Chronic oscillopsia and neck dystonia: atlanto-occipital origin

A 61-year-old woman presented with longstanding involuntary neck and head movements, characteristic of cervical dystonia, accompanied by oscillopsia. These symptoms severely impacted her daily activities, including basic tasks and overall quality of life. Cervical dystonia, a movement disorder caused by sustained or intermittent muscle contractions leading to abnormal postures or repetitive movements, was compounded in this patient by visual disturbances, including the perception of unstable surroundings.

To investigate a potential structural cause, magnetic resonance imaging (MRI) of the craniovertebral junction was performed. The imaging revealed significant right-sided atlanto-occipital arthropathy, evidenced by bony erosions, joint effusion and adjacent soft tissue changes (Figure 1). These abnormalities suggested underlying degenerative or inflammatory pathology involving this critical joint, which plays a fundamental role in head and neck mobility. The findings clarified the likely origin of her symptoms, indicating that the arthropathy contributed to both her dystonia and vestibular complaints.

Atlanto-occipital arthropathy, particularly when associated with effusion, can disrupt the integration between vestibular and proprioceptive systems, essential for spatial orientation and balance.¹ Inflammation and effusion may interfere with visual-vestibular pathways, manifesting as vertigo and oscillopsia.² This case underscores the importance of considering craniovertebral structural pathology in patients with atypical or refractory dystonia, where MRI can play a pivotal diagnostic role.

View Figure 1.