Persistent torticollis: Think about Grisel's syndrome

Abstract

Grisel's syndrome (GS) is defined as a non-traumatic subluxation of the atlanto-axial joint and is considered a rare complication of infectious or inflammatory processes of the head and neck region due to upper respiratory tract infections or following surgical otolaryngeal interventions. The etiopathogenesis of this clinical entity is not yet clear. Early recognition of pediatric atlanto-axial subluxation (AAS) is essential to avoid permanent damage and requires a combination of clinical assessment and appropriate radiologic imaging. Computed tomography (CT) is considered gold standard in the diagnosis of GS. We report a case of a young child who presented with torticollis and acute otitis media and discuss the potential role of magnetic resonance imaging (MRI) in first suggesting the diagnosis. A brief review of the literature is presented. Conclusion: radiologists should first consider MRI of the atlanto-axial joint in young patients with torticollis with a recent history of infection in the head and neck region.