UDLCO CRH: Narketpally ligamental imaginary pillow sign vs Tonic neck muscle spasm imaginary pillow sign

 Conversational learning transcripts:

[10/11, 07:25]hu1: Good morning 

I have seen a video that Pillow sign is seen  in Progressive supranuclear palsy(Parkinson plus syndrome)

[10/11, 07:25]hu1: Due to dystonia

[10/11, 07:57]hu2: Oh that's great. Please share that link

[10/11, 08:02]hu1: https://www.instagram.com/reel/DQY9e-sk52_/?igsh=aGlnb3JqY3F5d3I4

[10/11, 08:03]hu2: So we already know it's seen in catatonia and it's quite logical that it should be also seen in dystonia

We described here: https://pubmed.ncbi.nlm.nih.gov/40674544/, and here:https://medicinedepartment.blogspot.com/2025/03/project-7-years-in-narketpally.html?m=1, the Narketpally ligamental invisible pillow sign due to ossified posterior longitudinal ligamental fibrosis as opposed to the globally known catatonic psychological (and logically neck dystonic) invisible pillow sign  due to neck muscle spasm.

[10/11, 08:05]hu1: yes

[10/11, 08:06]hu1: But patient with parkinson also of same age group

[10/11, 08:07]hu1: Even though pt is having OPLL we cannot exclude Parkinson plus as both of them mostly are elderly

[10/11, 08:08]hu2: Parkinson's plus can be easily excluded on clinical examination

[10/11, 08:12]hu1: yes 

But can this sign be earliest one with no other signs present to exclude it or Dystonia itself is a progression of the disease?

[10/11, 08:16]hu2: Which disease? Parkinson's or fluorosis?

I agree that even with posterior longitudinal ligamental enthesitis in the early phase of fluorotic spondyloarthropathy, neck muscles can go into a state of dystonic spasm but then again it's easy to distinguish as eventually all tonic muscle spasms would recover and the pillow sign would disappear in them while ligamental ossification wouldn't disappear without surgery

Above images from: https://medicinedepartment.blogspot.com/2025/05/clinical-meeting-case-of-integrating.html?m=0

And here: https://pajrcasereporter.blogspot.com/2024/10/80m-diabetes-hypertension-30yrs-ckd.html?m=1/