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At least 217 records · Page 12Linked to original sources
PubMed1994

Spinal cord astrocytoma presenting as torticollis and scoliosis.

OBJECTIVE: To illustrate the importance of a careful differential diagnosis in children presenting with torticollis. CLINICAL FEATURES: A 14-yr-old boy presented with a 6-month history of neck pain, torticollis and increasing neurological deficit. Past physiotherapy and chiropractic treatment had not helped. A myelogram and MRI scan revealed a large intramedullary lesion. INTERVENTION AND OUTCOME: He was treated by laminectomy with partial excision of the lesion, followed by radiotherapy. Pathology confirmed the diagnosis of astrocytoma. The patient developed postlaminectomy instability and required spinal fusion. CONCLUSION: The differential diagnosis of torticollis in children is extensive and should always include spinal tumor.

Adolescent↗
PubMed1993

Chiropractic correction of congenital muscular torticollis.

OBJECTIVE: To present a case of congenital muscular torticollis and discuss the clinical manifestations and chiropractic treatment. CLINICAL FEATURES: A 7-month-old male infant with significant head tilt since birth was brought to a chiropractic physician for evaluation. The infant's history included ear infections, facial asymmetry and regurgitation. Significant spasm of the left sternocleidomastoid and trapezius muscles, a left lateral atlas and suboccipital joint dysfunctions were present upon examination. A diagnosis of congenital muscular torticollis was made. INTERVENTION AND OUTCOME: Treatments included chiropractic manipulation, trigger point therapy, specific stretches, pillow positioning and exercises. Excellent results were obtained. CONCLUSION: Suggests that chiropractic intervention is a viable treatment option for congenital muscular torticollis. Further studies should be performed to compare the effectiveness of other treatment options.

Cervical Vertebrae↗
PubMed1993

[Torticollis treated with botulinum toxin].

The effect of botulinum toxin A treatment was studied in patients with idiopathic torticollis. Twenty patients with idiopathic torticollis received electromyographically guided intramuscular botulinum toxin A into the hyperactive neck muscles. In all, 48 treatments were given. The injections were repeated with intervals of 11 to 35 weeks (mean 18.7 weeks). The grade of improvement was estimated subjectively using a visual analogue scale. An overall improvement of 55% compared with the status before treatment was found. The best result obtained in each individual patient varied from 20% to 84% (mean 66%). The effect of the treatment began to wear off after eight to 22 weeks (mean 11.5 weeks). The side effects consisted of short term dysphagia in two patients. The administration of botulinum toxin in idiopathic torticollis is a safe and beneficial treatment with few side effects. The EMG guidance of injections proved to be helpful as it restricted the injections into muscles with electromyographic hyperactivity, thereby economizing the amount of toxin given. It is doubtful if double-blind studies of botulinum toxin can be undertaken due to the marked muscular wasting and weakness caused by the injections.

Adult↗
PubMedDate not supplied

Spasmodic torticollis and tremor due to multiple sclerosis: a case report.

Different forms of symptomatic dystonia have been reported in patients with multiple sclerosis, but the appearance of spasmodic torticollis is extremely rare. We present the case of a 24-year-old man with postural and intentional left hand tremor and leftward spasmodic torticollis. The duration of the disease is 6 years, without remissions. The cerebrospinal fluid examination revealed oligoclonal (two bands) hypergammaglobulinemia. Auditory and visual evoked potentials showed altered sensory afferentation. On magnetic resonance imaging brain scan, multiple T2 high signal lesions involving the white matter of both cerebral hemispheres, mainly the periventricular regions, were found. There were also multiple lesions in the brain stem and some in the cerebellar hemispheres. Thus the diagnosis of multiple sclerosis could be considered as definite. In conclusion, extremely rarely, multiple sclerosis may appear with progressive spasmodic torticollis and rubral tremor.

Adult↗
PubMed1994

[Torticollis and C1-C2 rotation subluxation. Apropos of a case. The value of a dynamic scanner and of a 3-dimensional scanner].

The authors report the rare and complex case of a girl who had been followed since the age of 3 years for hydrocephalus the cause of which was found only when she was 6-year old. The causative agent was a pilocytic astrocytoma of the cerebellum. On April 10, 1990, she underwent subtotal excision of the tumour, associated with radiotherapy. Four months later she developed an increasingly painful and irreducible torticollis which did not respond to tractions. Dynamic CT scans and 3-dimensional CT scans were performed in the fourth month and provided a diagnosis of right C1-C2 rotatory subluxation. There was no history of injury and no sign of inflammatory process. Rotatory subluxation is a very rare lesion difficult to diagnose, and few cases have been published, although the signs are those of classical torticollis in children. When medical treatment fails, often due to belated diagnosis, the only surgical treatment is uni- or bilateral C1-C2 arthrodesis. If the diagnosis can be made at an early stage, reduction of the rotatory luxation is usually easy and without consequences to the child. It is therefore recommended to perform a dynamic CT scan and a 3D CT scan as soon as possible in all children with lasting painful torticollis.

Astrocytoma↗
PubMed1997

[Objective evaluation of selective peripheral denervation for spasmodic torticollis].

The authors evaluated the results of selective peripheral denervation (SPD) of posterior rami of the cervical spinal nerves and/or the accessory nerve for spasmodic torticollis. Five patients underwent seven operations in total and the results were evaluated with the modified Tsui's score which was used in the clinical trial of botulinum toxin (BTX) for torticollis in Japan. The preoperative score was 10.8 +/- 2.2 (mean +/- S.D.) and the postoperative score was 1.4 +/- 1.7. The score changes indicated the effects of the operation as "excellent" in four cases and "good" in one case. These results indicate that SPD is superior to BTX in terms of control of symptoms in spasmodic torticollis. After the initial operation, however, two patients showed the so-called "mole-hitting game phenomenon" in which normal muscles develop abnormal contraction after denervation of abnormal muscles. This forced us to perform the second operations. Although this phenomenon was first described in botulinum toxin treatment, this is probably the first report in surgically denervated cases.

Adult↗
PubMedDate not supplied

[The results of microvascular decompression of the accessory nerve in patients with spastic torticollis].

The results of microvascular decompression of accessory nerve in patients with spastic torticollis are reviewed. 40 patients with spastic torticollis were treated. Unilateral microvascular decompression of the XIth cranial nerve were used in 11 cases, lateral in 23 cases. 5 patient had complete recovery, positive results were achieved in 12 patients. Best results were observed after bilateral decompression including retrocollis patients. Surgical treatment of laterocollis patients was less successful. Unilateral microvascular decompression of accessory nerve proved to be effective in homolateral type of torticollis.

Accessory Nerve↗
PubMed1998

[Benign paroxysmal torticollis. Recurrent involuntary twisting of the head in infants and young children].

Benign paroxysmal torticollis occurs in infancy and early childhood. The etiology is unknown, although a vasomotor labyrinthine pathophysiology is possible. We report four cases with onset at ages of two to six months of recurrent episodes of torticollis and discomfort persisting between three hours and seven days. In three cases the torticollis was alternating. Photography or videorecording made by the parents during the attacks were helpful for the diagnosis in three cases. MRI may in some cases be necessary to rule out a space occupying lesion in the posterior fossa.

Female↗
PubMed2003

Treatment of severe neuroleptic-induced tardive torticollis.

BACKGROUND: The aim of this paper is to describe a case of severe neuroleptic-induced tardive torticollis successfully treated with a combination of clozapine, clonazepam and botulinum toxin-A. CASE REPORT: The patient, a 30-year old man with a seven-year history of delusional disorder experienced severe right torticollis with painful tightness of the neck and elevation of the shoulder. At this time he was receiving haloperidol 20 mg, trifluoperazine 5 mg, zuclopenthixol 20 mg and biperidine 4 mg daily. The combination therapy with clozapine and clonazepam and the long-term use of botulinum toxin-A resulted in a complete remission of dystonic movements. CONCLUSIONS: The present observations provide evidence indicating that this combination therapy may be of benefit in patients with severe neuroleptic-induced tardive torticollis.

Journal Article↗
PubMed1979

Bromocriptine treatment of spasmodic torticollis. A double-blind crossover study.

A double-blind crossover study (12 weeks and 12 weeks) was performed to evaluate the effects of bromocriptine on the symptoms and serum prolactin levels of 14 women with spasmodic torticollis. While the serum prolactin level decreased in response to bromocriptine, no difference was found between the effects of placebo and bromocriptine on the symptoms of spasmodic torticollis. Our findings suggest that dopaminergic neurotransmission is not involved in the pathogenesis of this syndrome.

Adult↗
PubMed1988

Ocular counterrolling abnormalities in spasmodic torticollis.

Spasmodic torticollis is a focal dystonic movement disorder of unknown origin, long hypothesized to have some vestibular involvement. An examination of otolith function, ocular counterrolling, was performed on eight patients with this disorder. The test consisted of photographing both eyes while the subject underwent rotation in both naso-occipital and earth-horizontal long axes. Measurements of eye torsion were made with a superimposition technique accurate to 0.1 degrees. Results showed all eight patients had abnormal ocular counterrolling. The most notable defect was the lack of sustained eye torsion at the extreme positions, resulting in rolling of the eyes in the direction of head tilt rather than counterrolling, a phenomenon previously observed only in persons with known brain-stem problems. That finding, as well as the majority of the patients showing spontaneous vestibular nystagmus in the dark and directional preponderance with caloric stimulation, implies that one difficulty in spasmodic torticollis lies in central vestibular connections, manifested by disruption of brain-stem pathways.

Adult↗
PubMed1977

Torticollis with hiatus hernia in infancy. Sandifer syndrome.

Two infants with torticollis and hiatus hernia (Sandifer Syndrome) are presented. Both infants improved with medical management. Abnormal head and neck positioning is attributed to esophagitis secondary to gastroesophageal reflux, with or without hiatus hernia. Since esophagitis due to reflux is not necessarily accompanied by vomiting, infants with torticollis shoud be studied for gastroesophageal reflux. If present, medical management is usually successful.

Gastroesophageal Reflux↗
PubMed1999

Static and dynamic balance function in spasmodic torticollis.

The consequences of abnormal head posture on static and dynamic balance skill were studied in a group of 10 patients with idiopathic spasmodic torticollis (ST). In static conditions, body sway was assessed using a conventional force platform with eyes open and with eyes closed. Standardized dynamic balance conditions were produced using a rocking platform; lateral and anteroposterior dynamic balance skills were assessed by measuring linear displacement both of the body base and of the head. Dynamic tests were repeated 6 weeks after botulinum toxin treatment in all patients. Patients' results were compared with those obtained from 10 control subjects. In static conditions, ST patients did not differ from control subjects, but in dynamic conditions, balance parameters were greater in the patient group than in the control group. This was true for the lateral direction and for dynamic balance parameters recorded both before and after botulinum toxin treatment. Eye closure significantly increased dynamic balance parameters in both groups. However, the effect of eye closure was greater in the patient group than the control group, especially for lateral sway, suggesting that patients used vision to compensate for the dynamic balance disturbance induced by the spasmodic torticollis. Despite a significant improvement of head posture in all patients after botulinum toxin treatment, no significant changes in dynamic balance parameters were observed between the first and second test. The possible origins of the dynamic balance disturbance observed in ST patients are discussed.

Adult↗
PubMed1991

Change in pattern of muscle activity following botulinum toxin injections for torticollis.

Twenty patients with torticollis had electromyographic studies of their neck muscles performed before and after a series of local injections of botulinum toxin. The pattern of muscle activity changed after the injections, and this effect persisted even after head position had returned to baseline. Patients who did not experience any clinical benefit from the injections also demonstrated a change in the pattern of muscle activity. These results suggest that the underlying abnormality in torticollis usually involves a general motor program for head position, rather than the activity of individual neck muscles.

Adult↗
PubMedDate not supplied

Botulinum A toxin for the treatment of spasmodic torticollis: dysphagia and regional toxin spread.

Chemodenervation of cervical muscles with botulinum A toxin, although useful in treating spasmodic torticollis, has been associated with dysphagia. Retrospective analysis of dose and injection site (sternomastoid vs. posterior cervical muscle groups) in 26 patients (49 injections) suggested that dysphagia was related to the quantity of toxin injected into the sternomastoid muscle: dysphagia, median 150 IU (7 injections); and no dysphagia, median 100 IU (42 injections; p = 0.026 Wilcoxon test). In a prospective study (31 injections to 24 patients), limiting the dose administered to the sternomastoid to 100 IU, substantially reduced the incidence of dysphagia (0 of 31, p = 0.27, Fisher's exact test). Denervation of human orbicularis muscle fibers, 5 weeks to 4 months after injection of botulinum A toxin for the treatment of blepharospasm, was successfully demonstrated by intense, diffuse acetylcholinesterase staining. A weight-adjusted dose similar to that given for torticollis was injected into longissimus dorsi muscle in 6 albino rabbits. Using the acetylcholinesterase stain as a marker, a diffusion gradient was noted over a distance of 30 to 45 mm from the point of injection and in contralateral muscle 15 to 25 mm from this point. Thus, denervation was demonstrated to occur within a definable area which crossed anatomic barriers, such as fascia and bone. These clinical and laboratory data suggest that dysphagia following botulinum toxin therapy results from toxin spread to pharyngeal musculature from the sternocleidomastoid injection site. Limiting of the injection dose to 100 IU or less to the sternomastoid substantially decreases the incidence of this complication.

Acetylcholinesterase↗
PubMed1987

Torticollis following radiation therapy.

A patient with adenocarcinoma in the apical portion of the lung producing a Pancoast's syndrome developed torticollis a few months after receiving a course of radiation therapy (5,040 rad) to his upper chest and neck. We describe this case, in which local radiation fibrosis of the neck muscles and perhaps segmental demyelination of the 11th cranial nerve resulted in peripheral nervous system lesion causing torticollis.

Adenocarcinoma↗
PubMed1993

Quantitative measurement of cervical range of motion in patients with torticollis treated with botulinum A toxin.

Improvement in cervical range of motion in patients with spasmodic torticollis by botulinum A toxin injection is difficult to objectively measure. Recently, a three-dimensional cervical range of motion system (EMROM) that measures primary as well as secondary cervical angles has been developed. This system uses an electromagnetic tracking system for data collection and a personal computer for analysis and graphic display of the data. We have tested the EMROM system and, from our results, believe that it can be used clinically to objectively and accurately measure cervical range of motion in patients who have spasmodic torticollis and who receive botulinum toxin injections.

Adult↗
PubMed1993

Use of botulinum toxin type F injections to treat torticollis in patients with immunity to botulinum toxin type A.

Fifteen patients with torticollis who had been treated with repeated injections of botulinum toxin type A (botox A) developed antibodies to the toxin. This resulted in loss of benefit in the 13 patients who had improved with botox A injections and failure to develop muscle atrophy after injection in all 15 patients. Patients were then injected with botulinum toxin type F (botox F) in the same muscles that had been injected with botox A. Ten of the 15 improved after botox F injections, including 9 of the 12 patients who had improved with type A toxin. Six of 9 patients with pain had improvement in pain after botox F injections. Patients reported similar improvement with type F and type A toxins, but duration of benefit was approximately 3 months with type A and approximately 1 month with type F. Botox F is an effective treatment for torticollis in patients who are immune to botox A. The usefulness of type F toxin, however, is limited by short duration of benefit.

Adolescent↗