He had joint limitations in the shoulders, elbows, and hands, with extrapyramidal side effects and pyramidal
hypertonia of the upper limbs.
Neurological symptoms are extremely variable between irritability, anxiety, agitation, confusion, delirium, convulsions and coma, and
hypertonia. Cerebral CT scan is usually negative.
His neurological exam revealed a slight upward gaze palsy and velocity-dependent
hypertonia in the upper extremities.
Central nervous system examination showcased normal cry,
hypertonia, decreased power, and exaggerated reflexes on both upper and lower limbs.
Fissures occurring in lateral positions should raise suspicions for other disease processes e.g.; crohn's disease, tuberculosis, syphilis, aids or anal cancer etc.3,7 It is generally accepted that chronicity is due to
hypertonia of anal canal which results in poor perfusion of anoderm especially in posterior midline that has inherently poor vascular supply.3,8
Spastic movement disorders such as cerebral palsy frequently lead to bruxism with masseter muscle
hypertonia. Botulinum toxin type-A (BoNT-A) injections effectively reduce
hypertonia.
In the newly recognized congenital Zika syndrome, infection is also associated with partially collapsed skull, retinal damage, congenital contractures, early-onset
hypertonia, and signs of extrapyramidal involvement; irrespective of a clear pathomechanism, infection is also associated with intrauterine growth restriction and low birth weight (1).
Comprehensive multispecialty medical and developmental follow-up documented that 10 of 13 infants had dysphagia, 7 had epilepsy, 3 had chorioretinal abnormalities, all 13 had
hypertonia, and 12 had pyramidal and extrapyramidal signs with dystonia (MMWR.
CNS examination revealed generalized
hypertonia, hyperreflexia, and spasticity and upgoing plantars.