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Francis O. Walker, MD; Vicki P. Hunt, RN
Wake Forest University Medical Center Winston-Salem, NC

JAMA. 1992;267(23):3149.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—We describe an unexpected fatality that was a secondary consequence from the administration of therapeutic botulinum toxin.

Report of a Case.

—A 55-year-old alcoholic man with severe, refractory retrocollis complained that he could not look straight ahead while walking or sitting. Physical examination revealed hypertrophy of cervical muscles and such severe involuntary neck extension that he indeed walked and sat looking up.

At his return visit, the patient was intoxicated. Using electromyogram needle guidance to identify the responsible posterior cervical muscles,¹ we injected them with 200 U of botulinum toxin. Within 2 weeks, he improved markedly and could look straight ahead without assistance.

He missed his return appointment. Treatment had enabled him to aim and use a gun. His wife told us that 10 weeks after the injections, while drinking, he argued with and then fatally shot his adult son. Six weeks later, escorted by prison . . . [Full Text PDF of this Article]

Footnotes
Edited by Drummond Rennie, MD, Deputy Editor (West), and Bruce B. Dan, MD, Senior Editor.

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