Cervical and axial dystonia in a patient with syringomyelia.

The diagnostic criteria for TA are mainly clinical; nevertheless, laboratory analysis frequently reveals increased ESR and CRP. Although they are not gold standard, CTA and MRI are useful keys to diagnosis1,4. During the acute phase, inflammatory infiltration affects all layers of the arterial wall, whereas at the chronic phase fibrous tissue replaces the damaged layers and arterial stenosis may develop1,2. Differential diagnoses include other type of large vessel inflammatory vasculitis1. CVT is a disease that also affects younger individuals; however, associated arterial thrombosis is identified in only 10% of the patients5. Whilst blood coagulation disorders are important causes of CVT, multiple factors may contribute as a precipitant of venous thrombosis5. Despite all the efforts to find its etiology, it remains unidentified in 20% of the patients3. Our patient fulfilled four of the six criteria for TA, had radiological imaging suggestive of CVT and was extensively investigated to exclude other conditions. CVT and TA have clinical similarities which are important to be remembered during the diagnostic work up3. Simultaneous presence of CVT and TA is unexpected and raises the possibility of either causal or casual association between these two conditions.