Movement Disorder Emergencies of the Upper Aerodigestive Tract

A 52-year-old man was transferred to the emergency room of a major hospital from a referral facility because of recent slurred speech. He had been admitted to the facility the week before for treatment of alcohol abuse. Upon his arrival in the emergency room, the neurology resident was called to evaluate the patient after a normal computed tomography scan was obtained. Examination revealed normal comprehension and expression, slurring of speech, and an inability to fully open his jaw and protrude his tongue. There were no defects in visual field perception, power, or sensation. Review of the medical record from the referring institution revealed that the patient had been started on 5 mg of haloperidol four times daily on his admission to the referral facility as part of his treatment for alcohol abuse—he was unaware he was receiving the medication. An acute dystonic reaction was diagnosed, and 25 mg of intravenous diphenhydramine was administered, with resolution of dysarthria and jaw restriction within 90 seconds of infusion. He was maintained on oral diphenhydramine 25 mg twice daily for one week after discharge.