Grisel's Syndrome Induced byMycobacterium tuberculosis

Abstract

Grisel's syndrome is a non-traumatic subluxation of the atlantoaxial joints, which is caused by an inflammatory process in the upper neck. It is rare to find literary reports of Grisel's syndrome with an evident pathogen in a lesion. For the first time in Korea, we report a 36-year-old female with Grisel's syndrome having an atlantoaxial subluxation, which was caused by a retropharyngeal abscess secondary to pulmonary Mycobacterium tuberculosis. The patient was treated with an anti-tuberculosis regimen and was prescribed a Philadelphia collar for the control of torticollis. The result of magnetic resonance imaging (MRI) showed an improved atlantoaxial alignment, after drug treatment and immobilization. This patient was neurologically intact and free from symptomatic complaints at follow-up visit. Dynamic cervical radiograph confirmed that the atlantoaxial joints had been stable. The pathophysiology of Grisel's syndrome, along with anatomical attributes, was explained on the basis of the patient's clinical course.

Grisel's Syndrome in an Adult After Endoscopic Nasopharyngectomy

“…Surgery is indicated for grade IV pathology, as well as in patients who have recurrent or irreducible subluxation. While children generally respond well to nonoperative treatment, adults tend to require surgical management . In our patient who had a persistent C1‐C2 subluxation and pathological odontoid fracture with severe spinal canal stenosis, surgical decompression and fusion would provide definitive long‐term stabilization .…”

“…Grisel's syndrome is rarely seen in adults. To the best of our knowledge, less than 20 adult cases have been reported in the literature . One could consider the role of nasopharyngectomy as analogous to adenoidectomy in children, as it involves the removal of the mucosa and soft tissue to expose the prevertebral fascia to microbes in the nasopharyngeal biome.…”

“…The treatment principles in Grisel's syndrome generally involve the treatment of infection with antibiotics and stabilization of the cervical spine to prevent neurological sequelae . A management paradigm for atlanto‐axial subluxation has been previously proposed by Wetzel and La Rocca based on the Fielding classification .…”

Surgical Treatment of Grisel Syndrome: A Pediatric Case Report and Review of the Literature

“…The isolation of Fusobacterium necrophorum, beta-hemolytic Streptococci, Pseudomonas aeruginosa, Staphylococcus aureus, methicillinresistant Staphylococcus epidermidis, the Epstein-Barr virus, and Mycobacterium tuberculosis have been reported in cases of Grisel syndrome. [4] The vast majority of cases occur in children and young adults; 68% of reported cases are under 12 years of age and 90% are under 21 years of age. [5] Grisel syndrome may present with torticollis, cervical pain, tinnitus, and limited, painful neck movement.…”

Retropharyngeal abscess causing grisel’s syndrome secondary to tuberculosis of cervical spine, a rare form of torticollis: case report

“…4 One of the various pathogens that can cause Grisel's syndrome is mycobacterium tuberculosis. 5 Grisel's syndrome is diagnosed based on the evaluation of clinical and radiological findings. 6…”