours-Days	Parkinsonism	−	+	+
Malignant hyperthermia	All	+++	Acute	−	−	−	−
Drug intoxication	All	+++	Acute	−	Psychosis	+	+/−
Intrathecal baclofen withdrawal	P-YA	+++	Acute-Hours	−	−	+	+
Delirium tremens	A	+++	Acute	Myoclonus	Psychosis	+	+
Autoimmune encephalitis (e.g. anti-NMDA)	P-YA	−	Days-Weeks	Chorea	Psychosis	+	+

This table provides the list of differential diagnosis of dystonic storm. Useful distinguishing features include age group (pediatric, young adult, adult and all), presence or absence of triggering factors (number of “+” sign correlates with stronger relationship; “+/−” represents inconsistent correlation; “−” represents no correlation), time course, movement disorder phenomenology, associated neurological signs, altered mental status and autonomic instability
Abbreviations: P pediatric, YA young adults, A adults, All all age groups

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