Acute dystonia can present with which of the following?

• A. Severe spasm of the tongue, neck, eyes, face and back; laryngeal spasms
• B. Tremor at rest
• C. Delusions
• D. Muscle weakness

Answer: (A)

Acute dystonia is an abrupt extrapyramidal motor reaction from dopamine blockade, causing sustained, painful muscle contractions and abnormal postures. It often occurs within hours to days after starting or increasing a dopamine-antagonist medication. The presentation described—severe, painful spasms of the tongue, neck, eyes, face, and back, with laryngeal involvement—fits this pattern, as dystonia can involve cervical and oropharyngeal muscles and even cause laryngeal spasms that threaten the airway. This is distinct from tremor at rest (a Parkinsonian sign), delusions (psychotic symptom), or muscle weakness (a neuromuscular deficit), which do not produce the same sustained abnormal contractions. Treatment is prompt administration of anticholinergic agents like benztropine or diphenhydramine, and addressing the offending medication.