Poster 60: Cervical soft tissue mass presenting as torticollis in a 51-year-old man: a case report

Abstract

Setting: University-based rehabilitation clinic. Patient: A 51-year-old male smoker with longstanding tardive dyskinesia presenting with torticollis. Case Description: The patient developed progressive severe right-sided neck pain and stiffness in the 3 years prior to presentation. Initially, the pain was intermittent, occurring every 3 to 4 months. Over the 6 months before presentation, the pain became constant, with increasing involuntary positioning of his head to the right. The patient received short-acting narcotics from the emergency department for this pain on 7 separate visits, but no work-up was conducted. At initial presentation, the physical examination revealed a head tilt to the right and increased tonic activity of the right scalenes, splenius capitis, sternocleidomastoid, and upper trapezius. The patient also had some weakness of shoulder abduction and hand intrinsic muscles on the right. Based on these findings, the patient was sent for a magnetic resonance imaging (MRI) of the cervical spine and a chest radiograph. Assessment/Results: MRI of the cervical neck revealed a multilevel, right sided, extradural, enhancing cervical soft tissue mass from C3–6 with impingement of the C4 and C5 nerve roots and infiltration into the paraspinal muscles. The chest radiograph was normal. Discussion: This case illustrates the relatively uncommon phenomenon of torticollis as a presenting sign of an underlying cervical soft tissue mass. Conclusions: Clinical suspicion for underlying mass should remain high in the face of worsening symptoms of torticollis and prompt early radiologic imaging of the cervical spine.