Grisel’s syndrome: A rare cause of torticollis with subluxation of the atlantoaxial joint secondary to a retropharyngeal abscess
Background: Atraumatic rotary subluxation of the atlantoaxial joint (Grisel’s syndrome) is a rare cause of torticollis. Although rare, prompt recognition and treatment of this disorder is essential in preventing permanent deformity.Case presentationA 4-year-old female with no significant past medica...
Main Authors: | , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Elsevier
2020-12-01
|
Series: | Interdisciplinary Neurosurgery |
Subjects: | |
Online Access: | http://www.sciencedirect.com/science/article/pii/S2214751920304333 |
id |
doaj-7639ff4881b942869e3e80eee252150a |
---|---|
record_format |
Article |
spelling |
doaj-7639ff4881b942869e3e80eee252150a2020-11-25T01:56:08ZengElsevierInterdisciplinary Neurosurgery2214-75192020-12-0122100872Grisel’s syndrome: A rare cause of torticollis with subluxation of the atlantoaxial joint secondary to a retropharyngeal abscessMichael D. White0David R. Hansberry1Arpan V. Prabhu2Nitin Agarwal3Vinay Kandula4Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213, United StatesDepartment of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107, United States; Department of Radiology, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE 19803, United States; Corresponding author at: Department of Radiology, Thomas Jefferson University Hospitals, 132 South 10th Street, Philadelphia, PA 19107, United States.Department of Radiation Oncology, UPMC Hillman Cancer Center, 5115 Centre Ave, Pittsburgh, PA 15232, United StatesDepartment of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213, United StatesDepartment of Radiology, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE 19803, United StatesBackground: Atraumatic rotary subluxation of the atlantoaxial joint (Grisel’s syndrome) is a rare cause of torticollis. Although rare, prompt recognition and treatment of this disorder is essential in preventing permanent deformity.Case presentationA 4-year-old female with no significant past medical history presented to the emergency department (ED) after an outpatient positive streptococcus test with intermittent subjective fevers for one week. In the ED, the patient had a temperature of 103.0 F and was found to have a leukocytosis of 26,700 K/UL with a leftward shift of neutrophils. Initial radiograph of the neck found asymmetric soft tissue fullness and increased opacity in the right upper and mid cervical neck. Subsequently, contrast-enhanced computed tomography (CT) of the soft tissues of the neck found a right-sided retropharyngeal abscess measuring 1.5 cm. It was located medial to the carotid space with surrounding edema, inflammation, and fluid tracking inferiorly along the prevertebral soft tissues. There was associated lateral displacement of the right cervical internal carotid artery and jugular veins with regional stenosis. Additionally, there was atlantoaxial subluxation of C1 on C2. The patient was medically managed with intravenous antibiotics. The patient received dexamethasone for the edema and was admitted as an inpatient. She subsequently improved and had an uneventful hospital course with discharge to home. Conclusions: Grisel’s syndrome is an infrequent diagnosis, which is seen with atlantoaxial rotary subluxation accompanying infection or recent otolaryngolic surgery. Diagnosis typically requires cross-sectional imaging, often with CT. Without treatment with reduction and immobilization, there can be permanent fixed deformity.http://www.sciencedirect.com/science/article/pii/S2214751920304333Grisel’s syndromeTorticollisRetropharyngeal abscessSubluxationGrisel syndrome |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Michael D. White David R. Hansberry Arpan V. Prabhu Nitin Agarwal Vinay Kandula |
spellingShingle |
Michael D. White David R. Hansberry Arpan V. Prabhu Nitin Agarwal Vinay Kandula Grisel’s syndrome: A rare cause of torticollis with subluxation of the atlantoaxial joint secondary to a retropharyngeal abscess Interdisciplinary Neurosurgery Grisel’s syndrome Torticollis Retropharyngeal abscess Subluxation Grisel syndrome |
author_facet |
Michael D. White David R. Hansberry Arpan V. Prabhu Nitin Agarwal Vinay Kandula |
author_sort |
Michael D. White |
title |
Grisel’s syndrome: A rare cause of torticollis with subluxation of the atlantoaxial joint secondary to a retropharyngeal abscess |
title_short |
Grisel’s syndrome: A rare cause of torticollis with subluxation of the atlantoaxial joint secondary to a retropharyngeal abscess |
title_full |
Grisel’s syndrome: A rare cause of torticollis with subluxation of the atlantoaxial joint secondary to a retropharyngeal abscess |
title_fullStr |
Grisel’s syndrome: A rare cause of torticollis with subluxation of the atlantoaxial joint secondary to a retropharyngeal abscess |
title_full_unstemmed |
Grisel’s syndrome: A rare cause of torticollis with subluxation of the atlantoaxial joint secondary to a retropharyngeal abscess |
title_sort |
grisel’s syndrome: a rare cause of torticollis with subluxation of the atlantoaxial joint secondary to a retropharyngeal abscess |
publisher |
Elsevier |
series |
Interdisciplinary Neurosurgery |
issn |
2214-7519 |
publishDate |
2020-12-01 |
description |
Background: Atraumatic rotary subluxation of the atlantoaxial joint (Grisel’s syndrome) is a rare cause of torticollis. Although rare, prompt recognition and treatment of this disorder is essential in preventing permanent deformity.Case presentationA 4-year-old female with no significant past medical history presented to the emergency department (ED) after an outpatient positive streptococcus test with intermittent subjective fevers for one week. In the ED, the patient had a temperature of 103.0 F and was found to have a leukocytosis of 26,700 K/UL with a leftward shift of neutrophils. Initial radiograph of the neck found asymmetric soft tissue fullness and increased opacity in the right upper and mid cervical neck. Subsequently, contrast-enhanced computed tomography (CT) of the soft tissues of the neck found a right-sided retropharyngeal abscess measuring 1.5 cm. It was located medial to the carotid space with surrounding edema, inflammation, and fluid tracking inferiorly along the prevertebral soft tissues. There was associated lateral displacement of the right cervical internal carotid artery and jugular veins with regional stenosis. Additionally, there was atlantoaxial subluxation of C1 on C2. The patient was medically managed with intravenous antibiotics. The patient received dexamethasone for the edema and was admitted as an inpatient. She subsequently improved and had an uneventful hospital course with discharge to home. Conclusions: Grisel’s syndrome is an infrequent diagnosis, which is seen with atlantoaxial rotary subluxation accompanying infection or recent otolaryngolic surgery. Diagnosis typically requires cross-sectional imaging, often with CT. Without treatment with reduction and immobilization, there can be permanent fixed deformity. |
topic |
Grisel’s syndrome Torticollis Retropharyngeal abscess Subluxation Grisel syndrome |
url |
http://www.sciencedirect.com/science/article/pii/S2214751920304333 |
work_keys_str_mv |
AT michaeldwhite griselssyndromeararecauseoftorticolliswithsubluxationoftheatlantoaxialjointsecondarytoaretropharyngealabscess AT davidrhansberry griselssyndromeararecauseoftorticolliswithsubluxationoftheatlantoaxialjointsecondarytoaretropharyngealabscess AT arpanvprabhu griselssyndromeararecauseoftorticolliswithsubluxationoftheatlantoaxialjointsecondarytoaretropharyngealabscess AT nitinagarwal griselssyndromeararecauseoftorticolliswithsubluxationoftheatlantoaxialjointsecondarytoaretropharyngealabscess AT vinaykandula griselssyndromeararecauseoftorticolliswithsubluxationoftheatlantoaxialjointsecondarytoaretropharyngealabscess |
_version_ |
1724981195901501440 |