1. A 45 year-old man with a pathognomonic dyskinesia
Candy sign
A 45 year-old man with a pathognomonic dyskinesia
Teaching NeuroImages
Neurology
Resident and Fellow Section
© 2016 American Academy of Neurology

2. VIGNETTE 45 year-old man;
Rapid progressive cognitive decline and behavioral symptoms;
Neurological examination:
Global cognitive impairment;
Episodic, non-rhythmic, brief contractions of the left orofacial muscles.
João Pedro Marto et al.
© 2016 American Academy of Neurology

3. IMAGING João Pedro Marto et al.
Episodic, non-rhythmic, brief and small amplitude contractions of the left orofacial muscles, occurring at rest and when the patient speaks, resembling movements seen when “sucking a candy”. Although sometimes a grimace-like movement is noted, this stereotyped phenomenon seems to be distinct from neuroleptic-induced dyskinesias, which tend to diminish when the orofacial muscles are activated and are commonly associated with tongue hyperkinesia.
João Pedro Marto et al.
© 2016 American Academy of Neurology

4. Candy Sign - The clue to the diagnosis of Neurosyphilis
Although rare and seldom documented, this dyskinesia coined “candy sign”, is considered pathognomonic of neurosyphilis;
Improvement with penicillin was observed, but response to treatment seems to be variable.
1 – Martinelli P, Rizzo G, Scaglione C, Capellari S. Neurosyphilis orofacial dyskinesia: the candy sign. Mov Disord 2013;28(2):246–7.
2 – Shah BB, Lang AE. Acquired neurosyphilis presenting as movement disorders. Mov Disord 2013; 27(6):690-5.
João Pedro Marto et al.
© 2016 American Academy of Neurology