Grisel syndrome

Discussion:

Grisel syndrome is non-traumatic atlanto-axial subluxation, resulting from inflammatory ligamentous laxity following an infectious process in the head and neck.

Upper respiratory tract infections are the commonest cause. However, any inflammatory process of the head and neck including post surgical inflammation (for example, adenotonsillectomy), can result in Grisel syndrome.

Variable presentation - may be associated with fever, dysphagia and hearing loss. Neurological complications (ranging from radiculopathy to death from medullary compression) occur in 15% of the cases.

In early stages medical treatment with antibiotics is adequate. With late presentation, invasive surgical treatment may be necessary to prevent morbidity. Therefore early recognition of this rare condition is vital to prevent long-term complications.

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