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Torticollis is a clinical sign defined by the lateral inclination of the neck and rotation of the head, which can be fixed or flexible and accompanied or not by cervical pain. It appears in disorders of different complexity. In a case of torticollis it is necessary to carry out a careful medical history and a complete physical examination and, if persistent, request imaging tests. Reference is made to a cause of torticollis not described in the literature. This is a compressive cystic tumor in the posterior cranial fossa, Blake's pouch cyst, in a small infant diagnosed by ultrasound in the Primary Care Pediatrics office. After diagnosis, she was referred to the referral hospital, where emergency intervention was performed by pediatric neurosurgery, by fenestration of the tumor by endoscopic ventriculostomy and ventriculo-peritoneal shunt. She is currently asymptomatic and without sequelae.

La tortícolis es un signo clínico definido por la inclinación lateral del cuello y rotación de la cabeza, que puede ser fija o flexible y acompañarse o no de dolor cervical. Aparece en trastornos de diferente complejidad. Ante un caso de tortícolis, es preciso realizar una historia clínica cuidadosa y un examen físico completo, y, en caso de ser persistente, solicitar pruebas de imagen. Se hace referencia a una causa de tortícolis no descrita en la literatura. Se trata de una tumoración quística compresiva en la fosa craneal posterior, quiste de la bolsa de Blake, en una lactante pequeña diagnosticada mediante ecografía en la consulta de Pediatría de Atención Primaria. Tras el diagnóstico, se remitió al centro hospitalario de referencia, donde se intervino de urgencia por Neurocirugía Pediátrica, mediante fenestración de la tumoración por ventriculostomía endoscópica y derivación ventrículo-peritoneal. Actualmente, se encuentra asintomática y sin secuelas.

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In this retrospective cohort study, we assessed the incidence of torticollis in infants with a history of neonatal abstinence syndrome. Understanding the elevated risk of torticollis in this population is important for early identification and treatment.

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INTRODUCTION: Pain and cervical muscle spasm are common reasons why parents bring children to the pediatric emergency department. The first steps are the gathering of medical history of the patient and a physical examination. If musculoskeletal damage is suspected, cervical spine x-rays should be obtained. An intervertebral disc calcification finding, in the absence of other radiological lesions should suggest pediatric intervertebral disc calcification. OBJECTIVE: To present a case of intervertebral disc calcification, a rare condition that must be considered in the differential diagnosis of torticollis and neck pain in childhood. CASE REPORT: A seven-year-old male patient without morbid history and no history of trauma or rough sport practice. He consulted the emergency room for pain and cervical contracture for the last six days. C reactive protein and red cell sedimentatio rates were slightly elevated. Imaging studies showed calcification of the C5-C6 intrvertebral disc and anterior disc protrusion. The patient was hospitalized for evaluation and pain management, with good clinical response and continue afterwards with non-steroidal anti-inflammatory drugs and a soft collar. At the 6-month-follow up, the patient had resolved symptoms and calcifications. CONCLUSIONS: Pediatric intervertebral disc calcification is a rare cause of acquired torticollis, with a benign and self-limited outcome. Conservative management, as well as clinical and imaging follow-up is recommended.

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Objetivos: Delinear un algoritmo de actuación ante un niño o adolescente con tortícolis aguda, para facilitar la asistencia médica adecuada y oportuna.Desarrollo: La atención de un niño o adolescente con tortícolis aguda, requiere que el médico considere un grupo de trastornos con diferentes pronósticos. Previamente debe poseer una estrategia diagnóstica que le permita llegar a conclusiones de una manera rápida y a la vez, correcta. Se presenta una propuesta para la asistencia de estos pacientes. Los principios se organizan de manera que en primer lugar se establezcan las características evolutivas del evento. Luego la inclusión en grupos con características comunes que permitanrealizar un acercamiento a un conjunto de enfermedades. Por último, se incluyen las sugerencias de los exámenes a indicar en caso desospecha de un trastorno en específico o incluso cuando no hay una orientación suficientemente clara de lo que ocurre.Conclusiones: El algoritmo de actuación delineado ante un niño o adolescente con tortícolis aguda puede facilitar la acción adecuada y oportuna, aunque constituye solo una orientación. Con la experiencia y los conocimientos de cada profesional, dicho algoritmo puede sermodificado ante las múltiples situaciones que pueden presentarse en un paciente pediátrico con tortícolis aguda(AU)

Objective: To delineate an algorithm of actuation designed for the attention to children and adolescents with acute torticollis and to offer them an efficient and opportune medical assistance.Development: The attention of children and adolescents with acute torticollis requires that the physician may consider a group of disorders with different outcomes. Previously he should have a strategy for diagnosis that it may let him to arrive to quick and correct conclusions.Here is presented a proposition about the assistance to patients with acute torticollis. The principles are organized and in the first line are considered evolution characteristic of events. Next, is important the inclusion of patients in groups with common characteristics that allow to carry out an approach to a cluster of illnesses. Lastly, should be included some suggestions about key investigations in occasion ofsuspicion of one specific disorder or even when there is not sufficient clear orientation of what happens.Conclusions: The delineated algorithm of actuation in children and adolescents with acute torticollis may to facilitate the correct and opportune action although this proposition only constitutes an orientation. With the professional experience and knowledge, the algorithm may be modified according different situations during the attention of one pediatric patient affected by acute torticollis(AU)

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Dystonia is a neurological disorder characterized by intermittent or sustained muscle contractions that cause abnormal, usually repetitive, movements and postures. Dystonic movements can be tremulous and twisting and often follow a pattern. They are frequently associated with overflow muscle activation and may be triggered or worsened by voluntary action. Most voluntary muscles can be affected and, in the case of the neck muscles, the condition is referred to as cervical dystonia (CD), the most common form of dystonia. The high incidence of pain distinguishes CD from other focal dystonias and contributes significantly to patient disability and low quality of life. Different degrees of pain in the cervical region are reported by more than 60% of patients, and pain intensity is directly related to disease severity. Botulinum toxin (BoNT) is currently considered the treatment of choice for CD and can lead to an improvement in pain and dystonic symptoms in up to 90% of patients. The results for BoNT/A and BoNT/B are similar. The complex relationship between pain and dystonia has resulted in a large number of studies and more comprehensive assessments of dystonic patients. When planning the application of BoNT, pain should be a key factor in the choice of muscles and doses. In conclusion, BoNT is highly effective in controlling pain, and its analgesic effect is sustained for a long time in most CD patients.

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Introducción: El dolor y la contractura muscular cervical son motivos de consulta usuales en los servicios de urgencia pediátrica. El primer enfrentamiento es la anamnesis y examen físico minucioso. Ante la sospecha de etiología musculoesquelética se debe solicitar radiografía de columna cervical. El hallazgo de calcificación de los discos intervertebrales, en ausencia de otras lesiones radiológicas, nos debe hacer sospechar de una discopatía calcificante de la infancia. Objetivo: Presentar un caso de discopatía calcificante de la infancia, enfermedad infrecuente, que se debe tener en cuenta como diagnóstico diferencial de tortícolis y dolor cervical en la infancia. Caso clínico: Paciente varón de 7 años, sin antecedentes mórbidos ni historia de traumatismo o deportes bruscos. Consultó por historia de dolor y contractura cervical de 6 días de evolución. La velocidad de eritrosedimentación y proteína C reactiva estaban discretamente elevadas. La radiografía de columna cervical y la tomografía computarizada mostraron calcificación discal C5-C6 y protrusión discal anterior. Se hospitalizó para estudio y tratamiento del dolor, con buena respuesta clínica, continuando el manejo ambulatorio con antiinflamatorios no esteroidales y collar blando. Evolucionó con resolución de la sintomatología clínica y de las calcificaciones a 6 meses de seguimiento. Conclusiones: El hallazgo de calcificaciones de los discos intervertebrales es una infrecuente causa de tortícolis adquirida, de evolución benigna y autolimitada. Se recomienda manejo conservador por tiempo acotado y seguimiento clínico e imagenológico.

Introduction: Pain and cervical muscle spasm are common reasons why parents bring children to the pediatric emergency department. The first steps are the gathering of medical history of the patient and a physical examination. If musculoskeletal damage is suspected, cervical spine x-rays should be obtained. An intervertebral disc calcification finding, in the absence of other radiological lesions should suggest pediatric intervertebral disc calcification. Objective: To present a case of intervertebral disc calcification, a rare condition that must be considered in the differential diagnosis of torticollis and neck pain in childhood. Case report: A seven-year-old male patient without morbid history and no history of trauma or rough sport practice. He consulted the emergency room for pain and cervical contracture for the last six days. C reactive protein and red cell sedimentatio rates were slightly elevated. Imaging studies showed calcification of the C5-C6 intrvertebral disc and anterior disc protrusion. The patient was hospitalized for evaluation and pain management, with good clinical response and continue afterwards with non-steroidal anti-inflammatory drugs and a soft collar. At the 6-month-follow up, the patient had resolved symptoms and calcifications. Conclusions: Pediatric intervertebral disc calcification is a rare cause of acquired torticollis, with a benign and self-limited outcome. Conservative management, as well as clinical and imaging follow-up is recommended.

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PURPOSE: The objective of this paper is to present a case series of patients with diagnosis of torticollis due to Grisel's syndrome and, in doing so, raise awareness of an unusual condition that could be fatal. A review of the literature is presented regarding diagnosis and treatment. METHODS: Case series of three patients that were 7, 10, and 12 years old with history of tonsillitis or neck surgery consulted to the service of Rehabilitation Medicine. RESULTS: Physical examination showed a fixed head or limitation of movement to neutral position and initially a normal neurological examination. Initial cervical X-rays were not diagnostic. The final diagnosis was made by CT scan or MRI. All 3 patients were treated with anti-inflammatory medications, immobilization, and/or cervical traction or surgery. CONCLUSION: Grisel's syndrome is a non-traumatic atlanto-axial rotatory fixation (AARF) with or without subluxation following infection or surgery in the head or neck region. This paper presents an unusual cause of torticollis that could be fatal or cause neurological injury if not recognized and treated appropriately.

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La estimulación cerebral profunda (ECP) es una alternativa de manejo para los pacientescon distonía cervical, un síndrome de etiología múltiple, de presentación variada eincapacitante y refractario al manejo médico, que incluye la toxina botulínica. El artículopresenta el caso de una mujer de 56 años de edad con distonía cervical manifiesta conretrócolis e hiperextensión de columna dorsal, de cuatro años de evolución, consideradarefractaria al tratamiento y con indicación de ECP...

Deep brain stimulation (DBS) is a management alternative for patients with cervicaldystonia, syndrome of multiple etiology, presentation varied, disabling and refractoryto medical management, including botulinum toxin. A case of a 56 year old woman withcervical dystonia manifested by retrocollis and hyperextension dorsal spine of 4 yearsof evolution, considered resistant to treatment that is an indication of DBS is presented...

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BACKGROUND: Cervical dystonia (CD) may be classified according to the underlying cause into primary or secondary CD. Previous exposure to neuroleptics is one of the main causes of adult-onset secondary dystonia. There are few reports that characterize the clinical features of primary CD and secondary neuroleptic-induced CD. Herein our aim was to investigate a series of patients with neuroleptic induced tardive CD and to describe their clinical and demographic features. PATIENTS AND METHODS: We retrospectively evaluated 20 patients with neuroleptic-induced tardive CD and compared clinical, demographic and therapeutic characteristics to another 77 patients with primary CD. All patients underwent Botulinum toxin type-A therapy. RESULTS: We did not identify any relevant clinical and demographic characteristics in our group of patients that could be used to distinguish tardive and primary CD. CONCLUSION: Patients with tardive CD presented demographic characteristics and disease course similar to those with primary CD.

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Objetivo: Conocer los resultados de nuestra cirugía correctora del tortícolis (T) horizontal por nistagmus ocular congénito sin estrabismo. Material y Métodos: Estudio retrospectivo de 31 casos operados con diferentes procedimientos según las características del bloqueo y magnitud del T. Según esto último, los casos se clasificaron en 5 grupos. Resultados: La corrección del T fue exitosa (T residual del 12° o menos) en 80.7 por ciento del total de casos. En dos grupos obtuvimos curación del 100 por ciento de los casos, en otros 2,77 por ciento y 75 por ciento, respectivamente. En el 5° grupo la cirugía no fue uniforme y no es posible extraer normas de sus resultados. Como complicaciones tuvimos la aparición de un pequeño estrabismo en 3 casos y 4 pacientes debieron ser reintervenidos por tortícolis residual. Conclusiones: Las publicaciones con procedimientos comparables a los nuestros son escasas o con resultados vagos. Este estudio permite sacar guías quirúrgicas cuantitativas recomendables para 4 de los 5 grupos.

Purpose: To evaluate our surgical results in horizontal ocular torticollis present in congenital nystagmus without strabismus. Methods: A retrospective review was made in 31 consecutive patients, undergoing different surgical procedures considering the so called null zone and quantity of torticollis. Cases were classified in five groups. Results: In 80.7 percent of cases a successful result was obtained, defined as a residual torticollis not greater than 12°. Two groups obtained 100 percent correction. Two other groups obtained 77 and 75 percent correction respectively. The surgery indicated in group five was too heterogeneous and therefore non conclusive. After surgery a small strabismus presented in 3 cases. Four other patients were reoperated due to remaining torticollis. Conclusions: Papers with comparable procedures are few and don't show exact or detailed results. Our review allows us to obtain guide lines at least in 4 of the 5 groups.

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Eosinophilic granuloma (EG) is a benign condition of histocytes proliferation localized or multifocal. It is presents in the cervical spine in 1.5%-20% of the cases of EG. We report the case of a seven-year-old girl that presented with a one month history of cervical pain, persistent wryneck and vicious posture of the neck. A computerized tomography was performed and confirmed the presence of spreading lesion, ostheodestructive to the level of the left laminae of C2, with invasion of the spine and the muscular tissue. A laminectomy was underwent for removal of the lesion. The patient had a good post-operative recovery with improvement of the symptoms. Chemotherapy with prednisone, vinblastine and ethoposide was administred. After six months, this protocol was repeated associaded to methotrexate. The patient improved and had no new symptoms in a follow-up of 36 months.

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A Síndrome de Grisel consiste na subluxaçäo rotatória da articulaçäo atlantoaxial, comumente näo associada a trauma ou doença óssea. Possui etiologia variada. Os pacientes se queixam de dor cervical constante e progressiva, apresentando torcicolo e, em certos casos, compressäo da espinha cervical. O diagnóstico é clínico e radiológico. o tratamento deve ser o mais precose possível. Realiza-se revisäo bibliográfica do assunto, visando alertar os otorrinolaringologistas para esta possibilidade diagnóstica.

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Dystonia is a rare consequence of head trauma. We describe one case of post-traumatic spasmodic torticollis and review thirty-one cases reported in the literature. The time course among the head injury and the onset of dystonia ranged from two hours to nine years. Eleven cases had mild head injury and twenty had severe. On CT studies, the most frequent lesion was extradural, subdural and thalamic hemorrhagies; on MRI there were lesions in contralateral basal ganglia or thalamus. In our case, initial CT findings were bilateral hygroma and generalized brain edema. A follow-up CT sixt days after head injury showed cerebral atrophy and MRI scan (one year later) showed cerebral atrophy either. The pathophysiologic mechanisms related to the appearence of dystonia are poorly understood. However, there are evidences suggesting that some dysfunction of lenticulothalamic neuronal circuits plays an important role. The period of time between the head injury and the appearance of post-traumatic dystonia, seems to be related to aberrant central neurons.

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A distonia pós-traumática (DPT) é sequela rara do traumatismo crânio-encefálico (TCE). Descrevemos um paciente com torcicolo espasmódico e revisamos 31 casos descritos na literatura. O intervalo de tempo entre o TCE e o aparecimento da distonia variou de 2 horas a 9 anos. Em 11 casos o TCE foi de média gravidade e em 20 foi severo. As lesoes na tomografia de crânio (CT) foram: hematomas extra e subdurais e hemorragias talâmicas. Na ressonância magnética a lesao mais frequente estava localizada no gânglio basal contralateral ou no tálamo. Em nosso caso, a CT de crânio evidenciava higroma bilateral e dema cerebral difuso, com reabsorçao 6 dias depois; a RMN encefálica realizada 1 ano após o TCE mostrou discreta atrofia cerebral. Apesar da fisiopatologia da DPT nao estar bem esclarecida, há indícios de disfunçao do circuito lentículo-talâmico e que a variaçao de tempo entre o TCE e o desenvolvimento da DPT, ocorra por presença de neurônios aberrantes.

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La fibromatosis colli es una patología rara caracterizada por fibrosis del músculo esternocleidomastoideo, que se presenta clínicamente como una casa en el cuello. Aparece por lo general en el recién nacido, y debe reconocerse de manera temprana para proporcionar un tratamiento adecuado y oportuno. Se presenta el caso de un niño con fibromatosis colli bilateral, y se discuten aspectos de fisiopatogenia, diagnóstico y tratamiento de esta entidad

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