This 41-year-old woman had systemic lupus erythematosus and a prior branch retinal vein occlusion of the right eye. She also had a history of what was labeled as “allergic reaction” to prochlorperazine (Compazine) following abdominal surgery.

Our patient suffered an acute dystonic reaction induced by prochlorperazine. Neurologic complications of dopamine receptor blocking agents (neuroleptics) can occur within days, such as in acute dystonic reactions, acute akathisia, and neuroleptic malignant syndrome, or may occur after several months or years of exposure, such as in neuroleptic-induced parkinsonism (sometimes yielding a “rabbit syndrome,” or perinasal tremor) and tardive dyskinesia. Acute dystonic reaction is an often dramatic and potentially life-threatening complication of neuroleptic treatment. Although traditionally antipsychotics are the neuroleptics considered as the typical offending agents, there is a growing prevalence of nonantipsychotic neuroleptics, particularly those used for nausea and cough (Table 67.1).

Acute dystonic reactions most commonly involve the muscles of the face, tongue, jaw, neck, or throat. Jaw-opening dystonia, in particular, is a common presentation, as demonstrated in second video. Most characteristic features include oculogyric crisis, trismus, and opisthotonic posturing. Pure truncal flexion (camptocormia) and the Pisa syndrome may occur as an acute dystonic reaction. A rarely reported extrapyramidal reaction is acute laryngeal dystonia (laryngospasm), a potentially life-threatening disorder, which may cause asphyxia.