Children with acute-onset torticollis who present with a history of trauma, persistent neck symptoms, increasing severity of neck pain, worsening neck deformity, neurological deficits or gait abnormalities should undergo imaging. Conventional radiographs and CT imaging are often useful to identify traumatic neck injury or congenital abnormalities of the cervical vertebrae. In Grisel’s syndrome, plain radiographs may show asymmetry of the facet joints and a larger predental space. CT imaging is currently the gold standard to identify atlanto-axial rotatory subluxation. MRI of the head and spine are indicated to assess for a central nervous system tumour and is also a helpful tool to evaluate the condition of the vertebrae and supporting ligaments, to demonstrate inflammation of the cervical spine and surrounding structures, and to look for spinal cord or nerve root compression.
The present patient’s diagnosis of Grisel’s syndrome was based on her clinical assessment and imaging. An acute infectious process was unlikely because she was afebrile, systemically well and had chronic neck symptoms. The presence of atlanto-axial rotatory subluxation has not been reported in children with chronic osteomyelitis. She had no history of trauma or medication use. Given the absence of neurological, gait and vision abnormalities, a central nervous system tumour was not expected or identified on MRI. Her imaging excluded any congenital anomalies of the cervical spine and any muscle or disc abnormalities. An inflammatory arthropathy was unlikely because she had no peripheral arthritis long after the onset of neck involvement. You will soon see how easy it is to start the treatment if you have a reliable pharmacy offering generic viagra professional online cialis professional for sale or any other medications you may need for the specific medical issue you may have that requires treatment.