Torticollis in children: an alert symptom not to be turned away

Abstract

Various underlying disorders from relatively benign to life-threatening conditions may present with torticollis. The first step should be always a careful and complete physical examination, which must include all systems. Imaging must be performed for ruling out underlying life-threatening diseases in children with torticollis, particularly, if acquired neurological symptoms exist. Besides craniospinal tumors, ophthalmological problems and central nervous system infections should also be kept in mind. Moreover, early diagnosis of these disorders will reduce mortality and morbidity. Therefore, alertness of clinicians in pediatric and pediatric neurosurgery practice must be increased about this alert symptom.

Two Different Life-Threatening Cases: Presenting with Torticollis

“…Less common etiologies include cervical adenitis, osteomyelitis, tuberculosis, and upper lobe pneumonia. Tumors, ophthalmological problems, and central nervous system infections should also be considered, as well as Grisel's syndrome, nontraumatic subluxation of the atlantoaxial joint caused by inflammation of the adjacent tissues, and Chiari 1 malformation, that are rare but possible cause of headache, opisthotonus, and neck pain in children [1, 2, 5, 6]. Accurate differential diagnosis is required to correctly identify the cause and choose the right treatment.…”

“…Acquired torticollis typically results from inflammatory processes of the cervical muscles, nerves, or vertebral synovia. Retropharyngeal abscesses and upper respiratory tract infections are the most common infections associated with torticollis [1, 2]. …”

Conservative Care of Pediatric Acquired Torticollis: A Report of 2 Cases

“…3,10 Because torticollis may be a red flag for underlying serious and perhaps nonmusculoskeletal pathology, diagnosis and appropriate treatment should not be delayed. 11,12 History and physical examination can identify most pathologic etiologies, obviating the need for special imaging. 1,13 Regrettably, after significant pathology has been ruled out, the acquired torticollis of muscular origin is often left unaddressed, consigning the patient to a prolonged painful and limiting disorder, even though it eventually resolves.…”

“…[4][5][6][7][8][9][10][11][12][13][17][18][19][20][21] The only case series in the literature featuring chiropractic management concerns missed diagnoses of underlying pathologies. 22 One case report of a child with congenital torticollis details how several providers missed diagnosing holocord astrocytoma resulting in quadriplegia.…”

The surgical strategy for eosinophilic granuloma of the pediatric cervical spine complicated with neurologic deficit and/or spinal instability

“…The bony destruction of vertebral EG might lead to spinal instability with severe mechanical back pain and even a pathological fracture. Pediatric patients with cervical EG can present with symptoms including acute onset of neck pain with/without history of trauma and torticollis or neck stiffness due to restricted motion [5, 6]. Vertebral collapse and impingement from extradural extension of the lesion may further result in nerve compression and subsequent neural deficit and myelopathy.…”