Jean-Yves Maigne1, Céline Mutschler, Levon Doursounian. 1. Department of Physical Medicine, Hôtel-Dieu University Hospital, Place du Parvis de Notre-Dame, F-75004 Paris, France. jy.maigne@htd.ap-hop-paris.fr.
Abstract
STUDY DESIGN: A case report is presented. OBJECTIVES: To describe a typical case of acute adolescent torticollis in which a disc lesion was detected with magnetic resonance imaging. SUMMARY OF BACKGROUND DATA: Acute torticollis is attributed to atlantoaxial rotary fixation of unknown etiology. The current view is that the lesion is caused by synovial fold entrapment in the C1-C2 interspace. METHODS: In a 15-year-old male adolescent, magnetic resonance imaging was performed a few hours after the onset of torticollis, and 3 weeks after resolution of symptoms.RESULTS Increased signal intensity compatible with a fluid collection was seen in the right uncovertebral region at C2-C3. This lesion was probably linked to a sudden disruption of the disc collagen fibers, and had caused excessive lateral pressure, pushing C2 toward the left. Magnetic resonance imaging at 3 weeks was unremarkable. CONCLUSIONS: The authors think that the observed disruption was a sudden and abnormal instance of a normal and, usually, very slow process of cleft formation with extension into the fibrocartilaginous core in the uncovertebral region. It is felt that this lesion may be a frequent cause of torticollis in adolescents.
STUDY DESIGN: A case report is presented. OBJECTIVES: To describe a typical case of acute adolescent torticollis in which a disc lesion was detected with magnetic resonance imaging. SUMMARY OF BACKGROUND DATA: Acute torticollis is attributed to atlantoaxial rotary fixation of unknown etiology. The current view is that the lesion is caused by synovial fold entrapment in the C1-C2 interspace. METHODS: In a 15-year-old male adolescent, magnetic resonance imaging was performed a few hours after the onset of torticollis, and 3 weeks after resolution of symptoms.RESULTS Increased signal intensity compatible with a fluid collection was seen in the right uncovertebral region at C2-C3. This lesion was probably linked to a sudden disruption of the disc collagen fibers, and had caused excessive lateral pressure, pushing C2 toward the left. Magnetic resonance imaging at 3 weeks was unremarkable. CONCLUSIONS: The authors think that the observed disruption was a sudden and abnormal instance of a normal and, usually, very slow process of cleft formation with extension into the fibrocartilaginous core in the uncovertebral region. It is felt that this lesion may be a frequent cause of torticollis in adolescents.