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PubMed1989

Torticollis due to a combination of sternomastoid contracture and congenital vertebral anomalies.

We report four children with sternomastoid contracture combined with torticolis secondary to congenital vertebral anomalies. Two had features of Klippel-Feil syndrome and a proximal release of the contracted sternomastoid produced good cosmetic correction initially. Progression of the deformity occurred subsequently without recurrence of sternomastoid contracture. One child had such mild deformity that it was merely observed. The fourth child was born with torticollis without sternomastoid tightness and a vertebral anomaly was later recognised. He slowly developed a sternomastoid contracture and his condition was considerably improved by sternomastoid release. This combination of causes of torticollis has not, as far as we know, been previously reported. The clinician should be aware of it and should also realise that radiographs of the very immature spine may not disclose the bony anomalies.

Child↗
PubMed1992

Benign paroxysmal torticollis of infancy.

Benign paroxysmal torticollis is a self-limiting condition occurring during infancy. It resolves by the age of two to three years. Periodic episodes of torticollis may randomly alternate from side to side and be associated with other symptoms. The aetiology is unknown and no treatment is effective. It is relatively uncommon, and has not been previously reported in the orthopaedic literature, although initial referral may well be to an orthopaedic surgeon. We report four cases, and review the literature.

Female↗
PubMed2003

Delayed onset of oculogyric crisis and torticollis with intramuscular haloperidol.

OBJECTIVE: To report a case of delayed-onset dystonic reactions, oculogyric crisis (OGC), and torticollis after treatment with intramuscular haloperidol lactate injection. CASE SUMMARY: A 22-year-old Mexican American woman received intramuscular haloperidol lactate 7.5 mg followed 4 hours later by 10 mg. Twenty-six hours after the first injection, the patient reported that she was unable to lower her gaze and that her neck was stiff. She was immediately given intramuscular benztropine 2 mg; there was a nearly complete remission of symptoms within 15 minutes of treatment. An objective causality assessment revealed a probable relationship between the OGC/torticollis and haloperidol therapy. DISCUSSION: Dystonic reactions have been reported in 10-60% of patients treated with neuroleptic medication, most commonly when patients just start or increase the dose of the drug. The highest frequency of dystonic reactions has occurred in patients receiving high-potency neuroleptics. It has also been suggested that haloperidol-induced dystonic reactions are a result of the toxic metabolites of that agent. CONCLUSIONS: OGC and torticollis reactions may occur 12-24 hours after treatment with a high-potency neuroleptic, even in the absence of symptoms of extrapyramidal side effects (EPSEs). The delayed dystonic reaction may begin suddenly (no early EPSE symptomatology).

Adult↗
PubMed1991

[Spasmodic torticollis and frontal meningioma].

A 57 year-old man developed a spasmodic torticollis with involuntary deviation of the head to the right-side. He had a left paramedian frontal meningioma. The association of spasmodic torticollis and other movement disorders has been reported with contralateral lesions in the basal ganglia. Its occurrence in association to a frontal lesion appears to be much less frequent suggesting a possible disorder of frontostriatal connections.

Frontal Lobe↗
PubMed2002

[Ekbom's sydrome and spasmodic torticollis: case report].

The Ekbom's syndrome, also known as delirium of parasitic infestation, acarophobia, delusional parasitosis, psychogenic parasitosis, is a disease of rare occurrence. Generally it is characterized by the firm conviction of the patients to be infected by worms that come out of the skin, usually from the scalp or even from the mouth, from the eyes or from the genital region. Most of the patients are elderly and female, and with frequent social isolation. Some cases are associated with organic diseases as hyperthyroidism, diabetes, cortical lesion, intoxication by medicines. To our knowledge the association between delusional parasitosis with spasmodic torticollis was not described in literature. We report the case of a 72-year-old-woman with delusional parasitosis associated with spasmodic torticollis.

Aged↗
PubMed2006

[Benign paroxysmal torticollis of infancy: diagnosis and clinical evolution of six patients].

Benign paroxysmal torticollis of infancy is an episodic disorder that occurs suddenly and spontaneously in the first months of life. The patient's head tilts to one side for hours or days, and sometimes it can be associated with other symptoms like vomiting, sweating, pallor, irritability, headache and unstable gait. We report six patients with benign paroxysmal torticollis of infancy, whose symptoms began within the first six months of life and disappeared by five years of age. It is important that the physician be able to recognize this benign disorder to provide appropriate prognosis and not do unnecessary exams which would only cause expenses and anxiety for the child and their parents.

Child, Preschool↗
PubMed1993

Treatment of spasmodic torticollis with intradural selective rhizotomies.

To determine the effects of ventral cervical and selective spinal accessory nerve rhizotomy on spasmodic torticollis, 58 patients who had undergone surgery between 1979 and 1987 were reviewed retrospectively. At the time of surgery, each nerve rootlet was electrically stimulated to determine its effect on the nuchal musculature prior to sectioning. Forty-nine patients (85%) had a marked improvement in their condition, with 33 (57%) attaining an excellent result and 16 (28%) noting significant improvement. Patients complained of abnormal head posture, nuchal muscle spasms, and pain prior to surgery. Muscle spasms were completely relieved in 42 patients (72%) and markedly reduced in 10 (17%). Of the 47 patients with preoperative pain, 30 (64%) were free of their pain and eight (17%) noted that the pain was reduced in intensity and frequency. Thirty-four patients (59%) reported that their resting head posture was restored to a neutral position. The likelihood that a patient's head posture returned to normal was inversely proportional to the preoperative duration of the spasmodic torticollis. Twenty-six patients (45%) suffered mild transient difficulty with swallowing solid foods in the immediate postoperative period. In most cases these minor difficulties abated in the months following surgery.

Accessory Nerve↗
PubMedDate not supplied

Photophobia, epiphora, and torticollis: a masquerade syndrome.

Three young children presented with photophobia, epiphora, and torticollis as the initial manifestation of a posterior fossa tumor. In each case there was a delay in treatment due to the presumptive diagnosis of a local ocular inflammatory condition. We recommend that children with unexplained photophobia, epiphora, and torticollis undergo an imaging technique to evaluate the posterior fossa.

Astrocytoma↗
PubMed1990

Treatment of idiopathic spasmodic torticollis with botulinum-A toxin: a pilot study of 19 patients.

Nineteen patients with spasmodic torticollis, unresponsive to standard therapy, were administered local injections of botulinum-A toxin into the affected muscles. During an average follow-up period of 11.5 months, a more than 25% improvement was noted in 14 of 19 patients. All those with purely focal dystonia and 9 of 10 patients with a disease history of less than three years benefited from treatment. Side effects were insignificant and transient. Botulinum toxin is a very effective and safe method of treatment for spasmodic torticollis.

Adult↗
PubMed1999

[Selective peripheral denervation for spasmodic torticollis involving the levator scapulae muscle].

Patients with laterocollis or rotatory type torticollis tend to show abnormal contraction of the levator scapulae muscle and the scalene muscles. These muscles are innervated from the anterior branches of the cervical spinal nerves. Because of this, the traditional Bertrand operation dealing with posterior branches does not adequately affect the symptoms of laterocollis. The authors report selective denervation of the levator scapulae muscle in three patients and discuss its rationale. All the three patients underwent denervation of both the C1-C6 posterior spinal rami and the branches from the C3 and C4 anterior rami to the levator scapulae muscle. We added myotomy of the scalene muscle in one patient, and denervation of the omohyoid muscle which is innervated from the ansa cervicalis and the descending branch of the hypoglossal nerve. The pre/post-operative Tsui scores were 12/4, 15/1, and 14/3 respectively. There were no complications. We conclude that selective peripheral denervation of the levator scapulae muscle is safe and effective in the treatment of laterocollic type torticollis.

Adult↗
PubMedDate not supplied

[Selective denervation of neck muscles in the treatment of spasmodic torticollis. Preliminary results].

The authors present a review of the methods of surgical treatment of spasmodic torticollis, particularly the selective denervation of cervical muscles. Based on the literature and own experience cases treated by means of this method are described. Using selective ramisectomy it is possible to attain permanent improvement in most patients suffering from spasmodic torticollis, with very low complication rate. Our preliminary cases indicates that this method of treatment allows to acquire improvement of quality of life in patients with this particular type of dystonia.

Adult↗
PubMed2000

Refractory torticollis after a fall.

Though multiple medical and psychiatric causes of torticollis have been described, cervical dystonias resulting from distant somatic dysfunctions have not. This article describes the treatment of a 62-year-old woman in whom refractory retrotorticollis of surmised pelvic etiology developed after a fall. Structurally, cervical dystonias have been addressed as problems that originate in the head and neck, but this limited view of the musculoskeletal component of torticollis may prevent physicians from directing osteopathic manipulative treatment to the underlying problem.

Accidental Falls↗
PubMed2001

[Torticollis after unnoticed pharyngeal perforation: suspected retropharyngeal abscess].

Pharyngeal perforations due to foreign bodies are severe when retropharyngeal space infection develops into an abscess. Although the common clinical presentation is sore throat and fever, when the perforation remains occult, torticollis can be a significant symptom. Palatopharyngeal lesions, caused by rigid objects' impactation through the mouth, are common in childhood. Most are not important, but all have the potential hazard of pharyngeal perforation with development of a retropharyngeal abscess. It must be suspected specially when air is shown in the retropharyngeal space on a lateral radiography of the neck, which should always be done. We report a 9-years old boy who had cervical stiffness and torticollis and elevation of the right shoulder, without previous known trauma. Air was shown in the retropharyngeal space on a lateral radiography of the neck in relation to a possible pharyngeal perforation which was later confirmed by a CT scan. We review the literature about diagnosis and treatment of retropharyngeal abscess in childhood.

Child↗
PubMedDate not supplied

[Surgical treatment of spasmodic torticollis. Physiopathological considerations and follow-up of 20 cases (author's transl)].

The standard surgical procedures on either peripheral or central nervous system in the treatment of primary spasmodic torticollis are: myotomy, neurotomy, cervical rhizotomy, cortical topectomy, prefrontal lobotomy and a variety of stereotaxic nucleotomies and tractotomies (globus pallidus, thalamus, subthalamus, midbrain). These procedures are briefly reviewed. Some newly proposed operations are than discussed (Svien's labyrinthine suppression and Mazar's interruption of cortico-capsular head-turning pathways). The former surgical intervention is based on physiological and experimental evidence than an altered influence of the reticular substance of the midbrain on the "central" vestibular circuits may be relevant in the genesis of primary spasmodic torticollis. The results are reported of 20 personal cases treated with various surgical procedures with a maximum follow-up of 14.4 years (mean = 6.7 years). It is concluded that at present the most effective and reliable treatment is bilateral anterior rhizotomy of C1-C3 combined with unilateral or bilateral neurotomy (or spinal rhizotomy) of the 11th cranial nerve. The results were rated clinically as useful in 66.6% of the 15 patients treated with this procedure.

Adolescent↗
PubMed1976

The influence of age on the results of open sternomastoid tenotomy in muscular torticollis.

The ideal age for surgery for muscular torticollis, the complications and results of open sternomastoid tenotomy were investigated in 60 patients operated on at different age-groups. Under the age of 1, tethering of the scar to the deeper structures was common and was mainly responsible for the lower percentage of good results (42.1 per cent). In the age-group 1 to 4 years, satisfactory correction of facial asymmetry, head and tilt and limitation of neck movements, was achieved with overall 66.7 per cent good results. However, in patients above the age of 5, not only was the correction of the secondary deformities uncertain but the late complications like loss of sternomastoid column, disfiguring scar and presence of lateral bands were more common. Only 33.3 per cent had good results in the 5 to 8 year age-group and none in the above 9 years age-group. The best time for surgery in muscular torticollis is in the patient between 1 and 4 years of age.

Age Factors↗
PubMed1992

[Botulinum toxin treatment of spastic torticollis].

Botulinum toxin A was administered to 19 patients with spasmodic torticollis. A significant decrease of abnormal head and neck movements was recorded, and all the patients who suffered pain reported relief. Side effects were minor and transient. The results of this study indicate that botulinum toxin is an effective means of treating torticollis.

Adult↗
PubMed1992

Ipsilateral pallidal control on the sternocleidomastoid muscle in cats: relationship to the side of thalamotomy for torticollis.

To elucidate the role of the basal ganglia on neck movement control and thus clarify the side of targets for stereotactic surgery of spasmodic torticollis, effects of electrical stimulation to the globus pallidus-entopeduncular nucleus complex (GP-EP) upon the activities of the sternocleidomastoid (SCM) muscle motoneurons were studied in cats. Repetitive stimulation of the ipsilateral GP-EP increased discharge rate in the majority of the SCM motoneurons, whereas contralateral GP-EP stimulation caused a decrease in discharge rate. These effects were gradually enhanced in the course of repetitive stimulation and lasted even after its cessation. Bilateral ablation of the motor and premotor cortices did not influence the effects of GP-EP stimulation. Latency studies suggested that the pallidal control of the SCM motoneuron is mediated by polysynaptic pathways on both sides; however, these same studies produced evidence of an ipsilateral oligosynaptic connection, as well. Repetitive antidromic stimulation of the accessory nerve caused a gradual increase in discharge rate of the SCM motoneurons, similar to the augmentation induced by ipsilateral GP-EP stimulation. Features of the responses indicate that the pallidal control on the neck muscles involves reverberating circuits in the brain stem and spinal cord. These experimental findings suggest that stereotactic thalamotomy of the ventrolateral nucleus for spasmodic torticollis should be performed on the side ipsilateral to the contracting SCM muscle.

Accessory Nerve↗