Patient description: A 62-year-old African-American man presented with left upper and lower extremity weakness, associated with dark visual spot in right eye, right facial numbness, facial drop and slurred speech. He denied dyspnea, headache, palpitations, chest pain, fever, dizziness, bowel or urinary incontinence, loss of consciousness. His medical history was significant for hypertension, hyperlipidemia and hypothyroidism. He smokes cigarette 1 pack per day for 40 years and alcohol consumption of 5 to 6 beers per week. He is not aware about his family history. He is using Levothyroxine, Atorvastatin and HTCZ. His vital signs were stable in the primary evaluation. Left-sided facial droop, dysarthria, and left-sided hemiplegia were seen in the physical exam. His National Institutes of Health Stroke Scale (NIHSS) score was calculated as 7. Initial CT angiogram of head and neck reported no acute intracranial findings. Intravenous recombinant tissue plasminogen activator (t-PA) was administered as well as high-dose statin therapy. The patient was admitted to the intensive care unit to be monitored for 24 hours. MRI of the head revealed an acute 1.7-cm infarct of the right periventricular white matter and posterior right basal ganglia.

Clinical trial eligibility criteria: eligible ages (years): 21.0-80.0,  Spasmodic Dysphonia Focal Dystonia Healthy research volunteers and adult patients with ADSD and WC will be eligible for the study. 1. Adult patients with ADSD will have clinically documented ADSD established by voice and speech testing and fiberoptic nasolaryngoscopy. Patients will be required to have Intermittent uncontrolled voice breaks in vowels, liquids (r & l), semivowels (w & y) during speech in ADSD (at least 3 voice breaks), or Less prominent symptoms during whisper, singing, falsetto, or shout Normal voice and vocal fold movement during protective laryngeal functions and emotional phonation, such as cough, laughter, cry. 2. Adult patients with WC will have clinically documented WC established by history and neurological examination. 3. Controls will be healthy subjects with a negative history of laryngeal, neurological, or psychiatric problems. 4. All participants will be from 21 to 80 years old and right hand dominant. 5. All participants should be able to perform a sequential finger-tapping task for 40 seconds consecutively  Subjects who are incapable of giving an informed consent. 2. Pregnant or breastfeeding women until a time when they are no longer pregnant or breastfeeding. 3. Subjects with past or present medical history of (a) neurological problems, such as stroke, movement disorders (other than SD and WC in the patient group), brain tumors, traumatic brain injury with loss of consciousness, ataxias, myopathies, myasthenia gravis, demyelinating diseases, alcoholism, drug dependence; (b) psychiatric problems, such as schizophrenia, major and/or bipolar depression, obsessive-compulsive disorder; (c) laryngeal problems, such as vocal fold paralysis, paresis, vocal fold nodules and polyps, carcinoma, chronic laryngitis. (d) ventricular arrhythmias, renal and hepatic insufficiency, vascular headache, or carcinoid syndrome. 4. Patients who are currently taking medications known to affect GABA and dopamine receptor binding. Occasionally, patients report receiving such medication, although dopaminergic and GABA agonist/antagonists are not typically prescribed in these patients. 5. Patients who received treatment with botulinum toxin injections into the laryngeal muscles within the past 3 months. 6. Patients with vocal and hand tremor or muscle tension dysphonia. 7. Subjects who have tattoos with contraindications to MRI, ferromagnetic objects in their bodies (e.g., implanted stimulators, surgical clips, prosthesis, artificial heart valve, etc.) that cannot be removed for the purpose of study participation. 8. Subjects who received previous radiation exposure greater than 5.0 rem per year. 9. WC patients who experience focal hand dystonia at rest. 10. WC patients who have focal hand dystonia associated with trauma or a known neuroanatomic lesion or disease