When You Hear Hoofbeats, Don't Forget the ZEBRA: Paroxysmal DYSKINESIAS as A Cause of Atypical Movements in Athletes

Unusual, episodic neurological disorders can easily be missed. Here, we present three athletes initially presenting with musculoskeletal complaints, but experiencing recurrent episodes of atypical movements during exercise. Paroxysmal dyskinesias are heterogeneous movement disorders characterized by episodic dystonia or other involuntary movements. Although rare, we demonstrate how such disorders should be considered as differential diagnoses when athletes present with symptoms atypical of musculoskeletal disorders. In particular, this case series serve to highlight the importance of collecting a detailed history, applying tools such as video examination, as well as conducting a thorough neurological investigation in such cases. Not only is it important to rule out potentially severe neurological disease; but appropriate treatment also may confer substantial benefit for the athlete.