97 results on '"Torticollis etiology"'
Search Results
2. CV Junction Drug-Resistant Tuberculosis Presenting as Acquired Torticollis: A Rare Case Presentation.
- Author
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Synmon B, Siangshai F, Nongrum H, and Wezah W
- Subjects
- Humans, Male, Antitubercular Agents therapeutic use, Adult, Torticollis drug therapy, Torticollis etiology, Tuberculosis, Multidrug-Resistant drug therapy, Tuberculosis, Multidrug-Resistant diagnosis
- Published
- 2024
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3. Pediatric torticollis: clinical report and predictors of urgency of 1409 cases.
- Author
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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, and Villani A
- Subjects
- Humans, Male, Female, Retrospective Studies, Child, Preschool, Child, Risk Factors, Infant, Hospitalization statistics & numerical data, Adolescent, Torticollis epidemiology, Torticollis etiology, Torticollis diagnosis, Emergency Service, Hospital
- 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., (© 2024. The Author(s).)
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- 2024
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4. Early recognition of unilateral absence of sternocleidomastoid muscle in a newborn presenting with contralateral congenital torticollis.
- Author
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Padre JA, Callaghan H, Lim R, and Thomas N
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- Infant, Newborn, Humans, Neck Muscles diagnostic imaging, Torticollis etiology, Torticollis congenital
- Abstract
Competing Interests: Competing interests: None declared.
- Published
- 2023
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5. PAllidal versus SubThalamic deep brain Stimulation for Cervical Dystonia (PASTS-CD): study protocol for a multicentre randomised controlled trial.
- Author
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Liu B, Xu J, Yang H, Yu X, and Mao Z
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- Humans, Globus Pallidus surgery, Quality of Life, Prospective Studies, Treatment Outcome, Randomized Controlled Trials as Topic, Multicenter Studies as Topic, Torticollis therapy, Torticollis etiology, Deep Brain Stimulation methods
- 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., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2023
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6. Neck stiffness and bone osteolytic lesion in a 3-years old child: a case report.
- Author
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Carraro C, Rabusin M, Murru FM, Ammar L, Barbi E, Amaddeo A, and Cozzi G
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- Infant, Female, Humans, Child, Child, Preschool, Tomography, X-Ray Computed, Catecholamines, Torticollis diagnostic imaging, Torticollis etiology, Bone Diseases, Neuroblastoma diagnosis, Neuroblastoma diagnostic imaging
- 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., (© 2023. Società Italiana di Pediatria.)
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- 2023
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7. [Atlantoaxial rotatory subluxation - a cause of torticollis in children].
- Author
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Åkerstedt J, Karlsson C, and Guez M
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- Humans, Child, Child, Preschool, Radiography, Magnetic Resonance Imaging, Torticollis diagnostic imaging, Torticollis etiology, Atlanto-Axial Joint diagnostic imaging, Atlanto-Axial Joint pathology, Atlanto-Axial Joint surgery, Joint Dislocations diagnosis, Joint Dislocations diagnostic imaging
- Abstract
Atlantoaxial rotatory subluxation is an important differential diagnosis in young children with torticollis. The condition rarely results in neurological deficits. Radiological examinations such as computer tomography (CT) and magnetic resonance imaging (MRI) are useful to determine the diagnosis. It is important for doctors in all areas of healthcare to be aware of the condition, as persistent problems or surgery can be avoided by early detection and treatment.
- Published
- 2023
8. Posterior Surgery in the Treatment of Craniovertebral Junction Deformity with Torticollis.
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Du J, Gao X, Huang Y, Yang X, Zheng B, Liu Z, Hui H, Gao L, Wu J, Zhao Z, He B, Yan L, and Hao D
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- Humans, Postoperative Complications, Retrospective Studies, Treatment Outcome, Spinal Fusion methods, Torticollis etiology, Torticollis surgery
- Abstract
Objective: To investigate the clinical effect of posterior surgery in the treatment of craniovertebral junction (CVJ) deformities with torticollis and methods for preventing and treating complications in order to obtain a reasonable treatment strategy., Methods: From January 2007 to December 2017, 78 patients who suffered from CVJ deformities with torticollis treated by posterior surgery were analyzed. The surgical techniques were all posterior correction and fusion to restore the anatomical alignment of the craniovertebral junction. The visual analog score (VAS) and Short Form-36 (SF-36) health survey questionnaire were utilized to evaluate preoperative and postoperative neck pain, and changes in the torticollis angle and atlas-dens interval (ADI) were evaluated through anteroposterior X-ray and computed tomography. Intra- and postoperative complications were all recorded. One-way ANOVA, LSD-t test, and χ
2 test were performed to evaluate the difference between the preoperative and postoperative data., Results: The mean follow-up time was 37.4 ± 15.7 months, the average operation time was 115.6 ± 12.8 min, and the average blood loss was 170.8 ± 26.3 mL. According to the deformity site, the range of posterior correction and fusion was as follows: 38 cases of C1 -C2 , 33 cases of C0 -C2 , and seven cases of C0 -C3 . The preoperative SF-36, VAS, torticollis angle, and ADI were 42.6 ± 8.8, 4.8 ± 1.1, 37.2 ± 11.2°, and 4.9 ± 2.3 mm, respectively. The difference was significant at 3 months post operation (p < 0.05), and there was no significant difference at the final follow-up compared with 3 months post operation (p > 0.05)., Conclusion: It can objectively achieve favorable correction and satisfactory clinical effects under posterior correction and fixation for CVJ deformities with torticollis. Intra- and postoperative complications can be settled by proper management., (© 2022 The Authors. Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.)- Published
- 2022
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9. Incidence of Congenital Muscular Torticollis in Babies from Southern Portugal: Types, Age of Diagnosis and Risk Factors.
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Minghelli B and Vitorino NGD
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- Aged, Child, Female, Humans, Incidence, Infant, Male, Portugal epidemiology, Pregnancy, Risk Factors, Muscular Diseases complications, Torticollis complications, Torticollis congenital, Torticollis etiology
- 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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- 2022
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10. Torticollis, Facial Asymmetry, Local Pain, and Barré-Liéou Syndrome in Connection with One-Sided Ponticulus Posticus: A Case Report and Review of the Literature.
- Author
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Li G, Wang Q, and Wang G
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- Adult, Facial Asymmetry etiology, Facial Asymmetry surgery, Humans, Male, Pain, Quality of Life, Young Adult, Cervical Atlas abnormalities, Cervical Atlas diagnostic imaging, Cervical Atlas surgery, Posterior Cervical Sympathetic Syndrome, Torticollis diagnostic imaging, Torticollis etiology, Torticollis surgery
- Abstract
Background: Ponticulus posticus (PP) occurs frequently and may cause symptom series, including vertebrobasilar insufficiency, migraine, hearing loss, and Barré-Liéou syndrome. However, few studies to date have described surgical treatment of PP. We report a rare case of a patient who suffered from torticollis, facial asymmetry, localized pain, and Barré-Liéou syndrome in connection with PP. We also review the pertinent literature, focusing on surgical treatment for symptoms due to PP., Case Presentation: A 23-year-old male presented with the chief complaint of continuous significant dizziness to the point of losing consciousness while rotating his head to the right. Plain radiographs and computed tomography (CT) scans of the cervical spine showed a С1 anomaly with the formation of complete PP on the left (dominant) side, with acute-angled, С-shaped kinking of the vertebral artery. Resection of PP via the posterior midline was performed successfully. The patient had satisfactory postoperative relief from localized pain and Barré-Liéou syndrome, but there were no obvious changes in the torticollis and facial asymmetry observed during the 3-month follow-up period., Conclusions: This case is a rare presentation of torticollis, facial asymmetry, localized pain, and Barré-Liéou syndrome in connection with one-sided complete PP. This tetrad indicates that PP may affect the patient earlier than expected. In such situations, early diagnosis and timely surgical treatment may significantly improve patients' quality of life and avoid the development of torticollis and face asymmetry., (© 2022 The Authors. Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.)
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- 2022
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11. A 10-year-old child with acute torticollis due to polymicrobial deep neck infection.
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Guri A and Scheier E
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- Child, Emergency Service, Hospital, Humans, Neck diagnostic imaging, Point-of-Care Systems, Ultrasonography, Torticollis diagnostic imaging, Torticollis etiology
- 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., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2022
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12. Cervical dystonia in Parkinson's Disease: frequency of occurrence and subtypes.
- Author
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Thiel MF, Altmann CF, and Jost WH
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- Humans, Parkinson Disease complications, Torticollis etiology
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- 2022
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13. Torticollis as a Sole Presentation of Spondyloarthritis in a 4-Year-Old Child.
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Parikh NS, McClellan N, Koehn M, and Ganguli S
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- Child, Preschool, Diagnosis, Differential, HLA-B27 Antigen, Humans, Syndrome, Spondylarthritis, Torticollis diagnosis, Torticollis etiology
- 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., (© 2021 Marshfield Clinic Health System.)
- Published
- 2021
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14. Sandifer Syndrome: A Case Report.
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Shrestha AB, Rijal P, Sapkota UH, Pokharel P, and Shrestha S
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- Child, Child, Preschool, Humans, Syndrome, Dystonic Disorders, Gastroesophageal Reflux complications, Gastroesophageal Reflux diagnosis, Gastroesophageal Reflux drug therapy, Torticollis diagnosis, Torticollis etiology
- 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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- 2021
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15. Traumatic atlanto-axial rotatory subluxation and dens fracture with subaxial SCIWORA of Brown-Sequard syndrome: A case report.
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Kim SK, Chang DG, Park JB, Seo HY, and Kim YH
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- Accidents, Traffic, Atlanto-Axial Joint diagnostic imaging, Brown-Sequard Syndrome etiology, Cervical Vertebrae injuries, Child, Humans, Joint Dislocations etiology, Ligaments, Articular diagnostic imaging, Ligaments, Articular injuries, Male, Neck Injuries diagnostic imaging, Neck Injuries etiology, Neck Pain diagnostic imaging, Neck Pain etiology, Radiography, Rupture, Spinal Cord Injuries etiology, Spinal Fractures etiology, Torticollis diagnostic imaging, Torticollis etiology, Atlanto-Axial Joint injuries, Brown-Sequard Syndrome diagnostic imaging, Joint Dislocations diagnostic imaging, Spinal Cord Injuries diagnostic imaging, Spinal Fractures diagnostic imaging
- 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., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)
- Published
- 2021
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16. Fibromatosis colli leading to positional plagiocephaly with gross anatomical and sonographic correlation.
- Author
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Rousslang LK, Rooks EA, Smith AC, and Wood JR
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- Fibroma complications, Fibroma therapy, Humans, Infant, Newborn, Male, Physical Therapy Modalities, Plagiocephaly, Nonsynostotic therapy, Torticollis diagnostic imaging, Torticollis etiology, Torticollis therapy, Ultrasonography, Fibroma diagnostic imaging, Neck Muscles, Plagiocephaly, Nonsynostotic diagnostic imaging, Plagiocephaly, Nonsynostotic etiology, Torticollis congenital
- Abstract
Fibromatosis colli, also known as 'sternocleidomastoid tumour of infancy' or 'pseudotumour of infancy', is a rare condition involving fibrosis and swelling, or 'tumour' of the sternocleidomastoid muscle in newborns that typically occurs after a traumatic delivery. Although usually self-limited, fibromatosis colli can lead to congenital muscular torticollis and positional plagiocephaly due to uneven forces on the neonatal skull. Ultrasound is the diagnostic imaging modality of choice and can prevent additional imaging and unnecessary intervention., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2021
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17. The Spectrum of Underlying Diseases in Children with Torticollis.
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Tumturk A, Gorkem SB, Ozmansur EN, Peduk Y, Arslan U, Gok V, Dogan H, Cetin BS, Sahin A, Gumus H, Guney A, Unal E, Kurtsoy A, and Per H
- Subjects
- Adolescent, Child, Child, Preschool, Ependymoma, Female, Humans, Infant, Male, Physical Examination, Retrospective Studies, Brain Neoplasms complications, Calcinosis complications, Eye Diseases complications, Neck Pain etiology, Spinal Diseases complications, Torticollis etiology
- Abstract
Aim: To investigate the underlying conditions in children with torticollis., Material and Methods: Between May 2016 and December 2019, 24 patients (10 girls and 14 boys; mean age, 8 years) presenting with twisted neck, neck pain, weakness of extremities, imbalance, and gait disorder were evaluated retrospectively., Results: Five of the patients had cranial pathologies (cerebellar anaplastic ependymoma and medulloblastoma, brain stem glioma, atypical teratoid rhabdoid tumor, and acute disseminated encephalomyelitis), and five of the patients had spinal pathologies (idiopathic intervertebral disc calcification, vertebral hemangiomatosis, compression fracture, multiple hereditary exostoses, and Langerhans cell histiocytosis at C4). Six of the patients had ocular pathologies (strabismus, Duane syndrome, and Brown syndrome each in two patients). Four patients had otorhinolaryngological infections (Sandifer syndrome, esophageal atresia, reflux, and spasmus nutans, with one patient each). Detailed clinical physical examination and necessary laboratory investigation were performed for all patients., Conclusion: Torticollis is a sign that is not always innocent and may herald an underlying severe disease. Misdiagnosis can lead to wrong and unnecessary surgical procedures and treatments, and sometimes, the results can be damaging due to underlying severe conditions if diagnosed late. In addition, we first report a case of vertebral hemangiomatosis and temporomandibular joint ankylosis that presented with torticollis in the English medical literature.
- Published
- 2021
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18. Shot in the dark: three patients successfully treated with onabotulinumtoxin A injections for relief of post-traumatic chronic headaches and dystonia induced by gunshot wounds.
- Author
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Ferguson LP, Abdukalikov R, Shbeeb D, and Gray TK
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- Drug Administration Schedule, Female, Headache Disorders etiology, Humans, Male, Middle Aged, Torticollis etiology, Treatment Outcome, Acetylcholine Release Inhibitors administration & dosage, Botulinum Toxins, Type A administration & dosage, Head Injuries, Penetrating complications, Headache Disorders therapy, Neck Injuries complications, Torticollis therapy, Wounds, Gunshot complications
- Abstract
Three patients ranging from 49 to 61 years-old presented to our pain clinic after failing multiple treatment attempts for debilitating, chronic post-traumatic headaches, neck pain and involuntary muscle spasm following gunshot wounds to the head, neck and face. Concurrent cervical dystonia was noted in each patient on presentation. All patients were treated with onabotulinumtoxin A (ONA) injections in the head and neck. Each patient reported between 70% and 100% improvement of their headache pain, neck pain and spasm with a significant reduction in the frequency, duration and intensity of their headaches. This level of improvement has been successfully maintained in all three patients with regular ONA injections at 90-day intervals. Two patients experienced a single relapse in symptoms when scheduling conflicts caused them to miss their regularly scheduled ONA injections by several weeks. These symptoms resolved when their ONA injections resumed, suggesting that ONA is the causative agent alleviating their symptoms., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2020
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19. Langerhans cell histiocytosis in the occipital condyle: a case study and a brief review of the literature.
- Author
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Barbosa NC, Ramos A, Sagarribay A, and Ribeiro MJ
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- Child, Preschool, Female, Histiocytosis, Langerhans-Cell complications, Histiocytosis, Langerhans-Cell surgery, Humans, Magnetic Resonance Imaging, Neck Pain etiology, Occipital Bone diagnostic imaging, Occipital Bone surgery, Radionuclide Imaging, Tomography, X-Ray Computed, Torticollis etiology, Histiocytosis, Langerhans-Cell diagnosis, Occipital Bone pathology
- Abstract
We present a case study of a 5-year-old patient, who presented with left-sided torticollis. Due to persistence of problems, a CT and an MRI were made showing a single osteolytic lesion centred on right occipital condyle. After an open biopsy, histology confirmed it to be Langerhans cell histiocytosis (LCH). Torticollis or restricted range of motion is a presenting feature in 76% of children with LCH with cervical involvement. There remains much debate on the best treatment strategy. The clinical and radiological outcomes of the case study presented on this article support the treatment of LCH with chemotherapy in cases with solitary involvement of the occipital condyle., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2020
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20. [Retropharyngeal abscess: case study of 5 cases and literature review].
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Keïta A, Diallo I, Fofana M, Diallo MA, Diallo MMR, Balde O, Camara A, and Sacko S
- Subjects
- Aged, Aged, 80 and over, Child, Child, Preschool, Drainage methods, Female, Humans, Male, Retropharyngeal Abscess etiology, Retropharyngeal Abscess therapy, Shock, Septic etiology, Tomography, X-Ray Computed, Torticollis etiology, Deglutition Disorders etiology, Foreign Bodies complications, Retropharyngeal Abscess diagnosis
- Abstract
The purpose of this study was to perform correlation of 5 cases and literature review. The study involved both children and adults. The major cause of retropharyngeal abscess was fish bone foreign body. Dysphagia associated with pain, fever and torticollis were the most common symptoms. Retropharyngeal abscess mainly occurred in the oropharyngeal and hypopharyngeal regions. Imaging tests, in particular CT scan, allowed for accurate information in 3 cases. Aerodigestive tract obstruction was found in most of our patients. Only 4 patients underwent incision and drainage. All patients received medical treatment. A 2-year-old died 5 days after surgery due to septic shock. This study highlights the rarity of this condition in our context as well as the importance of early diagnosis and treatment to prevent life-threatening complications., Competing Interests: Les auteurs ne déclarent aucun conflit d´intérêts., (Copyright: Abdoulaye Keïta et al.)
- Published
- 2020
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21. Torticollis as a sign of spinal tuberculosis.
- Author
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Boussetta R, Zairi M, Sami SB, Lafrem R, Msakeni A, Saied W, and Nessib N
- Subjects
- Antitubercular Agents administration & dosage, Biopsy, Cervical Vertebrae microbiology, Child, Female, Fever etiology, Humans, Neck Pain etiology, Torticollis microbiology, Tuberculosis, Spinal complications, Tuberculosis, Spinal drug therapy, Cervical Vertebrae pathology, Torticollis etiology, Tuberculosis, Spinal diagnosis
- Abstract
Bone localization of tuberculosis mainly affects the thoracolumbar spine. The cervical spine is rare. Its diagnosis is often late which exposes to great instability and potentially serious complications. We report the case of a 12-year old girl with no medical history, showing torticollis and high temperature without neurological complication. In the physical examination, he had torticollis and pain in the third, fourth and fifth cervical vertebra. When the biopsy was performed, we find an inter apophysis (between C7 and D1) collection. The histological examination confirmed the diagnosis of apophysis tuberculosis. The management based on tuberculosis chemotherapy and immobilization started as soon as possible., Competing Interests: The authors declare no competing interests., (Copyright: Rim Boussetta et al.)
- Published
- 2020
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22. Intervertebral disc calcification as a cause of painful torticollis in children.
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Fernández Gómez A, Bernal Calmarza R, Monge Galindo L, and Luis Peña Segura J
- Subjects
- Cervical Vertebrae, Child, Humans, Intervertebral Disc Degeneration, Calcinosis complications, Intervertebral Disc, Torticollis etiology
- Published
- 2020
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23. Bilateral pediatric pial arteriovenous fistulas accompanying a giant arachnoid cyst with torticollis: A case report.
- Author
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Li J, Wang T, Richard SA, Zhang C, Xie X, and Wang C
- Subjects
- Arachnoid Cysts, Arteriovenous Malformations complications, Arteriovenous Malformations surgery, Child, Computed Tomography Angiography methods, Humans, Male, Torticollis etiology, Arteriovenous Fistula diagnosis, Cerebral Veins abnormalities
- 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.
- Published
- 2020
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24. Body Weight at Birth: The Only Risk Factor Associated with Contralateral Clavicular Fracture in Patients with Congenital Muscular Torticollis.
- Author
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Lee Z, Cho JY, Lee BJ, Kim JM, and Park D
- Subjects
- Female, Fractures, Bone physiopathology, Gestational Age, Humans, Infant, Infant, Newborn, Male, Maternal Age, Muscular Diseases physiopathology, Odds Ratio, Risk Factors, Torticollis etiology, Torticollis physiopathology, Birth Weight physiology, Clavicle physiopathology, Fractures, Bone etiology, Parturition physiology, Torticollis congenital
- Abstract
To date and to the best of our knowledge, there have been limited studies on the risk factor of clavicle fracture combined with congenital muscular torticollis (CMT), despite it being the most common fracture in newborns. So, the aim of this study was to investigate the risk factors associated with clavicular fracture combined with CMT, and its effect on prognosis. In this study, a total of 134 infants with CMT were included. The risk factors associated with clavicular fracture combined with CMT were analyzed. To analyze the correlation between the clinical parameters and the clavicular fracture in patients with CMT, demographic data, such as body weight at birth, maternal age, gender, gestational age, delivery method, sternocleidomastoid (SCM) thickness of ipsilateral side, its ratio between the ipsilateral and contralateral side, and the first visitation date after birth were evaluated. In the results of this study, the clavicular fracture was found in 15 of 134 patients with CMT (19%). In multivariate logistic analysis, the body weight at birth was the only significant parameter for predicting clavicular fracture in patients with CMT (p-value < 0.05). However, there was no significant difference of treatment duration between CMT infants with or without clavicular fracture. In infants with CMT, the area under the ROC curve of the body weight at birth for predicting clavicular fracture was 0.659 (95% CI, 0.564-0.745.; p < 0.05). The optimal cut-off value obtained from the maximum Youden index J was 3470 g (sensitivity: 57.14%, specificity: 75.76%), and the odd ratio of clavicular fracture in patients with CMT increased by 1.244 times for every 100 g of body weight at birth. In conclusion, birth weight appears to be a clinical predictor of clavicular fracture in infants with CMT. More studies and discussions are needed on whether any screening should be recommended for detecting the concurrent clavicular fracture in subjects with CMT.
- Published
- 2019
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25. A rare case of hypereosinophilic syndrome presenting with unilateral proptosis and torticollis.
- Author
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Das JK, Gupta K, Deshmukh S, and Shrivastava R
- Subjects
- Child, Diagnosis, Differential, Exophthalmos diagnosis, Humans, Hypereosinophilic Syndrome diagnosis, Magnetic Resonance Imaging, Male, Rare Diseases, Torticollis diagnosis, Exophthalmos etiology, Hypereosinophilic Syndrome complications, Orbit diagnostic imaging, Torticollis etiology
- Abstract
Hypereosinophilic syndrome (HES) is a spectrum of myeloproliferative disorder, which is characterized by persistent and marked blood eosinophilia and damage to multiple organs due to eosinophilic infiltration. Idiopathic HES is identified after ruling out all other causes of eosinophilia. Poor prognosis is usually associated with cardiac involvement and malignant transformation of blood cells. We report a rare case of HES in an 8-year-old boy who presented with unilateral proptosis and torticollis. The patient responded well to corticosteroid therapy with reduction of proptosis and torticollis and normalization of serum eosinophil count., Competing Interests: There are no conflicts of interest
- Published
- 2018
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26. Pilot Study of a Device to Induce the Hanger Reflex in Patients with Cervical Dystonia.
- Author
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Asahi T, Sato M, Nakamura T, Kon Y, Kajimoto H, Oyama G, Hayashi A, Tanaka K, Nakane S, Takeshima T, Fujii M, and Kuroda S
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Pilot Projects, Severity of Illness Index, Torticollis diagnosis, Torticollis etiology, Treatment Outcome, Young Adult, Head Movements, Physical Therapy Modalities instrumentation, Reflex, Torticollis therapy
- Abstract
The hanger reflex (HR) is an involuntary head rotation that occurs in response to a clothes hanger encircling the head and compressing the unilateral fronto-temporal area. Here, we developed an elliptical device to induce the HR and examined its utility for the treatment of cervical dystonia (CD). The study included 19 patients with rotational-type CD. The device was applied to each subject's head for at least 30 min/day for 3 months. Severity scores on part 1 of the Toronto Western Spasmodic Torticollis Rating Scale were evaluated at baseline and after the 3-month trial. Mean scores without and with the device were significantly different both at baseline (16.6 vs. 14.7, respectively; P < 0.05) and after the trial (14.9 vs. 13.6, respectively; P < 0.05). This preliminary trial suggests that our device can improve abnormal head rotation in patients with CD.
- Published
- 2018
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27. Painful torticollis following adenotonsillectomy: a cardinal sign of atlantoaxial subluxation.
- Author
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Miller BJ, Lakhani R, Rashid A, and Tostevin P
- Subjects
- Atlanto-Axial Joint diagnostic imaging, Child, Humans, Joint Dislocations therapy, Male, Pain, Postoperative therapy, Tomography, X-Ray Computed, Torticollis diagnostic imaging, Torticollis therapy, Adenoidectomy adverse effects, Atlanto-Axial Joint injuries, Joint Dislocations etiology, Pain, Postoperative etiology, Tonsillectomy adverse effects, Torticollis etiology
- Abstract
An 11-year-old boy with a history of autism spectrum disorder attended the emergency department with his mother 8 days after an adenotonsillectomy reporting postoperative bleeding. Detailed physical examination revealed no active bleeding, but a rigid neck posture was noted. A head and neck CT scan demonstrated unilateral rotatory atlantoaxial subluxation and possible damage to the anterior spinal ligament. He was reviewed by neurosurgeons who performed manipulation under anaesthetic and successfully realigned the occipital cervical tract. Non-traumatic atlantoaxial subluxation (Grisel's syndrome) is a rare but serious complication of routine ear, nose and throat (ENT) procedures. An awareness of this complication among paediatricians, otolaryngologists and emergency physicians, and a high index of suspicion in any patient presenting with torticollis following ENT surgery is essential in preventing significant neurological morbidity., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
- Published
- 2018
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28. Do obstetric risk factors truly influence the etiopathogenesis of congenital muscular torticollis?
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Hardgrib N, Rahbek O, Møller-Madsen B, and Maimburg RD
- Subjects
- Birth Injuries complications, Female, Humans, Infant, Newborn, Male, Pregnancy, Pregnancy Outcome, Retrospective Studies, Risk Factors, Torticollis etiology, Pregnancy Complications, Torticollis congenital
- Abstract
Background: Congenital muscular torticollis (CMT) is seen in childhood and presents within months after birth. The etiology remains unknown; however, medical textbooks suggest trauma at birth as a main reason. The aim of this study was to systematically describe obstetric and perinatal outcomes in a population of children with a confirmed congenital muscular torticollis diagnosis., Materials and Methods: Children with a validated diagnosis of congenital muscular torticollis born at Aarhus University Hospital from 2000 to 2014 were included in the study. Information on perinatal, intrapartum and neonatal characteristics were obtained from databases and from medical records, and systematically described., Results: In this study, there were no differences in birth characteristics in children with left- and right-sided torticollis, between boys and girls or between the conservatively treated and the children who needed surgery. Most of the children with congenital muscular torticollis in this study were delivered at term without signs of birth complications or trauma. None experienced moderate or severe asphyxia., Conclusions: The results of the present study suggests that complicated birth or birth trauma may not be the main cause of congenital muscular torticollis and point towards intrauterine and prenatal reasons for its development. LEVEL OF EVIDENCE ACCORDING TO OCEBM LEVELS OF EVIDENCE WORKING GROUP: 3.
- Published
- 2017
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29. [Post-natally acquired torticollis: Giant cavernous cerebellum].
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Alonso Cadenas JA, Corredor Andrés B, Martín Díaz MJ, and de la Torre Espí M
- Subjects
- Cerebellar Neoplasms diagnosis, Cerebellum, Female, Hemangioma, Cavernous, Central Nervous System diagnosis, Humans, Infant, Cerebellar Neoplasms complications, Hemangioma, Cavernous, Central Nervous System complications, Torticollis etiology
- Published
- 2017
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30. Kicked to touch : Hoodwinked by torticollis.
- Author
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Mc Donald CK, Mc Goldrick N, Ni Fhoghlu C, and Shannon F
- Subjects
- Anti-Bacterial Agents therapeutic use, Cervical Vertebrae diagnostic imaging, Child, Preschool, Emergency Service, Hospital, Female, Humans, Joint Dislocations diagnostic imaging, Magnetic Resonance Imaging methods, Neck Injuries complications, Otitis Media diagnosis, Otitis Media drug therapy, Radiography methods, Retropharyngeal Abscess complications, Retropharyngeal Abscess drug therapy, Retropharyngeal Abscess surgery, Surgical Wound, Tomography, X-Ray Computed methods, Torticollis diagnosis, Treatment Outcome, Cervical Vertebrae injuries, Joint Dislocations complications, Retropharyngeal Abscess diagnostic imaging, Torticollis etiology
- Abstract
A 2-year-old girl presented to the emergency department with a 3-day history of a painful stiff neck after getting a kick to her head from her older brother. Her general practitioner had recently started her on oral antibiotics for otitis media. Plain film imaging of her cervical spine on admission revealed anterior subluxation of C2 on C3 suggestive of bifacetal dislocation. Subsequent CT imaging confirmed malalignment of the upper cervical spine. The patient was admitted and worked up with MRI of the cervical spine which unexpectedly revealed a large 4×2 cm retropharyngeal abscess extending from C1 to C4. No associated structural abnormality of the spine was detected. This case report highlights the life-threatening causes of torticollis (retropharyngeal abscess and cervical spine injury), and summarises the anatomy and normal variants that one should expect on interpretation of cervical spine imagery., Competing Interests: Competing interests: None declared., (2017 BMJ Publishing Group Ltd.)
- Published
- 2017
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31. Rotation of the second cervical vertebra in pediatric patient.
- Author
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Peyneau PD, Roque-Torres GD, Godolfim LR, Costa ED, Almeida SM, and Ambrosano GM
- Subjects
- Atlanto-Axial Joint diagnostic imaging, Child, Humans, Magnetic Resonance Imaging, Rotation, Tomography, X-Ray Computed, Torticollis etiology, Cervical Vertebrae diagnostic imaging, Torticollis diagnostic imaging
- Published
- 2016
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32. [Case study of two children with intervertebral disc calcifications].
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Kouamo EI, Nour M, Gennar JM, Guillaume JM, Choufani E, Merrot T, Alessandrni JP, Chaumoitre K, Panuel M, Doumbouya N, and Guemaleu P
- Subjects
- Calcinosis pathology, Cervical Vertebrae pathology, Child, Preschool, Female, Humans, Male, Neck Pain etiology, Spinal Diseases pathology, Torticollis etiology, Calcinosis diagnosis, Intervertebral Disc pathology, Spinal Diseases diagnosis
- Abstract
Disc calcifications are usually revealed in children by pain crises that affect the spine. The most common location for disc calcifications is the cervical spine. However, other locations are less symptomatic and they may well go unnoticed. We here report two cases of children hospitalized with symptomatic cervical disc calcifications. The first case involves a girl aged four and a half suffering from torticollis revealing the migration of a previously asymptomatic disc calcification ; the second case, instead, involves a 5-year old boy presenting for acute neck pain and in whom calcification disc was detected. Treatment was essentially conservative. Intervertebral disc calcifications in children are a rare condition whose etiopathogenesis remains unknown. In the case of children with unexplained back pain the diagnosis should not be made without careful neurological examination and imaging tests., Competing Interests: Conflits d’intérêts Les auteurs ne déclarent aucun conflit d'intérêts.
- Published
- 2016
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33. Acquired torticollis due to primary pyomyositis of the paraspinal muscles in an 11-year-old boy.
- Author
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Ray S, Iyer A, Avula S, and Kneen R
- Subjects
- Anti-Bacterial Agents therapeutic use, Child, Diagnosis, Differential, Fever etiology, Humans, Male, Physical Therapy Modalities, Pyomyositis complications, Pyomyositis therapy, United Kingdom, Paraspinal Muscles diagnostic imaging, Pyomyositis diagnosis, Torticollis etiology
- Abstract
Torticollis is characterised by tilting and rotation of the cervical spine in opposite directions. Causes can be congenital or acquired. Primary pyomyositis is a rare subacute deep bacterial infection of skeletal muscles that typically affects individuals under 20 years of age from tropical countries. Infrequently, pyomyositis occurs in individuals from temperate regions, usually in immunocompromised adults, and this is defined as secondary pyomyositis. We report a case of acquired torticollis due to primary pyomyositis of the paraspinal muscles in a previously healthy boy from the UK. A prolonged course of antibiotics and physiotherapy led to a complete resolution of his illness. We review how to differentiate pyomyositis from focal myositis, a more common inflammatory muscular cause of acquired torticollis., (2016 BMJ Publishing Group Ltd.)
- Published
- 2016
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34. An unusual case of an oesophageal foreign body presenting as torticollis.
- Author
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Walton JM, Darr A, and George A
- Subjects
- Child, Preschool, Female, Humans, Radiography, Esophagus diagnostic imaging, Esophagus physiopathology, Esophagus surgery, Foreign Bodies complications, Foreign Bodies diagnosis, Foreign Bodies physiopathology, Foreign Bodies surgery, Torticollis diagnostic imaging, Torticollis etiology, Torticollis physiopathology
- Abstract
Oesophageal foreign bodies (FBs) are commonly encountered in an otolaryngology setting. The majority of such cases remain in the paediatric population, where obtaining an accurate history of events is challenging. Oesophageal FBs present in a variety of ways other than dysphagia, which may result in delayed presentation, diagnosis and subsequent treatment. Where an ingested FB is a battery, early removal is advocated owing to the potential for significant complications, a problem highlighted by a patient safety alert issued by NHS England. A common paediatric presentation, torticollis has a multitude of potential underlying causes. We present an unusual case of torticollis in a two-year old girl, subsequently revealed to be caused by an ingested button battery.
- Published
- 2016
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35. Grisel's syndrome, a rare cause of anomalous head posture in children: a case report.
- Author
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Allegrini D, Autelitano A, Nocerino E, Fogagnolo P, De Cillà S, and Rossetti L
- Subjects
- Anti-Bacterial Agents therapeutic use, Anti-Inflammatory Agents therapeutic use, Atlanto-Axial Joint diagnostic imaging, Humans, Imaging, Three-Dimensional, Infant, Joint Diseases diagnosis, Joint Diseases drug therapy, Joint Dislocations diagnosis, Joint Dislocations drug therapy, Magnetic Resonance Imaging, Male, Muscle Relaxants, Central therapeutic use, Neck Pain diagnosis, Neck Pain drug therapy, Ocular Motility Disorders diagnosis, Ocular Motility Disorders drug therapy, Orthodontic Brackets, Pharyngitis diagnosis, Pharyngitis drug therapy, Tomography, X-Ray Computed, Torticollis diagnosis, Torticollis drug therapy, Atlanto-Axial Joint pathology, Joint Diseases complications, Joint Dislocations complications, Ocular Motility Disorders etiology, Posture, Torticollis etiology
- Abstract
Background: Anomalous head posture (AHP) or torticollis is a relatively common condition in children. Torticollis is not a diagnosis, but it is a sign of underlying disease. Grisel's syndrome (GS) is a rare condition of uncertain etiology characterized by a nontraumatic atlanto-axial subluxation (AAS), secondary to an infection in the head and neck region. It has not been considered, in ophthalmological papers, as a possible cause of AHP., Case Presentation: A case of AAS secondary to an otitis media is studied. The children showed neck pain, head tilt, and reduction in neck mobility. The patient had complete remission with antibiotic and anti-inflammatory therapy and muscle relaxants. Signs of GS should always be taken into account during ophthalmological examination (recent history of upper airway infections and/or head and neck surgeries associated to a new onset of sudden, painful AHP with normal ocular exam). In such cases it is necessary to require quick execution of radiological examinations (computer tomography and/or nuclear magnetic resonance), which are essential to confirm the diagnosis., Conclusion: GS is a multidisciplinary disease. We underline the importance of an accurate orthoptic and ophthalmological examination. Indeed, early detection and diagnosis are fundamental to achieve proper management, avoid neurological complications and lead to a good prognosis.
- Published
- 2016
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36. Post-Traumatic Torticollis Due to Odontoid Fracture in a Patient With Diffuse Idiopathic Skeletal Hyperostosis: A Case Report.
- Author
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Tsuji S, Inoue S, Tachibana T, Maruo K, Arizumi F, and Yoshiya S
- Subjects
- Aged, Cervical Vertebrae diagnostic imaging, Cervical Vertebrae surgery, Humans, Male, Neck Pain diagnosis, Neck Pain etiology, Spinal Fusion, Tomography, X-Ray Computed, Treatment Outcome, Hyperostosis, Diffuse Idiopathic Skeletal complications, Manipulation, Orthopedic methods, Odontoid Process diagnostic imaging, Odontoid Process injuries, Spinal Fractures complications, Spinal Fractures diagnosis, Spinal Fractures surgery, Torticollis diagnosis, Torticollis etiology, Torticollis therapy
- 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.
- Published
- 2015
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37. Acute febrile torticollis in youth: clinical investigation and current management.
- Author
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Ouattassi N, Chmiel M, El Kerouiti Z, Ridal M, and Alami MN
- Subjects
- Acute Disease, Child, Child, Preschool, Female, Fever therapy, Humans, Male, Torticollis therapy, Fever etiology, Torticollis etiology
- Abstract
Acute febrile torticollis in children is a rare and a special clinical picture of variable causes. It may indicate an inflammatory or an infectious pathology affecting any of the anatomical structures of the neck. Treatment is quite clearly defined, and it may be a therapeutic emergency. It is a condition that all ENT specialists must be familiar with since they are most likely to be the first physician to whom such a child is brought.
- Published
- 2015
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38. Pain Relief in Cervical Dystonia with Botulinum Toxin Treatment.
- Author
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Camargo CH, Cattai L, and Teive HA
- Subjects
- Humans, Pain epidemiology, Pain etiology, Pain Management, Torticollis epidemiology, Torticollis etiology, Torticollis therapy, Analgesics therapeutic use, Botulinum Toxins therapeutic use, Pain drug therapy, Torticollis drug therapy
- Abstract
Dystonia is a neurological disorder characterized by intermittent or sustained muscle contractions that cause abnormal, usually repetitive, movements and postures. Dystonic movements can be tremulous and twisting and often follow a pattern. They are frequently associated with overflow muscle activation and may be triggered or worsened by voluntary action. Most voluntary muscles can be affected and, in the case of the neck muscles, the condition is referred to as cervical dystonia (CD), the most common form of dystonia. The high incidence of pain distinguishes CD from other focal dystonias and contributes significantly to patient disability and low quality of life. Different degrees of pain in the cervical region are reported by more than 60% of patients, and pain intensity is directly related to disease severity. Botulinum toxin (BoNT) is currently considered the treatment of choice for CD and can lead to an improvement in pain and dystonic symptoms in up to 90% of patients. The results for BoNT/A and BoNT/B are similar. The complex relationship between pain and dystonia has resulted in a large number of studies and more comprehensive assessments of dystonic patients. When planning the application of BoNT, pain should be a key factor in the choice of muscles and doses. In conclusion, BoNT is highly effective in controlling pain, and its analgesic effect is sustained for a long time in most CD patients.
- Published
- 2015
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39. [Torticollis revealing medullary tumor in a child].
- Author
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Jemni S and Frioui S
- Subjects
- Astrocytoma complications, Brain Stem Neoplasms complications, Child, Humans, Male, Astrocytoma diagnosis, Brain Stem Neoplasms diagnosis, Torticollis etiology
- Published
- 2015
- Full Text
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40. [Pediatric intervertebral disc calcification: A rare cause of acquired torticollis. Case report].
- Author
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Cuevas Y, Schonhaut L, Espinoza A, Schonstedt V, Aird A, and Castoldi F
- Subjects
- Anti-Inflammatory Agents, Non-Steroidal therapeutic use, Calcinosis complications, Calcinosis pathology, Cervical Vertebrae pathology, Child, Diagnosis, Differential, Follow-Up Studies, Humans, Intervertebral Disc pathology, Male, Neck Pain etiology, Torticollis diagnosis, Torticollis pathology, Calcinosis diagnosis, Torticollis etiology
- Abstract
Introduction: Pain and cervical muscle spasm are common reasons why parents bring children to the pediatric emergency department. The first steps are the gathering of medical history of the patient and a physical examination. If musculoskeletal damage is suspected, cervical spine x-rays should be obtained. An intervertebral disc calcification finding, in the absence of other radiological lesions should suggest pediatric intervertebral disc calcification., Objective: To present a case of intervertebral disc calcification, a rare condition that must be considered in the differential diagnosis of torticollis and neck pain in childhood., Case Report: A seven-year-old male patient without morbid history and no history of trauma or rough sport practice. He consulted the emergency room for pain and cervical contracture for the last six days. C reactive protein and red cell sedimentatio rates were slightly elevated. Imaging studies showed calcification of the C5-C6 intrvertebral disc and anterior disc protrusion. The patient was hospitalized for evaluation and pain management, with good clinical response and continue afterwards with non-steroidal anti-inflammatory drugs and a soft collar. At the 6-month-follow up, the patient had resolved symptoms and calcifications., Conclusions: Pediatric intervertebral disc calcification is a rare cause of acquired torticollis, with a benign and self-limited outcome. Conservative management, as well as clinical and imaging follow-up is recommended., (Copyright © 2015 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.)
- Published
- 2015
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41. Grisel's syndrome: a rare complication following traditional uvulectomy.
- Author
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Elyajouri A, Assermouh A, Abilkacem R, Agadr A, and Mahraoui C
- Subjects
- Atlanto-Axial Joint pathology, Female, Humans, Infant, Neck pathology, Neck Injuries etiology, Syndrome, Torticollis diagnosis, Postoperative Complications diagnosis, Torticollis etiology, Uvula surgery
- Abstract
A case is reported of an eight-month-old female patient who had traditional uvulectomy for sore throat complicated by Grisel's syndrome. She was admitted into the hospital one week after uvulectomy with Torticolis. Grisel's syndrome is a nontraumatic atlantoaxial subluxation, usually secondary of an infection or an inflammation at the head and neck area, or after surgery in the same area. Patients typically suffer from painful torticollis. Diagnosis of Grisel's syndrome is largely based on suspicion of the patient who has recently undergone surgery or has a history of an infection in head and neck area. Physical examination and imaging techniques assist in diagnosis. Thus, clinicians should be aware of acute nontraumatic torticollis if patient had a recent surgery in the head or neck area or undergone an upper respiratory tract infection. In this paper, a case of an eight-month-old female patient who had Grisel's syndrome after uvulectomy is discussed. This case is reported to highlight this neurogical threatening complication following traditional uvulectomy as well as highlighting the unnecessary morbidity and mortality associated with this persisting mode of treatment in Africa.
- Published
- 2015
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42. A girl with a torticollis without trauma: Grisel's syndrome.
- Author
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Sogut O and Turkdogan KA
- Subjects
- Atlanto-Axial Joint diagnostic imaging, Atlanto-Axial Joint pathology, Child, Female, Humans, Joint Dislocations diagnostic imaging, Radiography, Syndrome, Torticollis diagnostic imaging, Atlanto-Axial Joint injuries, Joint Dislocations complications, Torticollis etiology
- Published
- 2014
- Full Text
- View/download PDF
43. Basilar invagination in headache associated with physical exertion and recurrent torticollis.
- Author
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Souza PV, Pinto WB, and Oliveira AS
- Subjects
- Humans, Magnetic Resonance Imaging, Male, Middle Aged, Tomography, X-Ray Computed, Headache etiology, Odontoid Process abnormalities, Physical Exertion, Platybasia diagnosis, Torticollis etiology
- Published
- 2014
- Full Text
- View/download PDF
44. Eosinophilic granuloma of the cervical spine manifesting as torticollis in a child.
- Author
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Akhaddar A and Boucetta M
- Subjects
- Cervical Vertebrae, Child, Eosinophilic Granuloma complications, Humans, Male, Neck Pain etiology, Spinal Diseases diagnosis, Spinal Diseases pathology, Eosinophilic Granuloma diagnosis, Spinal Diseases etiology, Torticollis etiology
- Published
- 2014
- Full Text
- View/download PDF
45. Atlantoaxial rotatory subluxation as a cause of torticollis in a 5-year-old girl.
- Author
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Bagouri E, Deshmukh S, and Lakshmanan P
- Subjects
- Accidental Falls, Child, Preschool, Female, Fractures, Bone therapy, Humans, Incidental Findings, Injury Severity Score, Joint Dislocations diagnostic imaging, Joint Dislocations rehabilitation, Magnetic Resonance Imaging methods, Risk Assessment, Tomography, X-Ray Computed methods, Torticollis diagnosis, Torticollis rehabilitation, Treatment Outcome, Atlanto-Axial Joint, Clavicle injuries, Fractures, Bone diagnosis, Joint Dislocations complications, Torticollis etiology
- Abstract
Many patients present to the emergency department complaining of a sore or stiff neck and lateral flexion of the neck with contralateral rotation. Under the pressure of the breaching time and busy shifts some of the patients are discharged to the care of their general practitioners without adequate investigations. While most of the cases are due to benign causes, torticollis can be due to many congenital and acquired pathologies, some of which may need further investigation and urgent management. Atlantoaxial subluxation (AAS), tumours of the base of the skull and infections are among these causes. Delayed diagnosis may lead to worsening neurology and complicate the management. We report a case of a 5-year-old girl who presented to our fracture clinic with a fractured clavicle and torticollis; her subsequent investigations confirmed the diagnosis of AAS. Our patient responded to non-operative treatment and improved with no neurological complications., (2014 BMJ Publishing Group Ltd.)
- Published
- 2014
- Full Text
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46. Solitary osteochondroma of the cervical spine presenting as recurrent torticollis.
- Author
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Akhaddar A and Boucetta M
- Subjects
- Cervical Vertebrae pathology, Humans, Male, Middle Aged, Osteochondroma pathology, Spinal Neoplasms pathology, Osteochondroma diagnosis, Spinal Neoplasms diagnosis, Torticollis etiology
- Published
- 2014
- Full Text
- View/download PDF
47. Not your typical torticollis: a case of atlantoaxial rotatory subluxation.
- Author
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Hussain K, Abdo MM, AlNajjar FJ, and Abbo M
- Subjects
- Atlanto-Axial Joint diagnostic imaging, Atlanto-Axial Joint surgery, Child, Diagnosis, Differential, Humans, Joint Dislocations diagnosis, Joint Dislocations diagnostic imaging, Joint Dislocations surgery, Male, Tomography, X-Ray Computed, Torticollis diagnostic imaging, Torticollis surgery, Atlanto-Axial Joint injuries, Joint Dislocations complications, Torticollis etiology
- 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.
- Published
- 2014
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48. Torticollis following tympanoplasty: an index case with lessons in encountering the unexpected.
- Author
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Ramdoo K, Hall A, Dimitriadis PA, and Singh A
- Subjects
- Adolescent, Atlanto-Axial Joint pathology, Congenital Abnormalities pathology, Humans, Magnetic Resonance Imaging, Male, Spinal Injuries pathology, Tomography, X-Ray Computed, Torticollis pathology, Atlanto-Axial Joint abnormalities, Cervical Vertebrae abnormalities, Congenital Abnormalities etiology, Neck Muscles, Spasm etiology, Spinal Injuries etiology, Torticollis etiology, Tympanoplasty adverse effects
- Abstract
The term torticollis is derived from the Latin words 'tortis' for twisted and 'collum' for neck. Typical features include sudden onset of severe unilateral pain, with restriction of movements and deviation of the neck to that side. Although torticollis is a well recognised abnormality, there is minimal literature identifying it as a sole long-standing complication in otological surgery. We present the case of a 15-year-old boy who developed permanent torticollis following a routine tympanoplasty. A CT of the neck revealed an atlantoaxial rotatory fixation with cross fusion between C1 and C2. This case highlights a rare cause of torticollis resulting from a routine otological procedure. It also differentiates between Grisel's syndrome, which is characterised by atlantoaxial subluxation as opposed to fusion. The role of the multidisciplinary team is imperative and in particular the need for urgent discussion with the neurosurgical team to ensure prompt assessment and management of the patient takes place.
- Published
- 2014
- Full Text
- View/download PDF
49. Effect of strabismus surgery on torticollis caused by congenital superior oblique palsy in young children.
- Author
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Kekunnaya R and Isenberg SJ
- Subjects
- Child, Preschool, Female, Follow-Up Studies, Humans, Male, Oculomotor Muscles physiopathology, Retrospective Studies, Time Factors, Torticollis etiology, Torticollis physiopathology, Treatment Outcome, Trochlear Nerve Diseases complications, Trochlear Nerve Diseases physiopathology, Eye Movements physiology, Head Movements physiology, Oculomotor Muscles surgery, Ophthalmologic Surgical Procedures methods, Torticollis surgery, Trochlear Nerve Diseases congenital
- Abstract
Purpose: To evaluate the outcome of strabismus surgery for congenital superior oblique palsy (SOP) in relation to correction of head tilt and hypertropia. The cohort of patients mainly involved very young children. This is the first study to use a standardized instrument to objectively measure torticollis before and after surgery., Materials and Methods: A non-comparative interventional case series of 13 cases of congenital superior oblique palsy with head tilt, who underwent simultaneous superior oblique tuck and inferior oblique recession between Jan 2000 and Dec 2008, were studied., Results: The mean duration of SOP until surgery was 36.8 months. Of the 12 unilateral cases, 8 were right-sided. Mean follow-up period was 17 months (range 7-36). The outcome was determined at the last follow-up. Mean pre-and post-operative hypertropia (p.d.) in forced primary position was 19 ± 7 and 2 ± 6, respectively ( P < 0.0001). The head tilt reduced from mean of 17 ± 9 to 2 ± 2 degrees ( P < 0.0001). Success, defined as hypertropia <5 PD and head tilt less than 5 degrees, was achieved in 69% (9/13. C.I. 42-88%) and 85% (11/13. C.I. 56-96%), respectively. The success rate for achieving both criteria was 61.5% (C.I. 35-88%). Five patients required additional surgery; usually a contralateral inferior rectus muscle recession, which was successful in all cases. One case developed asymptomatic Brown syndrome (7.69% - C.I. 6.7-22.2)., Conclusions: Simultaneous superior oblique tuck and inferior oblique muscle recession can successfully treat selected cases of congenital superior oblique palsy. About one-third required an additional procedure, which led to total normalization of the head position.
- Published
- 2014
- Full Text
- View/download PDF
50. An osteoporotic fracture mimicking cervical dystonia in idiopathic Parkinson's disease.
- Author
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Ostrowski C, Ronan L, Sheridan R, and Pearce V
- Subjects
- Absorptiometry, Photon, Aged, Antiparkinson Agents therapeutic use, Bone Density Conservation Agents therapeutic use, Cervical Vertebrae diagnostic imaging, Cervical Vertebrae pathology, Cervical Vertebrae surgery, Diagnosis, Differential, Disease Progression, Female, Humans, Magnetic Resonance Imaging, Medication Adherence, Motor Skills, Neck Pain etiology, Osteoporosis diagnosis, Osteoporosis drug therapy, Osteoporotic Fractures diagnosis, Osteoporotic Fractures surgery, Parkinson Disease diagnosis, Parkinson Disease drug therapy, Parkinson Disease physiopathology, Predictive Value of Tests, Spinal Fractures diagnosis, Spinal Fractures surgery, Spinal Fusion, Tomography, X-Ray Computed, Torticollis diagnosis, Treatment Outcome, Cervical Vertebrae injuries, Osteoporosis complications, Osteoporotic Fractures etiology, Parkinson Disease complications, Spinal Fractures etiology, Torticollis etiology
- 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.
- Published
- 2013
- Full Text
- View/download PDF
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