Zeldzame oorzaak van torticollis: een casusbespreking

Abstract

A rare cause of torticollis: case-report Torticollis can be a symptom of an underlying pathology that can present in children. These pathologies can be divided into congenital and acquired causes. The treatment options vary between conservative management and a surgical intervention. This case-report presents an 8-year-old girl with atraumatic torticollis after suffering from a viral infection. Previous conservative treatments didn’t have an impact on the pain. Clinically, the girl presented with a fixed position of the cervical spine with rotation to the right and lateroflexion to the left. Passive mobilisation of the cervical spine was not possible. The standard radiology was difficult to assess due to the presence of the malalignment. A CT scan of the cervical spine showed subluxation of the C1-C2 joints. An MRI of the cervical spine showed inflammation at the level of the dens axis. This atraumatic, postinfectious torticollis with subluxation at the level of the C1-C2 joints in children is a typical presentation of a rare syndrome, being Grisel’s syndrome. Passing through a viral infection is the most likely triggering factor for the development of subluxation in underlying hyperlaxity of the cervical ligaments and joints in children. This two-hit hypothesis was described by Battiata et al. This case presents a mild form with a single rotation around the dens axis, being the Fielding-Hawkins classification type 1, requiring a low-invasive treatment. The therapeutic options depend on this classification and the time to diagnosis. A rapid diagnosis is important to avoid invasive treatment options (such as a halo vest, dumbbell traction or surgical arthrodesis).