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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