Torticollis
Torticollis is a topic covered in the 5-Minute Emergency Consult.
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Basics
Description
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
LocalEtiology
- Acute wry neck:
- Develops overnight without provocation
- Most prevalent
- Self-limited, symptoms resolve in 1 to 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
Pediatric Considerations
Local
- Congenital:
- Odontoid hypoplasia
- Hemivertebrae
- Spina bifida
- Arnold–Chiari syndrome
- Pseudotumor of infancy
- Hypertrophy or absence of cervical musculature
- Otolaryngologic:
- 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
Compensatory
- Strabismus (4th cranial nerve paresis)
- Congenital nystagmus
- Posterior fossa tumor
Central
Dystonias:
- Torsion dystonia
- Drug induced
- Cerebral palsy
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Citation
* When formatting your citation, note that all book, journal, and database titles should be italicized* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Torticollis
ID - 307476
ED - Barkin,Adam Z,
ED - Barkin,Roger M,
ED - Hayden,Stephen R,
ED - Rosen,Peter,
ED - Schaider,Jeffrey J,
ED - Shayne,Philip,
ED - Wolfe,Richard E,
BT - 5-Minute Emergency Consult
UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307476/all/Torticollis
PB - Lippincott Williams & Wilkins
ET - 5
DB - Emergency Central
DP - Unbound Medicine
ER -