Abstract
Torticollis is a rather common presentation in pediatrics, with common etiologies.
This is a rare presentation of a spinal pathology secondary to an underlying infection
of the head and neck region causing anomalous head position masquerading as a torticollis.
Painful torticollis, or abnormal head position described as “cock-robin head” position
in children, draws attention. Grisel's syndrome (GS) is an inflammatory condition
of a nontraumatic atlantoaxial rotatory subluxation or fixation (AARS/F). Diagnosis
is derived clinically with radiological confirmation. The aim of this report is to
raise attention of positional masquerade during intervals of radiographs, leading
to the delay in diagnosis and heighten awareness of this syndrome that is needed to
derive the diagnosis. In this case, the patient initially presented to the institution
with a radiograph that had shown no overt abnormality and was requested for further
detailed imaging, but the child's parents had refused. Upon a revisit to the clinic
due to worsening of symptoms, a repeated radiograph was taken, a clear AARS was detected,
and proceeded with a computed tomography (CT) cervical imaging to confirm the subluxation.
The CT scan showed an overt subluxation with significant narrowing of the cord spaces
with a retropharyngeal abscess. Otolaryngology and Spine services were consulted,
and a surgical option was offered. However, the parents refused surgery and proceeded
conservatively with antibiotics and a cervical halter. Early diagnosis and early treatment
is fundamental to a better prognosis. Presence of GS is associated with late recovery
in comparison to non-Grisel's causes of AARS/F. A treating surgeon should be aware
of this condition and recognize it based on the “cock-robin” head position in absence
of a triggering trauma with an underlying inflammatory pathology of the head and neck
region. Presence of concomitant infection with AARS/F and Fielding and Hawkins classification
types are prognostic factors for late recovery.
Keywords
Grisel's syndrome - atlantoaxial rotatory subluxation - atlantoaxial rotatory fixation
- atlantoaxial instability - retropharyngeal abscess - cock robin - torticollis
