Torticollis

Description

• Torticollis is a symptom, not a disease
• “Twisted neck” (L. tortus, twisted + collum, neck)
• A fixed or dynamic posturing of the head and neck
• Synonym(s):
  • Cervical dystonia
  • Wry neck

Etiology

• Acute wry neck:
  • Develops overnight without provocation
  • Most prevalent
  • Self-limited, symptoms resolve in 1–2 wk
  • Cervical spine disease
  • Fracture
  • Dislocation, subluxation
  • Infections
  • Spondylosis
  • Tumor
  • Scar tissue–producing injuries
  • Ligamentous laxity in atlantoaxial region
• Inflammatory disease causing muscular damage:
  • Myositis
  • Lymphadenitis
  • Tuberculosis
  • Myasthenia gravis
  • Neuritis of the auriculotemporal branch of the trigeminal nerve
• Infections of surrounding soft tissues:
  • Nasopharyngeal abscess
  • Retropharyngeal abscess
  • Cervical adenitis
  • Tonsillitis
  • Meningitis
  • Mastoiditis
  • Sinusitis

• Tilt with essential head tremor (patient tilts head to suppress tremor)
• Ocular muscle palsy

• Idiopathic spasmodic torticollis:
  • Female > male
  • Onset 31–60 yr old
• Dystonias:
  • Torsion dystonia
  • Generalized tardive dystonia
  • Wilson disease
  • λ-Dopa therapy
  • Acute (neuroleptic drugs)
  • Strychnine poisoning

• Congenital:
  • Odontoid hypoplasia
  • Hemivertebrae
  • Spina bifida
  • Arnold–Chiari syndrome
  • Pseudotumor of infancy
  • Hypertrophy or absence of cervical musculature
• Otolaryngologic (Grisel syndrome):
  • Vestibular dysfunction
  • Otitis media
  • Cervical adenitis
  • Retropharyngeal abscess
  • Pharyngitis
  • Mastoiditis
  • Esophageal reflux
  • Syrinx with spinal cord tumor
• Trauma:
  • Cervical fracture/dislocation
  • Clavicular fractures
  • Pneumomediastinum
• Juvenile rheumatoid arthritis

• Strabismus (fourth cranial nerve paresis)
• Congenital nystagmus
• Posterior fossa tumor

• Dystonias:
  • Torsion dystonia
  • Drug induced
  • Cerebral palsy