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Torticollis

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Torticollis

  • Definition
  1. Head and neck rotation due to sternocleidomastoid shortening
  • Signs
  1. Head laterally bent toward the shortened sternocleidomastoid muscle
  2. Chin and neck rotated toward the opposite side
  • Causes
  1. Nondynamic Torticollis (nonparoxysmal)
    1. Congenital Torticollis
    2. Osseous Torticollis
      1. Klippel-Feil Syndrome (short neck, low occipital hair line, fused Cervical Vertebrae)
      2. Vertebral or spinal lesions
      3. Hemivertebrae or blocked Vertebrae
      4. Atlantoaxial Rotary Fixation (C1 subluxation on C2)
    3. Neurologic
      1. Posterior fossa malignancy (e.g. cerebellar or Brain Stem neoplasm)
      2. Mass lesions
      3. Chiari Malformation
    4. Ocular
      1. Congenital Cataract
      2. Microphthalmia
    5. Non-muscular soft-tissue
  2. Dynamic Torticollis (paroxysmal)
    1. Benign paroxysmal Torticollis
      1. Self limited, intermittent episodes lasting minutes to hours and recurring over weeks to months
      2. Onset in the first few months of life and resolves by age 2-3 years old
      3. May be associated with Ataxia, Nystagmus, Agitation, Vomiting, lethargy, pallor
    2. Spasmodic Torticollis (Cervical Dystonia)
      1. Sleep malposition
      2. Cervical Lymphadenitis (e.g. Strep Throat, Cat Scratch Disease, Tuberculosis)
      3. Local inflammation or Trauma
      4. Retropharyngeal Abscess or Peritonsillar Abscess
      5. Upper lobe Pneumonia
    3. Sandifer Syndrome
      1. Severe GERD or esophagitis results in Torticollis, opisthotonus, irritability
    4. Medication reaction
      1. Neuroleptic induced Dystonic Reaction
    5. Increased Intracranial Pressure
      1. Pseudotumor Cerebri
    6. Conversion Disorder
  • References
  1. Jhun, Grock, Ebenezer in Herbert (2016) EM:Rap 16(7): 11-3
  2. Tomczak (2013) J Child Neurol 28(3):365-78 +PMID: 23271760 [PubMed]