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Raucci U, Roversi M, Ferretti A, Faccia V, Garone G, Panetta F, Mariani C, Rizzotto E, Torelli A, Colafati GS, Aulisa AG, Parisi P, Villani A. Pediatric torticollis: clinical report and predictors of urgency of 1409 cases. Ital J Pediatr 2024; 50:86. [PMID: 38659045 PMCID: PMC11044417 DOI: 10.1186/s13052-024-01653-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/07/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND To date, the etiology and risk factors of torticollis are still poorly defined in the pediatric literature. Especially in the Emergency Department (ED) scenario, it is critical to reliably distinguish benign and transient conditions from (potentially) life-threatening disorders. This study describes the clinical characteristics of a large sample of children with torticollis. The aim of our study was to detect epidemiology, etiology and predictive variables associated with a higher risk of life-threatening conditions in acute torticollis. METHODS We conducted a pediatric retrospective study of acute torticollis over a 13-year period referred to the ED of a tertiary pediatric Hospital. We reported the characteristics in the overall sample and in two subgroups divided according to urgency of the underlying condition. Furthermore, we developed a multivariate model aimed at identifying the main clinical predictors of the need for urgent care. RESULTS 1409 patients were analyzed (median age 5.7 years, IQR 5.8). A history of trauma was present in 393 patients (27.9%). The symptom most frequently associated with torticollis were pain (83.5%). At least one pathological finding was found in 5.4 to 7.9% of patients undergoing further imaging. Hospitalization was required in 11.1% of cases (median duration 4 days). The most frequent etiologies of torticollis were postural cause (43.1%), traumatic (29.5%), and infective/inflammatory (19.1%). A longer time from onset of torticollis and the presence of headache or vomiting were strongly correlated with an underlying urgent condition, after adjusting for the other clinically and statistically significant variables in the bivariate analysis. CONCLUSION Our study shows that an urgent condition most commonly occur in patients presenting with history of trauma or headache, vomiting and torticollis for more than 24 h should undergo further diagnostic evaluation and short-term follow-up, restricting invasive or expensive investigations to patients with clinical suspicion of an underlying harmful condition.
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Affiliation(s)
- Umberto Raucci
- Institute of Child and Adolescent Health, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
- General Pediatrics and ED 2nd Level, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
| | - Marco Roversi
- Clinical Trial Area, Development and Implementation of Drugs, Vaccines, and Medical Devices for Pediatric Use, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- PhD Program in Immunology, Molecular Medicine and Applied Biotechnology, University of Rome Tor Vergata, Rome, Italy
| | - Alessandro Ferretti
- Chair of Pediatrics, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Valerio Faccia
- Chair of Pediatrics, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Giacomo Garone
- Chair of Pediatrics, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
- Neurology, Epilepsy and Movement Disorders Unit, Full Member of European Reference Network on Rare and Complex Epilepsies, EpiCARE, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fabio Panetta
- General Pediatrics and Emergency Department 2nd Level, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Carlo Mariani
- Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | - Eloisa Rizzotto
- Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | - Antonio Torelli
- Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | | | - Angelo Gabriele Aulisa
- Orthopaedics and Traumatology Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, 03043, Cassino, Italy
| | - Pasquale Parisi
- Chair of Pediatrics, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Alberto Villani
- General Pediatrics and Emergency Department 2nd Level, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Systems Medicine Department, University of Rome Tor Vergata, Rome, Italy
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Padre JA, Callaghan H, Lim R, Thomas N. Early recognition of unilateral absence of sternocleidomastoid muscle in a newborn presenting with contralateral congenital torticollis. BMJ Case Rep 2023; 16:e258532. [PMID: 38154876 PMCID: PMC10759018 DOI: 10.1136/bcr-2023-258532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023] Open
Affiliation(s)
| | - Hannah Callaghan
- Newborn Service, Western Health Foundation, Melbourne, Victoria, Australia
| | - Ruth Lim
- Newborn Service, Western Health Foundation, Melbourne, Victoria, Australia
| | - Niranjan Thomas
- Newborn Service, Western Health Foundation, Melbourne, Victoria, Australia
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Trinchillo A, D'Asdia MC, De Luca A, Habetswallner F, Iorillo F, Esposito M. Cervical dystonia following brain tumor: description of an unreported case and a systematic review of literature. Acta Neurol Belg 2023; 123:2357-2360. [PMID: 36630079 DOI: 10.1007/s13760-023-02179-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 01/05/2023] [Indexed: 01/12/2023]
Affiliation(s)
- Assunta Trinchillo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II" University, Naples, Italy
| | - Maria Cecilia D'Asdia
- Division of Medical Genetics, Fondazione IRCCS-Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Alessandro De Luca
- Division of Medical Genetics, Fondazione IRCCS-Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Francesco Habetswallner
- Clinical Neurophysiology Unit, Cardarelli Hospital, Via A. Cardarelli, 9, 80131, Naples, Italy
| | - Filippo Iorillo
- Clinical Neurophysiology Unit, Cardarelli Hospital, Via A. Cardarelli, 9, 80131, Naples, Italy
| | - Marcello Esposito
- Clinical Neurophysiology Unit, Cardarelli Hospital, Via A. Cardarelli, 9, 80131, Naples, Italy.
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Shah RS, Cogswell L, Mykula R, Sikander ME. Multipoint fixation with vascularised fibular bone graft and myotomy for atlanto-axial instability in cervical dystonia: a case report. Br J Neurosurg 2023; 37:1670-1674. [PMID: 34212785 DOI: 10.1080/02688697.2021.1935729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
Spinal instability is a challenging condition to manage in patients with cervical dystonia. Standard surgical stabilisation approaches may fail to cope with additional stress forces created by spasmodic muscles leading to construct failure either in the immediate or late post-operative period. Long-term stabilisation relies on the management of dystonic symptoms and adjunctive strategies to increase fusion success rate. We discuss the management of a challenging patient with translational C1/2 instability who had three metalwork failures with standard occipito-cervical fixation techniques within a 12 month period. A combined surgical approach using multipoint fixation, sternocleidomastoid myotomy and a vascularised fibular occiput-C2 bone graft successfully prevented further metalwork failure at over 2 years follow up.
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Affiliation(s)
- Rahul S Shah
- Department of Neurological Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Lucy Cogswell
- Department of Plastic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Roman Mykula
- Department of Plastic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Murtuza E Sikander
- Department of Neurological Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Liu B, Xu J, Yang H, Yu X, Mao Z. PAllidal versus SubThalamic deep brain Stimulation for Cervical Dystonia (PASTS-CD): study protocol for a multicentre randomised controlled trial. BMJ Open 2023; 13:e073425. [PMID: 37832982 PMCID: PMC10582967 DOI: 10.1136/bmjopen-2023-073425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION Deep brain stimulation (DBS) has been validated as a safe and effective treatment for refractory cervical dystonia (CD). Globus pallidus internus (GPi) and subthalamic nucleus (STN) are the two main stimulating targets. However, there has been no prospective study to clarify which target is the better DBS candidate for CD. The objective of this trial is to compare directly the efficacy and safety of GPi-DBS and STN-DBS, thereby instructing the selection of DBS target in clinical practice. METHODS AND ANALYSIS This multicentre, prospective, randomised, controlled study plans to enrol 98 refractory CD patients. Eligible CD patients will be randomly allocated to GPi-DBS group or STN-DBS group, with the DBS electrodes implanted into the posteroventral portion of GPi or the dorsolateral portion of STN, respectively. The primary outcome will be the improvement of symptomatic severity, measured by the changes in the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) severity subscale and the Tsui scale at 3 months, 6 months and 12 months after surgery. The secondary outcomes include the improvement of the TWSTRS-disability subscale, TWSTRS-pain subscale, quality of life, mental and cognitive condition, as well as the differences in stimulation parameters and adverse effects. In addition, this study intends to identify certain predictors of DBS efficacy for CD. ETHICS AND DISSEMINATION The trial has been approved by the Medical Ethics Committee of Chinese PLA General Hospital (S2022-613-01). The results of this study will be published in international peer-reviewed journals and shared in professional medical conferences. TRIAL REGISTRATION NUMBER NCT05715138.
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Affiliation(s)
- Bin Liu
- Medical School, Chinese PLA General Hospital, Beijing, China
- Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Junpeng Xu
- Medical School, Chinese PLA General Hospital, Beijing, China
- Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Haonan Yang
- Medical School, Chinese PLA General Hospital, Beijing, China
- Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xinguang Yu
- Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhiqi Mao
- Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China
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Abstract
BACKGROUND Cervical hemivertebrae are extremely rare anomalies which usually present with restriction of neck movements and torticollis in childhood. Hemivertebrae within the craniovertebral junction have only been reported once previously in the literature. We report a case of semisegmented C2 vertebra presenting in a young adult with cervical pain and torticollis with no other associated anomalies. CASE DESCRIPTION A 21-year-old lady presented with a history of neck pain for the past 10 days and longstanding torticollis with head tilt to the left. Computed tomographic scan of the cervical spine revealed a semisegmented hemivertebra located laterally between the C1 lateral mass and C2 on the right side which was not associated with any other bony anomalies, scoliosis or atlantoaxial dislocation. Conservative treatment with physical therapy was the chosen therapeutic strategy. CONCLUSION Hemivertebrae within the craniovertebral junction are exceedingly rare anomalies which may present with pain and deformity in childhood and are an important cause of congenital torticollis which may be associated with other spinal, craniofacial, cardiac or renal anomalies.
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Affiliation(s)
- Andrew Aranha
- Department of Neurosurgery, Post Graduate Institute of Medical Education & Research and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Ajay Choudhary
- Department of Neurosurgery, Post Graduate Institute of Medical Education & Research and Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Carraro C, Rabusin M, Murru FM, Ammar L, Barbi E, Amaddeo A, Cozzi G. Neck stiffness and bone osteolytic lesion in a 3-years old child: a case report. Ital J Pediatr 2023; 49:132. [PMID: 37775763 PMCID: PMC10543269 DOI: 10.1186/s13052-023-01534-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 09/18/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Neuroblastoma is the most frequent extracranial solid tumor occurring in childhood, representing approximately 28% of all cancers diagnosed in infants. Signs and symptoms of neuroblastoma vary with the site of development of the tumor and can mimic other diseases due to its extreme clinical variability. However, torticollis is not reported in the medical literature as a leading symptom of neuroblastoma. CASE PRESENTATION Here we report the case of a 3 years-old girl with fever and neck stiffness. Blood tests revealed a mild anemia and a rise in inflammatory markers. CT-scan showed a solid, heterogeneous, predominantly hypodense surrenal mass with eccentric calcification and extensive inhomogeneity of the vertebral metamers. Blood tests revealed raised serum levels of Neuron-Specific Enolase. At the 24-hours urine collection urinary catecholamines were greatly increased. A course of chemotherapy for neuroblastoma was promptly started with immediate clinical improvement. CONCLUSIONS This case shows that the presence of torticollis could be a chief complaint of neuroblastoma. To our knowledge, neuroblastoma is not mentioned among life-threatening underlying conditions of torticollis in most recent literature reviews.
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Affiliation(s)
- Carolina Carraro
- University of Trieste, Piazzale Europa, 1, 34127, Trieste, Italy.
| | - Marco Rabusin
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Flora Maria Murru
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Lydie Ammar
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Egidio Barbi
- University of Trieste, Piazzale Europa, 1, 34127, Trieste, Italy
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Alessandro Amaddeo
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Giorgio Cozzi
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
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Hajhouji F, Benyaich Z, Laghmari M, Ghannane H, Ait Benali S. Spontaneous spinal epidural hematoma in a toddler presenting with torticollis: case report and literature review. Childs Nerv Syst 2023; 39:1935-1939. [PMID: 36738321 DOI: 10.1007/s00381-023-05870-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/28/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Spontaneous spinal epidural hematoma (SSEH) is a rare entity, especially in toddlers and infants. The nonspecificity of its presenting symptoms in children may be a source of delayed diagnosis. CASE DESCRIPTION We report the case of a 20-month-old young boy without medical history who presented with irreducible torticollis, worsened a few days later by severe tetraplegia and respiratory distress. Spinal magnetic resonance imaging (MRI) showed a posterior epidural hematoma, extending from C3 to T1 and compressing the spinal cord. An urgent decompressive surgery via an extensive laminectomy and evacuation of the clot was performed. The patient demonstrated a partial neurological recovery on follow-up. CONCLUSION SSEH is a rare and serious condition that may compromise the functional and vital prognosis of the patient, hence the importance of prompt diagnosis and urgent treatment.
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Affiliation(s)
- Farouk Hajhouji
- Department of Neurosurgery, CHU Mohammed VI of Marrakech, Marrakech, Morocco
- Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Zakariae Benyaich
- Department of Neurosurgery, CHU Souss Massa, Agadir, Morocco.
- Faculty of Medicine and Pharmacy of Agadir, Ibn Zohr University, Agadir, Morocco.
| | - Mehdi Laghmari
- Department of Neurosurgery, CHU Mohammed VI of Marrakech, Marrakech, Morocco
- Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Houssine Ghannane
- Department of Neurosurgery, CHU Mohammed VI of Marrakech, Marrakech, Morocco
- Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Said Ait Benali
- Department of Neurosurgery, CHU Mohammed VI of Marrakech, Marrakech, Morocco
- Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
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Kilic-Berkmen G, Scorr LM, Rosen A, Wu E, Freeman A, Silver M, Hanfelt J, Jinnah HA. Thyroid disease in cervical dystonia. Parkinsonism Relat Disord 2023; 107:105274. [PMID: 36621155 PMCID: PMC10257803 DOI: 10.1016/j.parkreldis.2022.105274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/04/2022] [Accepted: 12/29/2022] [Indexed: 01/01/2023]
Abstract
There are many possible etiologies for cervical dystonia (CD), but a cause cannot be identified in most cases. Most recent attention has focused on genetic causes, although a few prior studies have highlighted autoimmune mechanisms instead. Because autoimmune disorders frequently co-exist, the current study evaluated the hypothesis that autoimmune disorders might be more common in CD than neurological controls. The frequency of 32 common autoimmune disorders was evaluated using a systematic survey comparing 300 subjects with CD with 391 neurological controls. The frequency of thyroid disease was significantly higher in CD (20%) compared with controls (6%). Regression analyses that accounted for age and sex revealed an odds ratio of 4.5 (95% CI 2.5-8.1, p < 0.001). All other autoimmune disorders occurred with similar frequencies in CD and controls. Although these studies do not establish a mechanistic link between CD and autoimmune disease, they suggest the need for further attention to a potential relationship, and more specifically with thyroid disease.
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Affiliation(s)
- Gamze Kilic-Berkmen
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Laura M Scorr
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Ami Rosen
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Ellen Wu
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Alan Freeman
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Michael Silver
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - John Hanfelt
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA, 30322, USA
| | - H A Jinnah
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA; Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, 30322, USA.
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Gross PW, Chipman DE, Doyle SM. The tilts, twists, and turns of torticollis. Curr Opin Pediatr 2023; 35:118-123. [PMID: 36336909 DOI: 10.1097/mop.0000000000001194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to outline the most recent understanding of torticollis in the pediatric population. RECENT FINDINGS It is important to diagnose the underlying condition of torticollis early in childhood, as some conditions that cause torticollis may result in major developmental delays in early motor milestones. Recent studies have highlighted that many of the rarer causes of torticollis are often misdiagnosed as congenital muscular torticollis, suggesting that physicians should pay close attention to the results of clinical and radiographic examinations when patients present with torticollis. SUMMARY Congenital muscular torticollis is the most common cause of torticollis. Other, less common causes of torticollis include vertebral abnormalities, ocular torticollis, gastrointestinal disorders, soft tissue infections of the neck, posterior fossa tumors, and benign paroxysmal torticollis. Although rare, these differential diagnoses should be considered during a clinical work-up for a patient who presents with torticollis.
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Affiliation(s)
- Preston W Gross
- Department of Pediatric Orthopedics, Hospital for Special Surgery, New York, New York, USA
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11
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Koizumi K, Fujihara H, Makino K, Yamamoto J, Watanabe N, Nakamura M. Kawasaki disease with intervertebral disc calcification and torticollis. Pediatr Int 2023; 65:e15537. [PMID: 36965068 DOI: 10.1111/ped.15537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/14/2023] [Accepted: 03/22/2023] [Indexed: 03/27/2023]
Affiliation(s)
- Keiichi Koizumi
- Department of Pediatrics, Fujiyoshida Municipal Hospital, Yamanashi, Japan
| | - Hiroyuki Fujihara
- Department of Pediatrics, Fujiyoshida Municipal Hospital, Yamanashi, Japan
- Department of Pediatrics, University of Yamanashi, Yamanashi, Japan
| | - Koichi Makino
- Department of Pediatrics, Fujiyoshida Municipal Hospital, Yamanashi, Japan
| | - Jin Yamamoto
- Department of Radiology, Fujiyoshida Municipal Hospital, Yamanashi, Japan
| | - Nagakazu Watanabe
- Department of Orthopedic Surgery, Fujiyoshida Municipal Hospital, Yamanashi, Japan
| | - Makoto Nakamura
- Department of Pediatrics, Fujiyoshida Municipal Hospital, Yamanashi, Japan
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De Moerloose S, Geerts PJ, Vanacker P, Lemmens GMD. A Case Report of Acute Cervical Dystonia After Electroconvulsive Therapy. J ECT 2022; 38:260-261. [PMID: 36417415 DOI: 10.1097/yct.0000000000000865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Partha Sarathi CI, Swords C, Bewick J. Torticollis in a child with otalgia. BMJ 2022; 378:e070608. [PMID: 36175022 DOI: 10.1136/bmj-2022-070608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | - Chloe Swords
- Department of Otolaryngology, Cambridge University Hospitals NHS Trust, Cambridge CB2 0QQ, UK
| | - Jessica Bewick
- Department of Otolaryngology, Cambridge University Hospitals NHS Trust, Cambridge CB2 0QQ, UK
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Minghelli B, Vitorino NGD. Incidence of Congenital Muscular Torticollis in Babies from Southern Portugal: Types, Age of Diagnosis and Risk Factors. Int J Environ Res Public Health 2022; 19:9133. [PMID: 35897505 PMCID: PMC9332427 DOI: 10.3390/ijerph19159133] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/14/2022] [Accepted: 07/22/2022] [Indexed: 12/01/2022]
Abstract
Congenital torticollis (CMT) is the most common type of torticollis and is defined as a unilateral contracture of the sternocleidomastoid muscle resulting in lateral head tilt associated with contralateral rotation, and early detection and treatment may present a high probability of recovery of head posture symmetry. This study aimed to verify the incidence of torticollis in babies born in southern Portugal types, age of diagnosis and the risk factors. This study comprised 6565 infants born in the south of Portugal at Algarve University Hospital Center, Portimão unit during a 5-year period (January 2016 to December 2020). The cases diagnosed with torticollis referred to the Pediatrics and Pediatric Physiatrist consultations at this hospital were included. 118 babies—77 (65.3%) male and 41 (34.7%) female—were diagnosed with torticollis. The incidence of a 5-year period was 1.5%. Spontaneous vaginal delivery was prevalent (n = 56; 47.5%), with 106 (89.8%) deliveries with cephalic presentation. 53 (44.9%) cases of torticollis were classified as postural, 37 (31.4%) as muscular torticollis with joint limitation and 28 (23.7%) as congenital torticollis (with the presence of a nodule). Postural torticollis was diagnosed at an average age of 70.14 days, muscular torticollis with joint limitation at an average of 64.12 days and congenital torticollis at 33.25 days (p < 0.001). Plagiocephaly was present in 48 (40.7%) babies with torticollis (p = 0.005) and joint limitation in 53 (44.9%) babies (p < 0.001). The data obtained revealed a low incidence of CMT, with the majority being classified as postural. The age of diagnosis varied between 33 to 70 days from birth. The baby’s gender, mode of delivery and the fetal presentation during delivery did not show a statistically significant association with the presence of torticollis. Despite presenting a low incidence, it is important to mention the importance of professional health intervention in the implementation of prevention strategies.
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Affiliation(s)
- Beatriz Minghelli
- Escola Superior de Saúde Jean Piaget Algarve, Instituto Piaget, 8300-025 Silves, Portugal
- Research in Education and Community Intervention (RECI), Instituto Piaget, 1950-157 Lisbon, Portugal
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Abstract
Torticollis is encountered often in the paediatric setting and should be considered a presenting symptom, rather than a diagnosis. Aetiologies of torticollis are numerous, and the nomenclature describing underlying diagnosis can be confusing. Furthermore, children with torticollis typically present in the first instance to primary or secondary care rather than to the subspecialist. These factors can contribute to erroneous treatment of this patient-group which could be time critical in some instances. In this review, we discuss the common causes for torticollis and propose a simple clinical assessment tool and early management scheme that will assist in the differential-diagnosis and treatment pathway of this challenging condition.Conclusion: Torticollis can be the initial presentation of various conditions. The diagnosis and management tools provided in this article can aid in guiding paediatricians as to the correct initial management, imaging, and specialist referral. What is Known: • Torticollis in childhood is a very common presenting symptom with numerous aetiologies. • Management is complex, requires multiple clinical and imaging examinations, and is usually performed by non-specialized professionals. What is New: • A new, simple clinical-assessment tool under the acronym PINCH designed to aid paediatric general practitioners in diagnosing correctly the aetiology of torticollis. • A practical management scheme to aid in the treatment pathway of children with torticollis.
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Affiliation(s)
- Ido Ben Zvi
- Paediatric Neurosurgery Department, Great Ormond Street Hospital, London, UK.
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16
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Guri A, Scheier E. A 10-year-old child with acute torticollis due to polymicrobial deep neck infection. BMJ Case Rep 2022; 15:e244331. [PMID: 34992062 PMCID: PMC8739054 DOI: 10.1136/bcr-2021-244331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 11/04/2022] Open
Abstract
Torticollis in children can be a sign of a potentially dangerous disease; the correct diagnosis is not always obvious on history and physical examination. The use of point-of-care ultrasound (POCUS) helps to limit the differential diagnosis and direct appropriate further laboratory and radiology-performed evaluation. We present a case of a 10-year-old child whose deep neck infection (DNI) was timely diagnosed in the paediatric emergency department by early use of POCUS and drained under POCUS guidance after admission to the hospital. The culture from the fluid grew Eikenella corrodens, Streptococcus constellatus and Prevotella buccae This case demonstrates that DNIs occur in children with acute acquired torticollis, even without fever and demonstrates the importance of early use of POCUS in cases where DNI is a potential diagnosis. Moreover, this case emphasises the importance of microbiological identification of DNIs that can be the key to successful treatment.
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Affiliation(s)
- Alex Guri
- Pediatrics, Kaplan Medical Center, Rehovot, Israel
- The School of Medicine, The Hebrew University and Hadassah Medical Centre, Jerusalem, Israel
| | - Eric Scheier
- Pediatrics, Kaplan Medical Center, Rehovot, Israel
- The School of Medicine, The Hebrew University and Hadassah Medical Centre, Jerusalem, Israel
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17
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Parikh NS, McClellan N, Koehn M, Ganguli S. Torticollis as a Sole Presentation of Spondyloarthritis in a 4-Year-Old Child. Clin Med Res 2021; 19:203-207. [PMID: 34933953 PMCID: PMC8691425 DOI: 10.3121/cmr.2021.1635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 04/29/2021] [Accepted: 05/04/2021] [Indexed: 11/18/2022]
Abstract
Spondyloarthritis presents in various and occasionally unusual ways that imitates other diseases. Without forthcoming risk factors, such atypical presentation may elude diagnosis for months. The case presented here of a child, aged 4 years, who is negative for human leukocyte antigen B27 (HLA-B27) and with no family history of HLA-B27 related disease, who developed torticollis with neck pain and lymphadenopathy, highlights the necessity of continually evaluating a diagnosis, especially when treatment fails to produce expected results. Painful torticollis in a child with adenopathy often is infectious in nature or potentially due to Griesel syndrome when persistent. Chronic arthritis of the cervical spine may enter the differential diagnosis when torticollis is persistent, and early recognition and aggressive treatment is necessary to prevent permanent functional impairment.
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Affiliation(s)
| | | | - Monica Koehn
- Pediatric Neurology, Marshfield Children's Hospital, Marshfield, Wisconsin, USA
| | - Suhas Ganguli
- Pediatric Rheumatology, Marshfield Children's Hospital, Marshfield, Wisconsin, USA
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18
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Shrestha AB, Rijal P, Sapkota UH, Pokharel P, Shrestha S. Sandifer Syndrome: A Case Report. JNMA J Nepal Med Assoc 2021; 59:1066-1068. [PMID: 35199701 PMCID: PMC9107820 DOI: 10.31729/jnma.6472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Indexed: 12/05/2022] Open
Abstract
Sandifer syndrome is an extra oesophageal manifestation of gastrointestinal reflux disease that usually presents with torticollis and dystonia (often mimicking epilepsy). Here, we describe a case of a four and a half years old child with convulsion, neck contortion, and irritability. Gastrointestinal reflux disease was suspected on the earlier visit of the patient based on the presenting symptom of vomiting and cough. Electroencephalogram revealed normal findings. A barium meal radiograph was performed which was insignificant for gastrointestinal reflux disease and hiatal hernia. Complete blood count showed results suggestive of iron deficiency anaemia, while the rest of the biochemical parameters and the infection screening were normal. The case was confirmed by a medication trial for gastrointestinal reflux disease. This syndrome is often misdiagnosed as infantile seizure and musculoskeletal disorder. So, physicians need to have a sound knowledge of Sandifer Syndrome while assessing a child presenting with convulsion and torticollis.
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Affiliation(s)
| | | | | | - Pashupati Pokharel
- Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
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19
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Karthigeyan M, Salunke P. Neck Tilt in a Child. J Pediatr 2021; 237:308-309. [PMID: 34126120 DOI: 10.1016/j.jpeds.2021.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/04/2021] [Accepted: 06/09/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Madhivanan Karthigeyan
- Department of Neurosurgery, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Pravin Salunke
- Department of Neurosurgery, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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20
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Kim SK, Chang DG, Park JB, Seo HY, Kim YH. Traumatic atlanto-axial rotatory subluxation and dens fracture with subaxial SCIWORA of Brown-Sequard syndrome: A case report. Medicine (Baltimore) 2021; 100:e25588. [PMID: 33879718 PMCID: PMC8078422 DOI: 10.1097/md.0000000000025588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/31/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE A case of traumatic atlanto-axial rotatory subluxation (AARS), dens fracture, rupture of transverse atlantal ligament (TAL), and subaxial spinal cord injury without radiographic abnormality (SCIWORA) of Brown-Sequard syndrome has never been reported in a child. PATIENT CONCERNS A 7-year-old boy presented to hospital with torticollis, neck pain, and limited neck rotation after a seat-belt injury sustained during a car accident. Neurologic examination revealed right-side motor weakness and left-side sensory abnormality, known as Brown-Sequard syndrome. DIAGNOSIS Radiologic examinations revealed type II AARS (Fielding and Hawkins classification), increased atlanto-dental interval (ADI) of 4.5 mm due to a type 1B TAL rupture (Dickman classification), a displaced transverse dens fracture along with an ossiculum terminale, and an intramedullary hemorrhage on the right side of the spinal cord at C3-4. INTERVENTIONS The patient immediately received methylprednisolone, and his motor weakness and sensory abnormality gradually improved. At the same time, the patient underwent initial halter traction for 2 weeks, but he failed to achieve successful reduction and required manual reduction under general anesthesia. OUTCOMES At the 7-month follow-up visit, radiologic examinations showed a corrected type II AARS that was well maintained and normalization of the ADI to 2 mm. The reduced transverse dens fracture was well maintained but still not united. All clinical symptoms were significantly improved, except the remaining motor weakness of the right upper extremity. LESSONS To the best of our knowledge, this is the first report of traumatic AARS, dens fracture, TAL rupture, and subaxial SCIWORA of Brown-Sequard syndrome in a child. Appropriate diagnosis and careful treatment strategy are required for successful management of complex cervical injuries in a child.
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Affiliation(s)
- Sung-Kyu Kim
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, Gwangju
| | - Dong-Gune Chang
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University
| | - Jong-Beom Park
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyoung-Yeon Seo
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, Gwangju
| | - Yun Hwan Kim
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Isogai N, Matsui I, Sasao Y, Nishiyama M, Funao H, Ishii K. A Rare Case of Nontraumatic Atlantoaxial Rotatory Fixation in an Adult Patient Treated by a Closed Reduction: A Case Report. JBJS Case Connect 2021; 11:01709767-202103000-00024. [PMID: 33599465 DOI: 10.2106/jbjs.cc.20.00675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 42-year-old woman presented with a severe neck pain and torticollis due to uncertain etiology. Because her radiographs and computed tomography revealed atlantoaxial rotatory fixation (AARF) that is an extremely rare condition in the adult population, a nonsurgical treatment was initially applied. Because 3 weeks of indirect traction failed, closed reduction was performed under general anesthesia at 2 months after onset, and her symptoms markedly improved without any complications and recurrence. CONCLUSION Closed reduction under general anesthesia for nontraumatic AARF in adult patients might be an effective treatment option, even for chronic cases or intractable cases by traction treatment.
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Affiliation(s)
- Norihiro Isogai
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Narita, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Mita Hospital, Tokyo, Japan
| | - Izumi Matsui
- Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Mita Hospital, Tokyo, Japan
| | - Yutaka Sasao
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Narita, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Mita Hospital, Tokyo, Japan
| | - Makoto Nishiyama
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Narita, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Mita Hospital, Tokyo, Japan
| | - Haruki Funao
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Narita, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Mita Hospital, Tokyo, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Narita Hospital, Narita, Japan
| | - Ken Ishii
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Narita, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Mita Hospital, Tokyo, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Narita Hospital, Narita, Japan
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Affiliation(s)
| | - Deepti Suri
- From the Department of Pediatrics, Advances Pediatrics Center
| | - Anindita Sinha
- Department of Radio-Diagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Amit Rawat
- From the Department of Pediatrics, Advances Pediatrics Center
| | - Surjit Singh
- From the Department of Pediatrics, Advances Pediatrics Center
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23
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Li J, Wang T, Richard SA, Zhang C, Xie X, Wang C. Bilateral pediatric pial arteriovenous fistulas accompanying a giant arachnoid cyst with torticollis: A case report. Medicine (Baltimore) 2020; 99:e20991. [PMID: 32590813 PMCID: PMC7328906 DOI: 10.1097/md.0000000000020991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/11/2020] [Accepted: 05/29/2020] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Pial arteriovenous fistula (PAVF) occurs when intracranial arteries communicate directly with veins. PAVFs are very rare congenital vascular lesions that are commonly seen in infants and children. Arachnoid cysts are congenital cavitation often filled with cerebrospinal fluid. We present a very rare associated occurrence of bilateral pediatric PAVF and a giant arachnoid cyst presenting as torticollis in a child. So far, this is the first case. PATIENT CONCERNS A 6-year-old male child was referred to our facility from a local hospital due to severe torticollis. DIAGNOSES An enhanced computed tomography scan revealed 2 slightly high-density masses at the anterior pontine cistern, right circumferential cistern, as well as left posterior occipital region. The same computed tomography scan revealed a giant arachnoid cyst in the left occipital as well as the temporal region with a thin cerebral cortex adjacent to the cyst. INTERVENTIONS Digital subtraction angiography confirmed that the 2 high-flow lesions were PAVFs. The patient was treated with a combination of detachable coils and Onyx Liquid Embolic System (Onyx HD-500) (Covidien/ev3 Neurovascular) via the transarterial endovascular route while the giant arachnoid cyst was managed conservatively. OUTCOMES The torticollis resolved 2 days after the procedure. He is currently well with no neurologic deficit. LESSONS We advocate that in cases of PAVF with accompanying cyst, the cyst should be managed conservatively if it is not associated with intracranial hemorrhage or focal neurologic deficit.
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Affiliation(s)
- Junrao Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ting Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Seidu A. Richard
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
- Department of Medicine, Princefield University, Ho-Volta Region, Ghana West Africa
| | - Changwei Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaodong Xie
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chaohua Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
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24
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Hansen OM, Nikitina OH, Longin E. [Grisel's syndrome causing torticollis in children]. Ugeskr Laeger 2019; 181:V01190028. [PMID: 31495358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This is a case report of an eight-year-old boy with CT-confirmed changes bringing attention to Grisel's syndrome as a differential diagnosis to torticollis. The syndrome - also known as atlantoaxial subluxation - is a complication to operations or infections in the ear, nose and throat region. It usually presents as a slightly flexed and rotated neck, and characteristic radiographic findings. Complications include neurological symptoms and rarely spinal cord compression. The treatment is debated, but it takes the underlying cause and immobilisation in consideration. In severe cases, repositioning in general anaesthesia or even surgical fusion may be necessary.
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25
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Falsaperla R, Piattelli G, Marino S, Marino SD, Fontana A, Pavone P. Grisel's syndrome caused by Mycoplasma pneumoniae infection: a case report and review of the literature. Childs Nerv Syst 2019; 35:523-527. [PMID: 30209598 DOI: 10.1007/s00381-018-3970-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/04/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Grisel's syndrome is a non-traumatic subluxation of the atlantoaxial joints, which is caused by an inflammatory process involving the upper neck. Torticollis, neck pain, and reduced neck mobility are the main clinical signs of presentation. Predisposing factors are trauma, hyperlaxity of the transverse and alar ligaments of the atlantoaxial joints, and surgical interventions carried out in this area. Several viral and bacterial pathogens have been reported as causative events of Grisel's syndrome, including Epstein-Barr virus, Kawasaki disease, Streptococcus pyogenes, Staphylococcus aureus, and other infectious agents. Grisel's syndrome linked to Mycoplasma pneumoniae infection as the trigger has not previously been reported. Mycoplasma pneumoniae is a small prokaryotic microbe and a frequent etiologic factor of respiratory tract infections and, less frequently, of extrapulmonary body organs. The recognition of the Grisel's syndrome is based on clinical and neuroradiological investigations, and early diagnosis and specific treatment are crucial to the successful outcome of the disease. RESULTS We report the case of an 8-year-old girl with Grisel's syndrome caused by an upper respiratory tract infection due to Mycoplasma pneumoniae. Diagnostic suspicion and treatment of Grisel's syndrome were established quickly by anamnestic and clinical data and confirmed by radiological findings. The girl was immediately treated with specific antibiotic therapy and cervical immobilization, thus preventing the most dangerous complications of the disorder. CONCLUSION Mycoplasma pneumoniae, among the other infectious agents, may be cause of scute torticollis and Gresel's syndrome.
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Affiliation(s)
- Raffaele Falsaperla
- Pediatric Emergency Department, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Gianluca Piattelli
- Department of Neurosurgery, University Hospital "Giannina Gaslini", Genoa, Italy
| | - Silvia Marino
- Pediatric Emergency Department, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Simona Domenica Marino
- Pediatric Emergency Department, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Alessandra Fontana
- Department of Pediatrics, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Piero Pavone
- Department of Pediatrics, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy.
- Department of Pediatrics, AOU Policlinico-Vittorio Emanuele, University of Catania, Via S. Sofia 78, 95123, Catania, Italy.
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26
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Ruff MW, Bhargav AG, Raghunathan A. A case of epidural glioblastoma metastasis presenting with a cervical myelopathy, torticollis, and L'hermitte's phenomenon. Brain Tumor Pathol 2018; 35:181-185. [PMID: 29744614 DOI: 10.1007/s10014-018-0319-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 04/30/2018] [Indexed: 12/31/2022]
Abstract
Extraneural glioblastoma metastases are exceedingly rare, though previously described in the literature. Activating mutations in the BRAF kinase gene (V600E) are present in a minority of glioblastoma patients. Here, we describe a case of systemic metastases of a clonal subpopulation of BRAF V600E mutated glioblastoma in a patient previously treated with surgery, radiation, temozolomide and bevacizumab. The patient presented with a subacute cervical myelopathy during adjuvant treatment. He underwent emergent surgical decompression of an epidural spine metastasis. Analysis of the metastatic tumor demonstrated clonal expansion of a BRAF V600E subpopulation. Though rare, systemic metastasis of glioblastoma should be considered in patients presenting with subacute complaints in line with a mass lesion.
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Affiliation(s)
- Michael W Ruff
- Department of Neurology, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA.
| | - Adip G Bhargav
- Mayo Clinic School of Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Aditya Raghunathan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
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27
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Affiliation(s)
- Tomohiro Sonoo
- Emergency Medicine and Critical Care Medicine Department, University of Tokyo Hospital, Tokyo, Japan
| | - Takuya Sato
- Emergency Medicine and Critical Care Medicine Department, University of Tokyo Hospital, Tokyo, Japan
| | - Shota Den
- Emergency Medicine and Critical Care Medicine Department, University of Tokyo Hospital, Tokyo, Japan; Department of Orthopedic Surgery, University of Tokyo Hospital, Tokyo, Japan
| | - Ryota Inokuchi
- Department of General and Emergency Medicine, JR Tokyo General Hospital, Tokyo, Japan
| | - Takehiro Matsubara
- Emergency Medicine and Critical Care Medicine Department, University of Tokyo Hospital, Tokyo, Japan; Department of Orthopedic Surgery, University of Tokyo Hospital, Tokyo, Japan
| | - Susumu Nakajima
- Emergency Medicine and Critical Care Medicine Department, University of Tokyo Hospital, Tokyo, Japan
| | - Naoki Yahagi
- Emergency Medicine and Critical Care Medicine Department, University of Tokyo Hospital, Tokyo, Japan
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28
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Teranishi Y, Shin M, Yoshino M, Saito N. Solitary Langerhans cell histiocytosis of the occipital condyle: a case report and review of the literature. Childs Nerv Syst 2016; 32:399-404. [PMID: 26307358 DOI: 10.1007/s00381-015-2850-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 07/19/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Despite the recent advent of various radiographic imaging techniques, it is still very difficult to correctly distinguish a pediatric osteolytic lesion in the occipital condyle, which makes it further complicated to decide on the necessity of and the adequate timing for radical resection and craniocervical fusions. To establish a legitimate therapeutic strategy for this deep-seated lesion, surgical biopsy is a reasonable choice for first-line intervention. The choice of surgical approach becomes very important because a sufficient amount of histological specimen must be obtained to confirm the diagnosis but, ideally, the residual bony structures and the muscular structures should be preserved so as not to increase craniocervical instability. In this report, we present our experience with a case of solitary Langerhans cell histiocytosis (LCH) involving the occipital condyle that was successfully treated with minimally invasive surgical biopsy with a far lateral condylar approach supported by preoperative 3D computer graphic simulation. CASE REPORT An 8-year-old girl presented with neck pain. Magnetic resonance imaging and computed tomography (CT) revealed an osteolytic lesion of the left occipital condyle. At surgery, the patient was placed in the prone position. A 3-cm skin incision was made in the posterior auricular region, and the sternocleidomastoid and splenius capitis muscles were dissected in the middle of the muscle bundle along the direction of the muscle fiber. Under a navigation system, we approached the occipital condyle through the space between the longissimus capitis muscle and the posterior belly of the digastric muscle and lateral to the superior oblique muscle, verifying each muscle at each depth of the surgical field and, finally, obtained sufficient surgical specimen. After the biopsy, her craniocervical instability had not worsened, and chemotherapy was performed. Twelve weeks after chemotherapy, her neck pain had gradually disappeared along with her torticollis, and CT showed remission of the lesion and marked regeneration of the left occipital condyle. Within our knowledge, this is the first reported case of LCH involving the occipital condyle. Although very rare, our case indicated that LCH can be an alternative in the differential diagnosis of osteolytic lesions in the craniocervical junction, in which early bone regeneration with sufficient cervical stability is expected after chemotherapy. CONCLUSIONS In cases of pediatric osteolytic lesions, when they initially presented with apparent cervical instability, craniocervical fusion may possibly become unnecessary after a series of treatments. Thus, the effort to maximally preserve the musculoskeletal structure should be made until its histological diagnosis is finally confirmed.
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Affiliation(s)
- Yu Teranishi
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-7655, Japan.
| | - Masahiro Shin
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-7655, Japan
| | - Masanori Yoshino
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-7655, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-7655, Japan
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29
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Arslan M, Gungor A, Akın O, Unay B, Yavuz ST. A rare complication of wasp sting: acute cervical dystonia. Childs Nerv Syst 2015; 31:2213-4. [PMID: 26499128 DOI: 10.1007/s00381-015-2939-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 10/15/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Mutluay Arslan
- Department of Pediatric Neurology, GATA Military School of Medicine, Ankara, Turkey.
| | - Ali Gungor
- Department of Pediatrics, GATA Military School of Medicine, Ankara, Turkey.
| | - Onur Akın
- Department of Pediatrics, GATA Military School of Medicine, Ankara, Turkey.
| | - Bulent Unay
- Department of Pediatric Neurology, GATA Military School of Medicine, Ankara, Turkey.
| | - Suleyman Tolga Yavuz
- Department of Pediatric Allergy and Immunology, GATA Military School of Medicine, 06018, Ankara, Turkey.
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30
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Tsuji S, Inoue S, Tachibana T, Maruo K, Arizumi F, Yoshiya S. Post-Traumatic Torticollis Due to Odontoid Fracture in a Patient With Diffuse Idiopathic Skeletal Hyperostosis: A Case Report. Medicine (Baltimore) 2015; 94:e1478. [PMID: 26356707 PMCID: PMC4616647 DOI: 10.1097/md.0000000000001478] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Descriptive case report.To report a rare case of post-traumatic torticollis by odontoid fracture in a patient with diffuse idiopathic skeletal hyperostosis (DISH).Cervical fractures in DISH can result from minor trauma, and a delay in presentation often prevents their timely diagnosis. Cervical fractures in patients with spinal DISH usually occur in extension injuries, and almost always occur in the lower cervical spine. Reports of odontoid fractures with torticollis in patients with spinal DISH are rare.A 73-year-old man with DISH presented with severe neck pain and a cervical deformity presenting as torticollis without neurological deficits. He gave a history of a fall while riding a bicycle at a low speed 3 months ago. X-ray showed torticollis in the right side, and computed tomography (CT) showed a type-II odontoid fracture and subluxation at the C1-2 level.We performed a staged treatment because this patient had severe neck pain associated with a chronic course. Initially, the fracture dislocation was reduced under general anesthesia and was stabilized with a halo vest. We then performed posterior occipitocervical in situ fusion after confirming the correction of the cervical deformity by CT. The patient showed significant amelioration of neck symptoms postoperatively, and bony fusion was achieved 1 year after surgery.For post-traumatic torticollis due to an odontoid fracture, plain CT is useful for diagnosis and posterior occipitocervical in situ fusion following correction and immobilization with a halo vest is a safe and an effective treatment.
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Affiliation(s)
- Shotaro Tsuji
- From the Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
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Affiliation(s)
- Alfonso Giordano
- From the Second University of Naples (A.G., G.T., A.T.) and the Institute for Diagnosis and Care "Hermitage Capodimonte" (A.G.), Naples, Italy
| | - Gioacchino Tedeschi
- From the Second University of Naples (A.G., G.T., A.T.) and the Institute for Diagnosis and Care "Hermitage Capodimonte" (A.G.), Naples, Italy
| | - Alessandro Tessitore
- From the Second University of Naples (A.G., G.T., A.T.) and the Institute for Diagnosis and Care "Hermitage Capodimonte" (A.G.), Naples, Italy.
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Diamond SG, Markham CH, Baloh RW. Vestibular involvement in spasmodic torticollis: an old hypothesis with new data from otolith testing. Adv Otorhinolaryngol 2015; 42:219-23. [PMID: 3265014 DOI: 10.1159/000416110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- S G Diamond
- Department of Neurology, UCLA School of Medicine
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Nevitt BN, Robinson N, Kratz G, Johnston MS. Effectiveness of Physical Therapy as an Adjunctive Treatment for Trauma-induced Chronic Torticollis in Raptors. J Avian Med Surg 2015; 29:30-9. [PMID: 25867664 DOI: 10.1647/2014-003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Management of trauma-induced chronic torticollis in raptors has historically been challenging. Euthanasia is common in affected birds because of their inability to maintain normal cervical position, although they may be able to function normally. To assess effectiveness of physical therapy of the neck and head as an adjunct treatment for this condition, a case-control study was done in raptors admitted to the Rocky Mountain Raptor Program from 2003 to 2010. Eleven cases were identified with a diagnosis of chronic torticollis resulting from traumatic brain injury. Five cases were treated with physical therapy of the head and neck, and 6 control cases did not receive any physical therapy for the torticollis. Of the control cases, 0 of 6 had resolution of the torticollis, 0 of 6 were released, and 5 of 6 were euthanatized. Of the treated cases, 4 of 5 had complete resolution of the torticollis and 5 of 5 were released. Resolution of torticollis differed significantly between cases receiving physical therapy and controls. These results indicate that physical therapy should be used as an adjunctive therapy in cases of chronic torticollis induced by trauma in raptors because it results in better resolution of the torticollis and increased likelihood of release.
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Jemni S, Frioui S. Torticolis de l’enfant révélant une tumeur médullaire. Pan Afr Med J 2015; 21:26. [PMID: 26401220 PMCID: PMC4561146 DOI: 10.11604/pamj.2015.21.26.6944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 05/08/2015] [Indexed: 11/11/2022] Open
Affiliation(s)
- Sonia Jemni
- Service de Médecine Physique et de Réadaptation Fonctionnelle, CHU Sahloul, Faculté de Médecine « Ibn El Jazzar », Sousse, Tunisie
| | - Samia Frioui
- Service de Médecine Physique et de Réadaptation Fonctionnelle, CHU Sahloul, Faculté de Médecine « Ibn El Jazzar », Sousse, Tunisie
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Abstract
A 9-year-old boy was pushed while carrying a heavy backpack. He had no fall or direct trauma to his neck. After a few hours from the incident, he presented with neck pain and torticollis. However, somewhat atypical for torticollis, he was not able to rotate his face to the neutral position. There were no neurological deficits. Concerned by his inability to rotate his neck, the clinician suggested CT of the upper cervical spine, which demonstrated rotary subluxation of the atlantoaxial junction. The patient was taken to the operating theatre. Reduction was performed under general anaesthesia. He did well and was back to school in the following days.
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Affiliation(s)
- Kosar Hussain
- Department of Internal Medicine, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
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Cafarotti A, Bascietto C, Salvatore R, Breda L, Chiarelli F, Piernicola P. A 6-month-old boy with uncontrollable dystonic posture of the neck. Sandifer syndrome. Pediatr Ann 2014; 43:17-9. [PMID: 24549078 DOI: 10.3928/00904481-20131223-05] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Merino ML, Gómez de Liaño P, Merino P, Franco G. [Duane vertical surgical treatment]. ACTA ACUST UNITED AC 2013; 89:170-2. [PMID: 24269466 DOI: 10.1016/j.oftal.2012.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 10/05/2012] [Accepted: 10/22/2012] [Indexed: 11/18/2022]
Abstract
CASE REPORT We report 3 cases with a vertical incomitance in upgaze, narrowing of palpebral fissure, and pseudo-overaction of both inferior oblique muscles. Surgery consisted of an elevation of both lateral rectus muscles with an asymmetrical weakening. A satisfactory result was achieved in 2 cases, whereas a Lambda syndrome appeared in the other case. DISCUSSION The surgical technique of upper-insertion with a recession of both lateral rectus muscles improved vertical incomitance in 2 of the 3 patients; however, a residual deviation remains in the majority of cases.
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Affiliation(s)
- M L Merino
- Sección de Motilidad Ocular, Departamento de Oftalmología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - P Gómez de Liaño
- Sección de Motilidad Ocular, Departamento de Oftalmología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - P Merino
- Sección de Motilidad Ocular, Departamento de Oftalmología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - G Franco
- Sección de Motilidad Ocular, Departamento de Oftalmología, Hospital General Universitario Gregorio Marañón, Madrid, España
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Abstract
We report on a case of a 65-year-old (CD) woman who sustained an atraumatic neck fracture. A combination of Parkinson's disease with motor fluctuations, chronic cervical dystonia and osteoporosis provided the basis for this interesting diagnosis. Mrs CD had progressed to complex phase idiopathic Parkinson's disease within 13 years of diagnosis. During this time she remained independent, only using a wheelchair when her motor fluctuations were bad. In 2011, she developed a sudden onset of neck spasm and occipital neuralgia, initially attributed to severe spasmodic cervical dystonia. Despite a titration regime of analgesics and weaning off of her Parkinson's disease medications, the pain persisted. An X-ray of her cervical spine showed degenerative discopathies from C4 to C7. Mrs CD underwent a trial of Botox injections to no avail and she was admitted acutely under the spinal team after an MRI of her spine showed abnormal oedema of the odontoid peg. Subsequent CT diagnosed a type II fracture of the odontoid peg on the background of severe osteoporotic bone (spinal T score -3.4 on subsequent DEXA scan) and she underwent a successful occipital cervical fusion of C1-C6. What makes this case interesting is the fact that this lady's profound powerful neck movements on a background of osteoporosis led to fracture of her neck. Post-operatively, she admitted to non-adherence to her bisphosphonates, prioritising levodopa in the morning with food rather than taking her alendronate on an empty stomach. She is now pain free and receives annual zolendronate infusions.
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Affiliation(s)
- Caroline Ostrowski
- Royal Devon and Exeter Hospital, Geriatric Medicine, William Wright House Barrack Road, Exeter EX2 5 DW, UK.
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Ren CH, Fang F. [Spasmus nutans]. Zhonghua Er Ke Za Zhi 2013; 51:635-637. [PMID: 24225300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Terao K, Kusunoki T, Mori K, Murata K, Doi K. A case of calcific retropharyngeal tendinitis: the significance of an early diagnosis. Ear Nose Throat J 2013; 92:74-83. [PMID: 23460215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
The clinical presentation of calcific retropharyngeal tendinitis, a rare entity, can mimic more serious disorders. We describe the case of a 35-year-old man who was referred to us for evaluation of a suspected retropharyngeal abscess. At presentation, the patient reported severe cervical pain and stiffness. He exhibited mild fever, torticollis, and a moderately elevated white blood count; no swelling of the retropharyngeal wall was observed. Based on the results of plain radiography and computed tomography (CT), we diagnosed the patient with calcific retropharyngeal tendinitis. He was treated with a 7-day course of a nonsteroidal anti-inflammatory drug and a 3-day course of a steroid, and he recovered well. We suggest that the true incidence of calcific retropharyngeal tendinitis is actually higher than what is generally believed because this diagnosis is frequently missed. Contrast-enhanced CT can aid in diagnosing calcific retropharyngeal tendinitis. CT should be performed in patients who present with nonspecific symptoms such as severe neck pain, sore throat, odynophagia, and mild fever.
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Affiliation(s)
- Kyoichi Terao
- Department of Otolaryngology, Kinki University Faculty of Medicine, Osaka, Japan.
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van Breemen MSM, van der Kuip M, Ang CW, van Furth AM, Wolf NI. [Torticollis and seizures due to neuroborreliosis in a child]. Ned Tijdschr Geneeskd 2012; 156:A5157. [PMID: 23249509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND In children, neuroborreliosis often manifests itself as cranial neuritis (particularly facial palsy) or aseptic meningitis. Presentation with torticollis and simple partial seizures resulting from diffuse leptomeningeal inflammation is rare. CASE DESCRIPTION A seven-year-old boy who had developed torticollis and partial seizures, lost weight and was complaining of tiredness was seen by a paediatric neurologist. A brain and spinal cord MRI showed diffuse leptomeningeal enhancement, in combination with a hyperintense cervical cord lesion. Laboratory testing of serum and cerebrospinal fluid confirmed the diagnosis of neuroborreliosis. The boy was treated with intravenous ceftriaxone for 30 days and made a full recovery. CONCLUSION As illustrated by this case neuroborreliosis can manifest itself atypically with torticollis, seizures and diffuse leptomeningeal enhancement due to inflammation. If there is leptomeningeal enhancement on MRI then neuroborreliosis should be included in the differential diagnosis. In childhood neuroborreliosis can be successfully treated and the prognosis is good.
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Mittal R, Sharma V. Cervical spine injury--a rare cause of torticollis. Indian Pediatr 2011; 48:989-990. [PMID: 22253166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Al Kaissi A, Ganger R, Hofstaetter JG, Klaushofer K, Grill F. The aetiology behind torticollis and variable spine defects in patients with Müllerian duct/renal aplasia-cervicothoracic somite dysplasia syndrome: 3D CT scan analysis. Eur Spine J 2011; 20:1720-7. [PMID: 21553338 PMCID: PMC3175860 DOI: 10.1007/s00586-011-1835-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 03/17/2011] [Accepted: 04/25/2011] [Indexed: 10/18/2022]
Abstract
The aim of the article is fourfold; firstly, to detect the aetiology of torticollis in patients with Müllerian duct/renal aplasia-cervicothoracic somite dysplasia syndrome; secondly, spine pathology in Müllerian duct/renal aplasia-cervicothoracic somite dysplasia syndrome varies considerably from one patient to another and there are remarkable differences in severity and localization; thirdly, mismanagement of congenital spine pathology is a frequent cause of morbid/fatal outcome; and fourthly, the application of prophylactic surgical treatment to balance the growth of the spine at an early stage is mandatory. Reformatted CT scans helped in exploring the craniocervical and the entire spine in these patients. The reason behind torticollis ranged between aplasia of the posterior arch of the atlas, assimilation of the atlas and extensive fusion of the lower cervical vertebrae (bilateral failure of segmentation) in four patients; in one patient, in addition to the hypoplastic posterior arch of the atlas, we observed ossification of the anterior and the posterior longitudinal spinal ligaments giving rise to a block vertebrae-like suggestive of early senile ankylosing vertebral hyperostosis (Forestier disease). Scoliosis at different spine levels was attributable to variable spine defects. Pelvic ultrasound showed the classical renal agenesis in four patients; whereas in one patient, the MRI showed pelvic cake kidney (renal fused ectopia) associated with ovarian, uterine and vaginal abnormalities. This is the first exploratory study on the craniocervical and the entire spine in a group of patients with MURCS association.
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Affiliation(s)
- Ali Al Kaissi
- 4th Medical Department, Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK, AUVA Trauma Centre Meidling, Hanusch Hospital, Heinrich Collin Str. 30, 1140 Vienna, Austria.
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Persefonis G, Karaiskos D, Tzavelas E, Paparrigopoulos T. [The spectrum of Tourette Syndrome and difficulties in differential diagnosis: a case report]. Psychiatriki 2011; 22:249-253. [PMID: 21971200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Tourette syndrome (TS) is a neurodevelopmental disorder characterized by early onset motor and vocal tics. TS should be differentiated from various movement disorders. We report the case of a 21 year-old-man who was admitted to our clinic due to treatment resistant cervical dystonia attributed to neuroleptics. During the last five years he had been treated for depressed mood, somatic delusions and aggressive behaviour. He had been given SSRIs and atypical antipsychotics at low doses; six months prior to his admission he had been switched to risperidone. Clinical examination revealed torticollis, motor stereotypies, vocal tics (sniffing, repetition of words), mental koprolalia and obsessive-compulsive symptoms. He complained of repetitive intrusive thoughts of harming his sister and thoughts of a "delusional" nature regarding somatic complaints. The patient was diagnosed as TS and was successfully treated accordingly. The presented case illustrates that TS can mimic other movement disorders. Whether patients with TS are at higher risk of developing dystonia, or tics and dystonia share a common pathophysiological mechanism (dopamine-inhibiting processes are probably involved in both conditions) is still debatable.
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Affiliation(s)
- G Persefonis
- 1st Psychiatric Department, University of Athens, Athens, Greece
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Taddio A, Pellegrin MC, Gregori M, Wientroub S, Padeh S, Lepore L. Atlanto-axial joint involvement as exclusive manifestation of juvenile idiopathic arthritis (JIA). Clin Exp Rheumatol 2011; 29:755. [PMID: 21906438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 03/18/2011] [Indexed: 05/31/2023]
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Becher T. ["My child frequently twists his head...!" Sandifer syndrome - not just a rare occurrence]. Kinderkrankenschwester 2011; 30:153-156. [PMID: 21744568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Thomas Becher
- Kinderneurologischen Zentrum, Düsseldorf-Gerresheim, Sana Kliniken Düsseldorf.
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Aggarwal A, Kumar R, Sharma RC, Sharma DD. Persistent dystonia following opioid withdrawal. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:640. [PMID: 20685372 DOI: 10.1016/j.pnpbp.2010.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2010] [Revised: 05/25/2010] [Accepted: 05/26/2010] [Indexed: 11/16/2022]
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Magden ER, Weiner CM, Gilliland JC, DeGroote MA, Lenaerts AJ, Kendall LV. Torticollis in mice intravenously infected with Mycobacterium tuberculosis. J Am Assoc Lab Anim Sci 2011; 50:244-7. [PMID: 21439219 PMCID: PMC3061426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 09/17/2010] [Accepted: 09/30/2010] [Indexed: 05/30/2023]
Abstract
Female BALB/cAnNCrl (n = 170; age, 6 to 9 wk) mice were infected by intravenous inoculation of 5 × 10(6) cfu Mycobacterium tuberculosis strain Erdman (ATCC 35801). Between day 52 and 5 mo after infection, 10 of the 170 mice infected according to this protocol developed torticollis, including mice in treatment groups that received combination antibiotic therapy of rifampin-pyrazinamide or moxifloxacin-rifampin-pyrazinamide. Torticollis did not develop in mice receiving isoniazid- rifampin-pyrazinamide therapy, nor was it present in the cohort of aerogenically infected mice. Affected mice were euthanized, and complete necropsy evaluation was performed on 4 mice. Gross necropsy evaluation revealed typical tuberculosis lesions in lungs of infected mice. Histologic evaluation of tissues revealed granulomatous otitis media with intralesional acid-fast bacilli consistent with Mycobacterium tuberculosis. These cases represent an unusual finding specific to the intravenous mouse model of Mycobacterium tuberculosis and may represent a model of a similar condition in humans that is known as tuberculous otitis media.
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Affiliation(s)
- Elizabeth R Magden
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Cristina M Weiner
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Janet C Gilliland
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Mary Ann DeGroote
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Anne J Lenaerts
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Lon V Kendall
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
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