Grisel syndrome

Case contributed by Dr Aparna Srinivasa Babu

Presentation

Torticollis. No history of trauma. Past history of upper respiratory tract infection.

Patient Data

Age: 4 years
Gender: Male
Modality: CT

Abnormal lateral placement of C1 on C2, with lesser degree of abnormal lateral placement of occipital articular facets with respect to C1.

Case 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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Case Information

rID: 10723
Case created: 12th Sep 2010
Last edited: 10th Sep 2015
Inclusion in quiz mode: Included

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