Abstract
Background: Sandifer syndrome (SS) is the association of gastroesophageal reflux disease (GERD) with neurological manifestations (spastic torticollis and paroxysmal dystonic postures with arching of the back and rigid opisthotonic posturing. Case presentation: A 3-month-old male infant presented to our emergency department with torticollis and dystonic episodes for two months associated with vomiting. These movements were observed during or just after feeding. Since the patient developed regurgitations with torticollis and dystonic episodes with arching of the back and rigid opisthotonic posturing. The electroencephalogram was normal. Barium swallow/meal examination revealed GERD without evidence of hiatus hernia. Apgar scores were 7 at 1 min and 9 at 5 min. Conclusion: Early recognition and treatment of GERD in patients with Sandifer syndrome enhance the success of medical management and contributes to improved quality of life for patients with brain damage. The paroxysmal dystonic behaviors were dramatically disappeared completely after medical management in this patient.
Highlights
Sandifer syndrome (SS) is the association of gastroesophageal reflux disease (GERD) with neurological manifestations
We report a 3-months-old male patient presented to our ED with torticollis, dystonic episodes with severe arching of the back and rigid opisthotonic posturing since birth associated with vomiting
Sandifer syndrome is a syndrome characterized by paroxysmal dystonic posturing with opisthotonus and unusual twisting of the head and neck are temporally associated with GERD episodes [3] [13]
Summary
Sandifer’s syndrome (SS) is a combination of neurological manifestations (sudden abnormal spastic torticollis and dystonic body movements and dystonic movements of the head, neck, eyes and upper part of the trunk) with severe GERD [1] [2]. Kinsbourne in 1962, who noticed a disorder of the neurological manifestations in association with upper gastrointestinal tract occurring mainly in children and adolescents [3]. The neurological manifestations are thought to be a response to the pain associated with GERD, to protect the airway or reduce acid reflux-associated pain [11]. We report a 3-months-old male patient presented to our ED with torticollis, dystonic episodes with severe arching of the back and rigid opisthotonic posturing since birth associated with vomiting. SS was suspected and the above symptoms resolved completely after medical treatment
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