Neuropediatrics 2005; 36(1): 45-49
DOI: 10.1055/s-2004-830533
Short Communication

Georg Thieme Verlag KG Stuttgart · New York

Persistent Fixed Torticollis due to Atlanto-Axial Rotatory Fixation: Report of 4 Pediatric Cases

L. Chiapparini1 , G. Zorzi2 , T. De Simone1 , C. Maccagnano1 , B. Seaman1 , M. Savoiardo1 , C. Corona3 , N. Nardocci2
  • 1Department of Neuroradiology, National Neurological Institute “C. Besta”, Milano, Italy
  • 2Department of Child Neurology, National Neurological Institute “C. Besta”, Milano, Italy
  • 3Department of Neurosurgery, Casa di Cura Igea, Milano, Italy
Further Information

Publication History

Received: May 24, 2004

Accepted after Revision: November 10, 2004

Publication Date:
09 February 2005 (online)

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Abstract

Atlanto-axial rotatory fixation (AARF) is a rare cause of childhood torticollis that may occur spontaneously or in association with trauma and upper respiratory infections. We describe the clinical findings, as well as the effectiveness of imaging in the diagnosis and the treatment of 4 children with AARF, in whom acute fixed non-dystonic torticollis was the presenting symptom. Onset of torticollis was spontaneous in Case 1, after general anesthesia for cholesteatoma surgery in Case 2, after a trauma in Case 3, and during hypersomnia in Case 4. Duration of torticollis prior to diagnosis was 3 months in the first two patients and 20 days in the other two. All the patients underwent cervical X-rays examinations, which were not contributory to the diagnosis, followed by CT, which demonstrated C1-C2 rotatory fixation. One patient had a spontaneous resolution; treatment with Gardner's tongs and soft collar permitted restoration of the normal alignment in the other 3 patients. AARF must be considered in all the patients with persistent painful torticollis.

References

MD Luisa Chiapparini

Department of Neuroradiology
Istituto Nazionale Neurologico „C. Besta“

Via Celoria 11

20133 Milano

Italy

Email: lchiapparini@istituto-besta.it