Grisel's syndrome: a rare complication of tonsillectomy

Sia, K J; Tang, Ing Ping; Kong, C K L; Nasriah, A

doi:10.1017/s0022215112000175

Cited by 15 publications

(11 citation statements)

References 11 publications

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“…3-6 GS has also been reported after tonsillectomy and adenoidectomy. 7-9 The majority of cases present in children aged 5 to 12 years old 2,10-12 and can mimic other diagnoses such as meningitis, retropharyngeal abscess, painful lymphadenopathy, or trauma. 10 Classically, patients demonstrate torticollis and neck pain, with imaging studies showing rotary alanto-axial subluxation, although the degree of subluxation is variable.…”

Section: Discussionmentioning

confidence: 99%

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More Than a Pain in the Neck: An Unusual Case of Persistent Neck Stiffness in a 10-Month-Old

Tam

Lee

Stover

2019

Clin Pediatr (Phila)

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Section: Discussionmentioning

confidence: 99%

“…13 Many case reports that describe significant neurological complications or sequelae cite a delay in diagnosis. 8…”

Section: Discussionmentioning

confidence: 99%

More Than a Pain in the Neck: An Unusual Case of Persistent Neck Stiffness in a 10-Month-Old

Tam

Lee

Stover

2019

Clin Pediatr (Phila)

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“…Several reasons account for this: the facet joints, specifically in C1 and C2, are shallow and more horizontal; the atlanto-occipital joint is less stable; the condyles are smaller; the ligamentous attachments are more lax and easier to disrupt; the uncinate process is poorly developed, causing excessive lateral bending and rotation; and the head size disproportion present in children (short neck with minimal musculature) [7][8][9]. Several reasons account for this: the facet joints, specifically in C1 and C2, are shallow and more horizontal; the atlanto-occipital joint is less stable; the condyles are smaller; the ligamentous attachments are more lax and easier to disrupt; the uncinate process is poorly developed, causing excessive lateral bending and rotation; and the head size disproportion present in children (short neck with minimal musculature) [7][8][9].…”

Section: Pathophysiologymentioning

confidence: 99%

“…Some authors recommend a dynamic test, which is done by rotating the patient's head to the opposite direction, showing that the atlas and the axis do not rotate independently of each other but as a unit [6][7][8]11,14]. Cervical X-rays are limited by the deformity and the child's uncooperativeness due to the pain.…”

Section: Diagnosismentioning

confidence: 99%

Grisel's syndrome: An unusual cause of Torticollis

Ortiz

Pratts

Ramos

2013

Journal of Pediatric Rehabilitation Medicine

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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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“…Atlantoaxial subluxation associated with infection at the pharynx and its surrounding tissues is called Grisel’s syndrome [ 7 ]. Grisel’s syndrome has also been described in association with postoperative inflammation in surgical conditions such as tonsillectomy and adenoidectomy, in which a clear infective factor is not always proved [ 8 , 9 ]. The majority of reported cases occurred in patients under 21 years of age [ 10 ]; it is rare in adults [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Acute neck pain caused by septic arthritis of the lateral atlantoaxial joint with subluxation: a case report

et al. 2015

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IntroductionCrystal-induced arthritis of the lateral atlantoaxial joint may be intimately involved in acute neck pain in the elderly. Patients typically have a good prognosis, and symptoms usually subside within a few weeks. On the other hand, septic arthritis of the lateral atlantoaxial joint requires early diagnosis and antibiotic treatment. Diagnostic delay is a risk factor for an unfavorable outcome of vertebral osteomyelitis. Even though septic arthritis of the lateral atlantoaxial joint is a very rare clinical entity, it is important to differentiate septic arthritis from crystal-induced arthritis.Case presentationA 53-year-old Japanese man presented with neck pain, stiffness, and loss of power of his left upper extremity which started 20 days before his visit to our hospital. A physical examination revealed a limited range of motion of his neck, with rotation being especially very restricted. Atlantoaxial subluxation was seen on plain radiography of his cervical spine. During puncture of the lateral atlantoaxial joint, clear yellow fluid was collected. Cultures later grew methicillin-sensitive Staphylococcus aureus. He was diagnosed with septic arthritis of the lateral atlantoaxial joint with atlantoaxial subluxation. After diagnosis, intravenous administration of antibiotics was begun. The atlantoaxial region was stabilized with the Brooks procedure. Plain radiography showed complete bone union 8 months after operation. At a follow-up evaluation 7 years after initial onset, he had complete relief of neck pain, and there were no neurological abnormalities.ConclusionsA patient with septic arthritis of the lateral atlantoaxial joint with subluxation presenting with acute neck pain was successfully treated with antibiotics and fusion surgery. In patients with persistent neck pain, septic arthritis of the lateral atlantoaxial joint should be considered and further examinations performed.

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Grisel's syndrome: a rare complication of tonsillectomy

Cited by 15 publications

References 11 publications

More Than a Pain in the Neck: An Unusual Case of Persistent Neck Stiffness in a 10-Month-Old

More Than a Pain in the Neck: An Unusual Case of Persistent Neck Stiffness in a 10-Month-Old

Grisel's syndrome: An unusual cause of Torticollis

Acute neck pain caused by septic arthritis of the lateral atlantoaxial joint with subluxation: a case report

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