Overview
Grisel's syndrome is a non-traumatic atlanto-axial rotatory fixation often triggered by infections or surgeries in the head or neck region, leading to torticollis 1.Diagnosis
Clinical Presentation: Fixed head position or limitation of neck movement, often following tonsillitis or neck surgery 1.
Initial Tests: Cervical X-rays may not be diagnostic; advanced imaging like CT scan or MRI is crucial for definitive diagnosis 1.
Anatomical Insight: Pharyngovertebral veins may explain the hematogenous spread of infection to cervical spinal structures 3.Management
First-Line Treatments: Anti-inflammatory medications 1.
Adjunctive Treatments: Immobilization, cervical traction, or surgical intervention in severe cases 1.Special Populations
Pediatrics: Cases reported in children (ages 7-12) highlight the condition's occurrence in pediatric populations 1.Key Recommendations
Prompt Imaging: Utilize CT scan or MRI for definitive diagnosis when torticollis follows head or neck infections/surgeries (Evidence: Weak) 1.
Early Intervention: Initiate anti-inflammatory treatment and consider immobilization or traction to prevent neurological complications (Evidence: Weak) 1.
Surgical Consideration: Evaluate surgical intervention for cases refractory to conservative management (Evidence: Expert opinion) 1.References
1 Ortiz GL, Pratts I, Ramos E. Grisel's syndrome: an unusual cause of torticollis. Journal of pediatric rehabilitation medicine 2013. link
2 Sokolyan AV, Murashko AV, Krechetova LV, Ziganshina MM, Sukhikh GT. The significance of angiogenic growth factor in the pathogenesis of gestosis in pregnant women with varicose disease. Bulletin of experimental biology and medicine 2008. link
3 Parke WW, Rothman RH, Brown MD. The pharyngovertebral veins: an anatomical rationale for Grisel's syndrome. The Journal of bone and joint surgery. American volume 1984. link
4 Haeckel R, Riedel H, Büttner J. Estimation of decision criteria for the uric acid concentration for the early diagnosis of gestosis. Journal of clinical chemistry and clinical biochemistry. Zeitschrift fur klinische Chemie und klinische Biochemie 1981. link