Archive for the ‘Grisel’s syndrome’ Category

A pain in the neck: GRISEL’S SYNDROME (part 5)

The key to successful management of Grisel’s syndrome is early diagnosis and initiation of therapy. Failure of reduction, recurrence and complications are more likely with a prolonged delay before starting treatment. Inappropriate treatment may lead to permanent deformity and neurological deficits. There is an underlying head and neck infection. A trial of immobilization with a cervical collar and anti-inflammatory medications may be successful if initiated early after the onset of subluxation. More significant C1-C2 rotatory subluxation may require immobilization and traction, which alleviates pain and reduces the fixation.

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A pain in the neck: GRISEL’S SYNDROME (part 4)

A pain in the neck: GRISEL’S SYNDROME (part 4)

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.
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A pain in the neck: GRISEL’S SYNDROME (part 3)

A pain in the neck: GRISEL’S SYNDROME (part 3)

The differential diagnosis for new onset of neck pain and torticollis during childhood is extensive. It includes benign paroxysmal torticollis, traumatic neck injury, infections, calcification of the cervical disc, congenital abnormalities of the cervical vertebrae such as hemiatlas, Arnold-Chiari malformation, central nervous system tumours, neurogenic or drug-induced dystonias, gastroesophageal reflux with torsional neck spasms (Sandifer syndrome), inflammatory arthritis and myositis. A careful clinical assessment is necessary to differentiate benign causes from more serious causes of neck pain and torticollis.
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A pain in the neck: GRISEL’S SYNDROME (part 2)

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.
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A pain in the neck: GRISEL’S SYNDROME (part 1)

A pain in the neck: GRISEL’S SYNDROME (part 1)

A 10-year-old African-Canadian girl experienced a sudden onset of neck stiffness. There was no history of preceding trauma, but she had reported a sore throat and hoarse voice three weeks earlier. Over the next year, she developed progressively worsening torticollis with associated neck pain, daily headaches and intermittent diplopia. She was taking ibuprofen two to three times daily for head and neck pain with partial improvement.
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