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Images in paediatrics
An unusual life threatening cause of torticollis in a child
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  1. P Lehtinen1,
  2. O Ruuskanen1,
  3. P Sonninen2
  1. 1Department of Pediatrics, University Hospital, Turku, Finland; olli.ruuskanen{at}tyks.fi
  2. 2Department of Radiology, University Hospital, Turku, Finland

http://dx.doi.org/10.1136/adc.88.4.349

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    A n 8 year old girl was admitted to hospital because of fever, neck stiffness, and enlarged cervical lymph nodes. A diagnosis of lymphadenitis was made and she was treated in hospital two days with intravenous cefuroxime followed by oral cephalexin. Five days after discharge, the girl was readmitted to hospital for severe torticollis. She was not able to move her head but had no other abnormal neurological signs. The white blood cell count was 14.2 × 109/l and serum C reactive protein 23 mg/l, increasing within two days to 97 mg/l.

    Magnetic resonance imaging (MRI; see fig) revealed potentially life threatening atlantoaxial subluxation (1) with atlas rotation of 40°, inflammatory changes in the atlantoaxial joint (2), and enlarged cervical lymph nodes (3)—Grisel’s syndrome, an infectious process of the atlantoaxial joint.1 She was treated with intravenous cefuroxime and clindamycin, analgesics, muscle relaxants, and neck support for nine days. Cefuroxime axetil, clindamycin, and neck support were continued for five weeks at home. MRI obtained three months later showed a normal atlantoaxial joint and the girl was asymptomatic.

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    Reference

    1. ↵
      Wetzel FT, La Rocca H. Grisel’s syndrome. Clin Orthop1989;240: 141–52.