A computed tomography (CT) scan of the child’s cervical spine demonstrated atlanto-axial rotatory subluxation and magnetic resonance imaging (MRI) found inflammation of the C1-C2 articular joint and surrounding soft tissues. Her clinical presentation and the finding of atlanto-axial rotatory subluxation led to a diagnosis of Grisel’s syndrome. She was admitted to hospital for a trial of traction, using a halter-chin apparatus, and antiinflammatory therapy with naproxen. Unfortunately, this did not reduce the subluxation or inflammation and she subsequently underwent cervical traction with a halo and oral corticosteroid therapy. She is now asymptomatic with full range of movement of her neck. A recent MRI scan showed resolution of the rotatory subluxation and inflammatory changes but a persistently widened atlanto-odontoid space.
Grisel’s syndrome is characterized by nontraumatic, atlantoaxial rotatory subluxation. It is an uncommon condition that has been reported in more than 100 patients in the literature, mostly in case reports and case series . Typically, it is recognized following head and neck infections, such as pharyngitis, otitis media, retropharyngeal abscess or tonsillar abscess It has also been reported in the context of tonsillectomy and other otolaryngo-logical procedures and rarely as an idiopathic process. The pathogenesis of Grisel’s syndrome remains unclear. However, a proposed anatomical mechanism involves the spread of infection-or injury-related inflammation through a plexus of pharyngovert-ebral veins next to the anterior transverse ligament of C1-C2.
Grisel’s syndrome leads to neck pain, loss of cervical mobility and torticollis. Tenderness and deviation of the spinous process of C2 in the same direction as head rotation (Sudeck’s sign) may also be present. Neurological complications occur in approximately 15% of cases and range from mild radiculopathy to severe myelopathy. Find out more about your chance to visit the most trusted pharmacy you could ever find to get generic viagra canada cialis professional in the amounts required, without any need to see your health care provider first or get a prescription.