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PubMedDate not supplied

[The microsurgical decompression of the accessory nerve in spasmodic torticollis].

Microsurgical decompression of the accessory nerve was conducted in 10 patients with spasmodic torticollis (tonic and tonic-clonic forms). Compression of the roots of the accessory nerve of the posterior inferior cerebellar and the vertebral arteries was discovered. Decompression was accomplished by division of the arachnoid adhesions, anastomosis with sensory roots of C1 and C2, and placing a layer of muscular tissue between the nerve and the vessel. The results of treatment of spasmodic torticollis are analysed and the efficacy of neurovascular decompression is emphasized.

Accessory Nerve↗
PubMedDate not supplied

[Benign paroxysmal torticollis. Our experience gained over a 15-year period].

INTRODUCTION: Benign paroxysmal torticollis (BPT) is characterised by recurring episodes of lateral bending of the neck, occasionally accompanied by vegetative symptoms, ataxia or an abnormal position of the trunk, with a tendency to disappear spontaneously after some months or years, and with no alterations between episodes. AIM: To analyse the clinical and developmental characteristics of the cases evaluated by the Neuropaediatric Service at our hospital that were classified as BPT. PATIENTS AND METHODS: We reviewed the history of the patients with BPT included in the Neuropaediatric Service database over a 15-year period. Patients who were not following any kind of control were contacted by telephone. RESULTS: We found 13 BPT patients with typical criteria, and 4 others with possible BPT (p-BPT), because they had had an isolated episode of torticollis. Neuroimaging was carried out in nine children (69.2%) from the BPT group: this included only transfontanellar ultrasound recording (TF USR) in six cases, TF USR and computerised axial tomography (CAT) in one child, only a CAT scan in one case, and CAT and magnetic resonance imaging in another. Neuroimaging was performed in all the cases of p-BPT: CAT scans were carried out in two cases and TF USR was used in two others. CONCLUSIONS: Atypical cases can be excluded by establishing a diagnosis of BPT with strict criteria. Since no biological markers are available, the diagnosis must be based on the clinical pattern and course and, in some cases, complementary examinations have to be performed to preclude other pathologies. When a child is diagnosed with BPT, the family needs to be reassured and told that it is a benign process with a tendency to disappear spontaneously.

Child↗
PubMed2006

[An asymmetrical face due to torticollis in two young children].

In 2 girls, 4 years and 8 months of age, respectively, torticollis had been diagnosed a few weeks after birth. Kinesiotherapy, given for a period of 1 year and 6 months, respectively, had little effect. Both girls were then referred to the Orthopaedic Outpatient Clinic where a shortened sternocleidomastoid muscle and an asymmetrical face were diagnosed. The shortened muscle was cleaved surgically. Over half a year later, the face of the older child was still asymmetrical but that of the younger child symmetric. It is recommended that children with torticollis due to a shortened sternocleidomastoid muscle first be given stretch exercises under the guidance of a physiotherapist. If the result at the age of 1 year is unsatisfactory, an orthopaedic surgeon can then cleave the muscle.

Child, Preschool↗
PubMedDate not supplied

Ataxia-telangiectasia associated with torticollis: report of a case.

Ataxia-telangiectasia (A-T) is an autosomal recessive, multisystem disease characterized clinically by the onset of progressive cerebellar ataxia at about one year of age, followed by the development of fan-shaped telangiectasia of bulbar conjunctiva, usually at four- to six-years of age; and frequent sinopulmonary infections. The outstanding pathological findings in the central nervous system in A-T are loss of Purkinje cells and, to a lesser degree, basket and granular cells of the cerebellum. Although choreoathetosis and myoclonic jerks had been described in patients with A-T, torticollis has never been reported in the literature. A 7-year-old girl with A-T and torticollis is therefore presented in this paper.

Ataxia Telangiectasia↗
PubMed1991

[Therapeutic possibilities in spasmodic torticollis].

Spasmodic torticollis is classified as a focal dystonia. It is characterized by involuntary contractions of the muscles of the neck, with consequent deviation of the head from the correct posture. Psychological factors are recognized as important trigger and aggravating mechanisms. The various possibilities of therapeutic management (medical and surgical treatment, psychological methods and psychotherapy) are reviewed. Therapy of spasmodic torticollis should be started with methods such as biofeedback, behaviour therapy, and anticholinergic drugs. If these procedures not successful, local application of botulinum toxin offers a new and highly effective technique. Surgical treatment such as neurotomy, rhizotomy, or stereotaxic operations should be restricted to otherwise intractable cases.

Accessory Nerve↗
PubMed1990

[Surgical therapy of spasmodic torticollis. Selective peripheral denervation].

The authors report on their experience with 19 patients treated with a new operative procedure for spasmodic torticollis--microneurosurgical selective denervation of the hyperactive muscles. In comparison with earlier surgical approaches, the procedure, described by the Canadian neurosurgeon Claude Bertrand, is associated with a high success rate and an absence of the sequelae not infrequently seen with other procedures (stereotactic thalamotomy, intradural divisioning of the anterior roots C1-C3, etc.). The procedure is thus indicated whenever spasmodic torticollis still persists two years after onset, despite conservative therapy.

Follow-Up Studies↗
PubMed1990

[Compensatory head positioning as a result of ocular changes or torticollis of muscular origin in children].

Presented are the causes and clinical picture of the compensatory positioning of the head arising in the consequence of ocular changes and changes in the muscles of the neck. The material was divided into 3 groups: 1) with paresis of the ocular muscles (20 cases), 2) caused by nystagmus (20 cases) and 3) torticollis of muscular origin (20 cases). The basis of the differential diagnosis of compensatory positioning of the head of ocular origin and of torticollis of muscular origin as well as the criterion of a cooperation between the ophthalmologist and the orthopaedic surgeon are delineated.

Adolescent↗
PubMed1990

Local treatment of spasmodic torticollis with botulinum toxin.

Fifteen patients with spasmodic torticollis were treated with local injections of botulinum--A toxin. All the patients were followed for a period of 4 to 7 months. Thirteen out of 15 patients (86%) improved in the amount of sustained movements of torticollis. In six out of 9 patients presenting with pain complete relief was noted. Beneficial effects of botulinum toxin injections lasted from 2 to 3 months, with reproducible efficacy after repeated injections. The most frequent side effect was dysphagia, presented in 10 patients.

Adult↗
PubMed1990

[Benign paroxysmal torticollis in infancy: case report].

Since Snyder reported first twelve cases of benign paroxysmal torticollis in infancy (BPT) in 1969, about 30 cases have been reported mainly in the North America and Europe, but not in Japan. The authors experienced such a case of one-year-old boy. The attack occurred at the age of 2 months for the first time and continued to repeat every 2 weeks periodically. The head tiltings were always noticed when he woke up in the morning and lasted for about 5 to 6 days, but they disappeared during sleep. He tilted his head to the lateral side more often to the left than to the right. There were associated symptoms and signs including irritability, vomiting, gait disturbance, and abnormal truncal posture during the attacks. He did not demonstrate any neurological abnormalities between the attacks. The study of cerebrospinal fluid, caloric test, computed tomography, electroencephalography and brainstem auditory evoked responses were also normal. The frequency of the attacks gradually decreased after the age of 2 years and disappeared at the age of 3 years, and he has not complained of severe headache or vertigo up to 6 years of age. This case is reported to emphasize that BPT has to be included in the differential diagnosis of acquired torticollis. And it is required to accumulate such cases to elucidate its etiological factors.

Diagnosis, Differential↗
PubMed1989

[Paroxysmal torticollis in the developmental age].

An insufficiently elucidated clinical picture of paroxysmal alternating torticollis in the developing age is considered in this paper. This phenomenon is characterized by inclination of the head temporary on one side and the other, it is of various duration, with pauses and without any disturbances and symptoms. This appearance is observed in children aged 1-5. The authors assume that this rare state is a sequel of asymmetric maturation of the axial tonus. In that case, this torticollis is only the most striking phenomenon in the whole clinical picture of one-sided predomination of the axial tonus in its maturation.

Child, Preschool↗
PubMed1989

[Surgical treatment of spasmodic torticollis: effectiveness of microvascular decompression].

We report two patients of spasmodic torticollis who underwent different types of surgery according to their pathogenetic mechanisms. The first case was a 42-year-old man who had two years history of right-sided antecollis. EMG of the sternocleidal muscle on the affected side showed pathological findings. Characteristic findings on the vertebral angiography were a low position of the branching of tortuous PICA. At operation, we confirmed sandwich-like compression of left accessory nerve between the PICA and vertebral artery. Decompression of the nerve from these arteries led to a remarkable relief of the symptom. The second case was a 70-year-old man whose neck had been forced to bend backward; retrocollis over two years. EMG study was negative. The vertebral angiography showed no abnormality, either. Because there was no evidence of vascular compression on both accessory nerves at surgery, we chose bilateral C1-3 anterior root section which was effective in consequence. We found so far sixteen cases of spasmodic torticollis in the literature including ours who were benefited by microvascular decompression (MVD). All of them presented antecollis or horizontal type. The characteristic operative finding was the compression of the accessory nerve located at between the dural perforation of the vertebral artery and dural attachment of C1 dentate ligament. We can therefore propose a mechanism that the compression at the junction of the central and peripheral myelin causes such a neuroexcitatory symptom as in cases of facial spasm and trigeminal neuralgia.(ABSTRACT TRUNCATED AT 250 WORDS)

Accessory Nerve↗
PubMed1989

[Torticollis--an unusual origin].

On account of left-sided chronic otitis with cholesteatoma an otherwise healthy eight year-old girl underwent an otological operation lasting five hours. The course was technically uncomplicated. Postoperatively, persistent torticollis with turning of the head to the right was observed. X-ray and CT-scanning revealed atlanto-axial subluxation. No other cause than the rotation of the head during the operation was demonstrated. It is concluded that subluxation should be considered if torticollis is present after operations during which the head has been rotated.

Child↗
PubMed1989

Acute torticollis secondary to rupture of the sternocleidomastoid.

Trauma to the neck musculature and cervical spine is frequently caused by hyperextension injuries which may result in muscular spasm or rupture. Partial rupture of the sternocleidomastoid muscle with subsequent formation of a fibrotic band is an unusual cause of acute torticollis. The case of a 21-year-old man who developed an acute torticollis and cervical pain after a motor vehicle accident is presented. Computed tomography scan demonstrated 75% rupture of the left sternocleidomastoid muscle with fibrotic band replacing the absent muscle tissue. Neck range of motion was markedly decreased. The patient underwent a trial of muscle relaxants and intensive physical therapy with no significant improvement. Surgical release of the residual fibrotic band was performed, and the left deviation of the neck was reduced from 25 degrees preoperatively to 5 degrees postoperatively. With surgical release and intensive postoperative physical therapy, the patient regained full motion and strength of the cervical spine musculature.

Adult↗
PubMed1989

[Decoupling or ultra-short therapy of torticollis].

S. Rentrop's survey of literature on the history of the psychotherapeutic treatment of torticollis (76 titles) last year has encouraged us to contribute two examples of treatment to the discussion. The large number of theories, explanations, and treatment methods reveals the wide variety of increasingly effective treatment techniques, but it also makes apparent the dilemma involved in the search for a clear and comprehensive theory. On the basis of two case studies, we would like to show how torticollis symptoms could be eliminated with the help of a one-time focus on a largely unconscious traumatic complex, without additional therapy. One of the two female patients was treated in a supportive clinical environment, the other appeared at the out-patient clinic only once. Finally, we discuss the theoretical approach involved.

Adult↗
PubMed1988

[Benign infantile paroxysmal torticollis. Apropos of 3 cases].

We report three children with benign paroxysmal torticollis (BPT) and review the literature. BPT represents a self-limited disorder that occurs mainly in infancy and in females. The condition is characterized by recurrent spells of torticollis which may, or may not, be accompanied by other symptoms such as vomiting, pallor, ataxia, irritability and drowsiness. The diagnosis of BPT should be established clinically, although, in some cases, it is necessary to rule out conditions such as posterior fossa tumor, cervical dislocation, ocular palsy, dystonia due to side effects of drugs, or Sandifer's syndrome. The etiology of the syndrome remains unknown and, at present, there is no effective therapy.

Child, Preschool↗
PubMed1978

Treatment of spasmodic torticollis by dorsal column stimulation.

A new method is described to treat spasmodic torticollis with the implantation of a dorsal column stimulator at the C1--2 level or with transcutaneous stimulation. 22 patients were evaluated. 3 had sufficient relief to be treated with transcutaneous stimulation only. An additional 6 patients had surgically implanted dorsal column stimulators. It was empirically determined that a frequency of 800--1,100 Hz gave the best relief from torticollis. 1 patient had an excellent result; 3 have had good results; 1 had a fair result, and 1 had a poor result. An additional patient with dystonia musculorum deformans was considerably improved by the use of dorsal column stimulation.

Adult↗
PubMed1988

[Changes in functional cerebral laterality of patients with torticollis spasmodicus].

By comparing the results of tapping with and without simultaneous speaking and by evaluating their lateral differences the probable lateralization of functional speech centre was established in 28 patients with torticollis spasmodicus and 28 healthy controls. In doing this, it became evident that unlike the controls the patients as a hole in a significant way lateralized the speech centre more frequently to the right. The changed cerebral laterality in the patients was supposed to be stimulated by pronounced emotional conflicts and to be involved in the disease of torticollis spasmodicus.

Brain↗