Affiliations: Physical Medicine, Rehabilitation, and Sports Medicine
Department, University of Puerto Rico, San Juan, Puerto Rico
Note: [] Corresponding author: Gerardo L. Ortiz, Paseo Las Brisas, Niza
street {\#}29, San Juan, 00926, Puerto Rico. Tel.: +1 787 638 8415; Fax: +1 787
754 1478; E-mail: gortiz3@hotmail.com
Abstract: PURPOSE: The objective of this paper is to present a case
series of patients with diagnosis of torticollis due to Grisel's syndrome and,
in doing so, raise awareness of an unusual condition that could be fatal. A
review of the literature is presented regarding diagnosis and treatment. METHODS: Case series of three patients that were 7, 10, and 12 years old with
history of tonsillitis or neck surgery consulted to the service of
Rehabilitation Medicine. RESULTS: Physical examination showed a fixed
head or limitation of movement to neutral position and initially a normal
neurological examination. Initial cervical X-rays were not diagnostic. The
final diagnosis was made by CT scan or MRI. All 3 patients were treated with
anti-inflammatory medications, immobilization, and/or cervical traction or
surgery. CONCLUSION: Grisel's syndrome is a non-traumatic atlanto-axial
rotatory fixation (AARF) with or without subluxation following infection or
surgery in the head or neck region. This paper presents an unusual cause of
torticollis that could be fatal or cause neurological injury if not recognized
and treated appropriately.
Keywords: Torticollis, Grisel's syndrome, atlantoaxial rotatory fixation, atlantoaxial subluxation, children
