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    Torticollis

    Torticollis is a topic covered in the 5-Minute Emergency Consult.

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    Basics

    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

    Local
    • 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
    Compensatory
    • Tilt with essential head tremor (patient tilts head to suppress tremor)
    • Ocular muscle palsy
    Central
    • 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 -