Overview
Spasmodic torticollis encompasses various forms including benign paroxysmal torticollis, inflammatory torticollis, and cases due to neurovascular compression. It is characterized by episodic head tilting, often with associated symptoms like pain and, in some cases, migrainous features 1234.Diagnosis
Clinical Presentation: Episodic unilateral head tilt, often with chin rotated contralaterally 12.
History: Seek antecedent infections, family history of migraines, and associated symptoms like ataxia or vomiting 14.
Imaging: CT and MRI useful for ruling out structural causes, such as subluxation of the atlantoaxial joint or retropharyngeal abscess 2.
Neurological Examination: Assess for signs of nerve compression or inflammatory processes 3.Management
Supportive Care: Environmental modifications and symptomatic relief 1.
Pharmacological Treatment: Specific drug classes/doses not detailed; supportive care often includes analgesics and muscle relaxants as needed 1.
Address Underlying Causes: Treat identified infections or resolve neurovascular compression surgically if applicable 23.Special Populations
Pediatrics: Acute torticollis often linked to upper respiratory infections, sinusitis, or otolaryngologic issues; careful evaluation for occult infections is crucial 2.
Comorbidities: Consider association with migraines and other paroxysmal syndromes, especially in pediatric cases 14.Key Recommendations
Evaluate pediatric patients with acute torticollis for underlying otolaryngologic infections and consider imaging to rule out structural abnormalities (Evidence: Moderate 2).
In cases of spasmodic torticollis suspected due to neurovascular compression, surgical intervention to relieve compression may be curative (Evidence: Weak 3).
For benign paroxysmal torticollis, focus on supportive care and monitor for evolution into other episodic syndromes; consider family history of migraines (Evidence: Expert opinion 1).References
1 Yates T. Benign paroxysmal torticollis. Handbook of clinical neurology 2023. link
2 Bredenkamp JK, Maceri DR. Inflammatory torticollis in children. Archives of otolaryngology--head & neck surgery 1990. link
3 Pagni CA, Naddeo M, Faccani G. Spasmodic torticollis due to neurovascular compression of the 11th nerve. Case report. Journal of neurosurgery 1985. link
4 Hanukoglu A, Somekh E, Fried D. Benign paroxysmal torticollis in infancy. Clinical pediatrics 1984. link