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Tan ETC, Rostamzad P, Esser YS, Pleumeekers MM, Loudon SE. Torticollis in Non-Syndromic Unicoronal Craniosynostosis Is Predominantly Ocular Related. J Clin Med 2023; 12:6059. [PMID: 37762999 PMCID: PMC10531492 DOI: 10.3390/jcm12186059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: Patients with unicoronal craniosynostosis (UCS) often show torticollis which can result from either an ocular cause or contraction of the sternocleidomastoid muscle. For clinicians, it is crucial to know the prevalence of ocular torticollis (OT) to ensure appropriate referral for treatment. Furthermore, associated ophthalmic features with OT in these patients are scarcely described. The aim of this study was to determine the prevalence of OT in non-syndromic UCS patients and investigate its associated ophthalmic features. (2) Methods: In this descriptive cross-sectional study medical records of non-syndromic UCS patients treated between 1994-2022 in one tertiary care hospital in The Netherlands were retrospectively reviewed. Collected data included: diagnosis and type of torticollis, binocular single vision (BSV), strabismus, ocular motility, alphabetical patterns, refractive error, and amblyopia. Patients were classified as OT, based on their ophthalmic and/or orthoptic diagnosis. Prevalence was determined with the 95% CI using the Clopper-Pearson exact test. Associations between OT and the ophthalmic features were determined using Chi-square or Fishers' exact test and its effect size was calculated using Cramer's V. (3) Results: In total, 146 patients were included, of whom 57 had torticollis. An ocular cause for the torticollis was found in 54 patients. The prevalence of OT was 37% (n = 146; 95% CI [0.292-0.454]). Significant associations were found between OT and strabismus (p < 0.001), ocular motility abnormalities (p < 0.001), alphabetical patterns (p < 0.001), and amblyopia (p = 0.002). BSV (p = 0.277) and refractive error (p = 1.0) were not significantly associated with OT. However, in OT the BSV was relatively poor (42.1%) and more frequently absent (26.3%) compared to the non-torticollis group (7% poor and 16.3% absent). In both groups, excyclotorsion was predominantly present (62.3%). (4) Conclusions: In 95% of cases, torticollis in UCS patients is ocular-related. Overall, one in three patients with UCS have OT. This study emphasizes the importance of a timely referral of all patients with UCS with torticollis to an orthoptist and/or ophthalmologist, specialized in diagnosing and treatment of OT, before considering physiotherapy.
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Affiliation(s)
- Emily T. C. Tan
- Department of Ophthalmology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands
- Clinical Sciences for Health Professionals, Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht University, 3584 CS Utrecht, The Netherlands
| | - Parinaz Rostamzad
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Yasmin S. Esser
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Mieke M. Pleumeekers
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Sjoukje E. Loudon
- Department of Ophthalmology, Erasmus MC, University Medical Center, 3000 CA Rotterdam, The Netherlands
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Hallundbæk L, Hagstrøm S, Mathiasen R, Herlin T, Hasle H, Weile KS, Amstrup J, Brix N. Musculoskeletal misdiagnoses in children with brain tumors: A nationwide, multicenter case-control study. PLoS One 2023; 18:e0279549. [PMID: 37352313 PMCID: PMC10289381 DOI: 10.1371/journal.pone.0279549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/08/2023] [Indexed: 06/25/2023] Open
Abstract
OBJECTIVE Childhood brain tumors belong to the cancer type with the longest diagnostic delay, the highest health care utilization prior to diagnosis, and the highest burden of long-term sequelae. We aimed to clarify whether prior musculoskeletal diagnoses in childhood brain cancer were misdiagnoses and whether it affected the diagnostic delay. STUDY DESIGN In this retrospective, chart-reviewed case-control study we compared 28 children with brain tumors and a prior musculoskeletal diagnosis to a sex and age-matched control group of 56 children with brain tumors and no prior musculoskeletal diagnosis. Using the Danish registries, the cases were identified from consecutive cases of childhood brain cancers in Denmark over 23 years (1996-2018). RESULTS Of 931 children with brain tumors, 3% (28/931) had a prior musculoskeletal diagnosis, of which 39% (11/28) were misdiagnoses. The misdiagnoses primarily included torticollis-related diagnoses which tended to a longer time interval from first hospital contact until a specialist was involved: 35 days (IQR 6-166 days) compared to 3 days (IQR 1-48 days), p = 0.07. When comparing the 28 children with a prior musculoskeletal diagnosis with a matched control group without a prior musculoskeletal diagnosis, we found no difference in the non-musculoskeletal clinical presentation, the diagnostic time interval, or survival. Infratentorial tumor location was associated with a seven-fold risk of musculoskeletal misdiagnosis compared to supratentorial tumor location. CONCLUSION Musculoskeletal misdiagnoses were rare in children with brain tumors and had no significant association to the diagnostic time interval or survival. The misdiagnoses consisted primarily of torticollis- or otherwise neck-related diagnoses.
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Affiliation(s)
- Laura Hallundbæk
- Department of Pediatric and Adolescent Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Hagstrøm
- Department of Pediatric and Adolescent Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Rene Mathiasen
- Department of Pediatric and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Troels Herlin
- Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Hasle
- Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Kathrine Synne Weile
- Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper Amstrup
- Department of Pediatric and Adolescent Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Ninna Brix
- Department of Pediatric and Adolescent Medicine, Aalborg University Hospital, Aalborg, Denmark
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Baklizi N, Raswoli M, Burges M, Moreira DC, Qaddoumi I. Torticollis as a presenting symptom of pediatric CNS tumors: A systematic review. Semin Oncol 2022; 49:419-425. [PMID: 36180292 DOI: 10.1053/j.seminoncol.2022.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 11/11/2022]
Abstract
To assess the frequency of torticollis as a presenting symptom of pediatric CNS tumors and its impact on pre-diagnostic symptom intervals (PSIs) and patient outcomes. We performed a systematic review of studies reporting torticollis in children with various CNS tumors. We searched PubMed for studies published from January 1972 to March 2021 in English. Case reports were included in the analysis if the following criteria were met (1) torticollis was the presenting symptom secondary to a CNS tumor (2) children <18 years of age, (3) underwent imaging intervention and (4) outcome data provided. Of 1,365 relevant articles, 45 were eligible for analysis according to our inclusion criteria representing 95 patients. Two independent investigators extracted the data, and a third investigator arbitrated discrepancies. We found that 38.9% of CNS tumors exhibited torticollis as the only presenting symptom. PSI lengths ranged from 0 to 4 years (median, 5 months) for low-grade tumors, and patient age and PSI length were inversely associated. Of patients with low-grade tumors, 23.8% received physiotherapy, in contrast with 0% of patients with high-grade tumors. PSI length also increased for patients who received rehabilitation, and 39.3% and 7.1% of patients with high-grade and low-grade tumors, respectively, died of their disease. Patients with low-grade tumors and torticollis as a primary presenting symptom were more likely to have a prolonged PSI. Therefore, CNS tumors should be considered in the differential diagnosis of acquired torticollis in children.
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Affiliation(s)
- Nadejda Baklizi
- Departments of Global Pediatric Medicine and Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Musthafa Raswoli
- Departments of Global Pediatric Medicine and Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Michala Burges
- Departments of Global Pediatric Medicine and Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Daniel C Moreira
- Departments of Global Pediatric Medicine and Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Ibrahim Qaddoumi
- Departments of Global Pediatric Medicine and Oncology, St. Jude Children's Research Hospital, Memphis, TN.
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Characteristic and management of pediatric arachnoid cysts: A case series. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.1028090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background/Aim: Arachnoid cysts (ACs) are the collection of fluid, which is similar in composition to cerebrospinal fluid, within the congenitally duplicated arachnoid membrane. ACs are clinically silent lesions, but sometimes they can manifest themselves with headache, convulsion, focal neurological deficits, cognitive decline, torticollis, and macrocephaly. Although the appropriate surgical approach is less clear, there is a consensus on the need for surgical treatment in symptomatic ACs. This study aims to reveal the advantages and disadvantages of cystoperitoneal shunt and microsurgical fenestration techniques.
Methods: One hundred ninety-one consecutive patients from 1 month to 15 years old with AC were evaluated for suitability. Sixteen patients who underwent surgery were included in the study. Medical records of the patients with AC managed at our institutions were retrospectively collected and analyzed. Sixteen of 191 patients underwent surgical treatment via craniotomy for microsurgical cyst fenestration (CF) and cysto-peritoneal shunting (CS). CF was performed with partial cyst wall excision in all patients.
Results: Seizure was the most common presentation in the patients, followed by headache and trauma, respectively. In our series the most common indications of the surgery were increased intracranial pressure (IICP). CF was performed in nine patients, and CS was performed in seven as the primary treatment. CS-related complications, such as infection (n = 2), dysfunction (n = 2) and intraabdominal abscess (n = 1) were the most commonly observed complications. No infections were observed after CF, but subdural hematoma was observed in one child.
Conclusions: Although the most common symptoms in cases with arachnoid cysts are headache, rare symptoms, such as torticollis, may exist. Due to this, clinicians should reveal the cyst-complaint relationship first. Given the increased complications of CS, in addition to shunt independency and being free from shunt-related complications, the microsurgical CF with wide excision of the membranes seems to be the more preferable surgical option.
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Infants With Torticollis Who Changed Head Presentation During A Physical Therapy Episode. Pediatr Phys Ther 2022; 34:185-191. [PMID: 35385451 DOI: 10.1097/pep.0000000000000879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study is to describe infants with congenital muscular torticollis (CMT) who changed head presentation during an episode of physical therapy. METHODS Data were extracted from electronic medical records between January 2015 and December 2018 to describe infants with CMT who changed presentation. RESULTS Eighty-nine infants met criteria (predominantly male, non-Hispanic, White, with private insurance). Torticollis symptoms were noticed by 3 months in 90% of infants with a physical therapy examination before 6 months in 100% of infants. Most infants had early mild CMT with abnormal head shape and greater limitation in active cervical range of motion (ROM) than passive cervical ROM. Clinicians frequently recommended weekly physical therapy that included first- choice and supplemental interventions. Episodes of care averaged 7 visits over 64 days with 73% of infants meeting goals. CONCLUSION Physical therapists should recognize that infants with CMT may change presentation but benefit from physical therapy to resolve symptoms.Digital Abstract available at: http://links.lww.com/PPT/A366.
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Mitani Y, Kikuchi K, Oguma E, Kurihara J, Fukuoka K. Infantile torticollis caused by the epidural Ewing sarcoma family of tumors. Pediatr Int 2022; 64:e14889. [PMID: 34905658 DOI: 10.1111/ped.14889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 05/31/2021] [Accepted: 06/14/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Yuichi Mitani
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Kenjiro Kikuchi
- Division of Child Health and Human Development, Saitama Children's Medical Center, Saitama, Japan
| | - Eiji Oguma
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Jun Kurihara
- Department of Neurosurgery, Saitama Children's Medical Center, Saitama, Japan
| | - Kohei Fukuoka
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
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Yoon JA, Choi H, Shin YB, Jeon H. Development of a questionnaire to identify ocular torticollis. Eur J Pediatr 2021; 180:561-567. [PMID: 32979091 DOI: 10.1007/s00431-020-03813-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 11/30/2022]
Abstract
Ocular disease is one of the causes of abnormal head positioning. Conventionally, the behavioral characteristics of ocular torticollis patients are different from those of non-ocular torticollis patients, though research addressing the significance of this difference is yet limited. This prospective, cross-sectional study aims to develop a questionnaire based on the clinical features in children with abnormal head posture being ocularly assessed. Children aged ≥ 6 months who visited our rehabilitation medicine clinic with a chief complaint of abnormal head posture were included. Patients with apparent orthopedic and neurological diseases were excluded. A 10-item questionnaire was developed to analyze the behavioral characteristics of patients. The patients were divided into ocular and non-ocular torticollis groups according to ophthalmologic examination results. Thirty-four and 13 patients were assigned to the non-ocular torticollis and ocular torticollis groups, respectively. Five questions were finally selected and the questionnaire was scored as the sum of the scores for the each questions (yes = 1 point, no = 0 point). The median (interquartile range) score of the ocular torticollis group (3.0 (3.0-4.0)) was significantly higher than that of the non-ocular torticollis group (2.0 (1.0-3.0); p = 0.000).Conclusion: Our parent-reported torticollis assessment questionnaire may be useful for screening ocular torticollis. What is known: • Ocular disease is one of the various causes of abnormal head positioning. • The behavioral characteristics of patients with ocular torticollis are different from those of patients with non-ocular torticollis; research on this matter is limited. What is new: • We delveloped a questionnaire to differentiate ocular and postural torticollis and the score of the questionnaire was different between patients with or without ocular disease. • The questionnaire based on behavioral characteristics may help screening and determining the need of ophthalmic evaluation in patients with torticollis.
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Affiliation(s)
- Jin A Yoon
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Busan, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Heeyoung Choi
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea.,Department of Ophthalmology, Pusan National University Hospital, Busan, South Korea
| | - Yong Beom Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Busan, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Hyeshin Jeon
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea. .,Department of Ophthalmology, Pusan National University Hospital, Busan, South Korea.
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8
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Kim MW, Kim DY, Lee DW, Ryoo DH, Kim J, Jang DH. Concurrence of Congenital Muscular Torticollis and Congenital Torticollis Due to Other Anomalies: Two Case Reports. Front Pediatr 2021; 9:709616. [PMID: 34778123 PMCID: PMC8578520 DOI: 10.3389/fped.2021.709616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: Congenital muscular torticollis (CMT) is the most common cause of torticollis in infants; other causes, including osseous, ocular, and central nervous system torticollis can easily be overlooked. We report two rare cases of CMT with concurrent osseous or ocular torticollis. Case 1: A 1-month-old female infant with a right neck mass and right-tilting head posture was referred. Neck ultrasonography showed diffuse hypertrophy and hyperechoic findings on the right sternocleidomastoid (SCM) muscle, which was consistent with right CMT. A clavicle X-ray imaging was conducted to identify an associated fracture due to birth trauma on the same day and a suspected congenital vertebral anomaly was coincidentally found. Subsequent three-dimensional computed tomography of the cervical spine showed a T1 hemivertebra causing the right-tilting head. The patient was diagnosed with the concurrent manifestation of CMT and congenital osseous torticollis. Case 2: A 3-month-old male infant with a 20° head tilt to the right with a limited cervical range of motion was referred. Neck ultrasonography showed a fibromatosis colli in the right SCM, suggesting CMT. He proceeded to physical therapy for seven months; however, there was little clinical improvement in his head and neck posture. The patient underwent an additional ophthalmologic examination and orbital magnetic resonance imaging (MRI) at 10 months of age. The result showed congenital agenesis of the left fourth cranial nerve with hypoplasia of the superior oblique muscle causing the right-tilting of the head. Ultimately, the boy was diagnosed with a concurrent manifestation of CMT and congenital ocular torticollis. Conclusion: Unless careful examinations are conducted, congenital vertebral anomalies and congenital agenesis of the fourth cranial nerve can go unnoticed in the present two cases. If a patient with CMT displays unusual features or does not respond to physical therapy, clinicians should consider not only a differential diagnosis but also concurrence with other causes of congenital torticollis.
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Affiliation(s)
- Min-Wook Kim
- Department of Rehabilitation Medicine, College of Medicine, Incheon St Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Da-Ye Kim
- Department of Rehabilitation Medicine, College of Medicine, Incheon St Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Dong-Woo Lee
- Department of Rehabilitation Medicine, College of Medicine, Incheon St Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Da-Hye Ryoo
- Department of Rehabilitation Medicine, College of Medicine, Incheon St Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Jaewon Kim
- Department of Rehabilitation Medicine, College of Medicine, Incheon St Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Dae-Hyun Jang
- Department of Rehabilitation Medicine, College of Medicine, Incheon St Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
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Boushra M. A Case Report of B-cell Lymphoblastic Leukemia/Lymphoma Presenting as Isolated Torticollis in a 2-year-old Female. Clin Pract Cases Emerg Med 2020; 4:603-606. [PMID: 33217283 PMCID: PMC7676797 DOI: 10.5811/cpcem.2020.8.48524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/21/2020] [Indexed: 11/15/2022] Open
Abstract
Introduction Malignancy is a rare cause of acquired torticollis in children, and spinal cord involvement from hematolymphoid malignancies is similarly unusual. Neurologic abnormalities may not be present on initial evaluation, and delayed diagnosis and treatment is associated with increased risk of permanent paralysis. Case Report The author describes a case of isolated torticollis in a 2-year-old evaluated multiple times in the emergency department (ED) and outpatient settings. For her first three presentations, the patient had no associated neurologic abnormalities. She was discharged with return precautions and a presumptive diagnosis of viral infection/lymphadenitis. She later developed weakness of her left arm and was diagnosed with a B-cell lymphoblastic leukemia/lymphoma causing spinal cord compression. Conclusion This case highlights the importance of continued comprehensive and meticulous physical examination in patients with repeat ED visits, as well as the value of detailed discharge instructions in mitigating diagnostic delays in these patients.
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Affiliation(s)
- Marina Boushra
- East Carolina University School of Medicine, Department of Emergency Medicine, Greenville, North Carolina. Vidant Medical Center, Department of Emergency Medicine, Greenville, North Carolina. Vidant Beaufort Hospital, Department of Emergency Medicine, Washington, North Carolina
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Patel F, Benjamin JS, Gadiwala S. Acute Torticollis in a 3-year-old Child: Think Outside the Neck. Pediatr Rev 2020; 41:596-598. [PMID: 33139413 DOI: 10.1542/pir.2018-0349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Torticollis due to aneurysmal bone cyst located in the thoracic vertebrae: A case report. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.792258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Congenital Spinal Cysts: An Update and Review of the Literature. World Neurosurg 2020; 145:480-491.e9. [PMID: 32822959 DOI: 10.1016/j.wneu.2020.08.092] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 01/14/2023]
Abstract
Congenital spinal cysts are rare and encompass a wide variety of diseases including arachnoid, enterogenous, teratomatous, neurenteric, foregut, bronchogenic, epithelial, ependymal, dermoid, and epidermoid cysts. Here, we elucidate the epidemiology, pathology, pathogenesis, and diagnostic findings of the most common congenital spinal cysts, followed by a discussion of their presentation and treatment options. Differentiating the cause of each lesion is crucial for targeted clinical and surgical management for the patient. Our review describes how arachnoid cysts can be observed, fenestrated, percutaneously drained, or shunted; however, the primary goal for neurenteric, dermoid, and epidermoid cysts is removal. Further, we discuss how patient presentation is dependent on the rate of growth and location of compression on the spinal cord and nerve roots. However, although many of these lesions are discovered incidentally on imaging, the spectrum of possible symptoms include pain, weakness, ataxia, bladder incontinence, and progressive or acute neurologic deficits. We present and review the histology and imaging of a variety of cysts and discuss how although the goal of treatment is resection, the risks of surgery must be considered against the benefits of complete resection in each case.
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Vulfsons S, Minerbi A. The Case for Comorbid Myofascial Pain-A Qualitative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145188. [PMID: 32709141 PMCID: PMC7400256 DOI: 10.3390/ijerph17145188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 02/07/2023]
Abstract
Myofascial pain syndrome is widely considered to be among the most prevalent pain conditions, both in the community and in specialized pain clinics. While myofascial pain often arises in otherwise healthy individuals, evidence is mounting that its prevalence may be even higher in individuals with various comorbidities. Comorbid myofascial pain has been observed in a wide variety of medical conditions, including malignant tumors, osteoarthritis, neurological conditions, and mental health conditions. Here, we review the evidence of comorbid myofascial pain and discuss the diagnostic and therapeutic implications of its recognition.
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Affiliation(s)
- Simon Vulfsons
- Correspondence: ; Tel.: +972-47772234; Fax: +972-47773505
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Holzapfel J, Kandels D, Schmidt R, Pietsch T, Warmuth‐Metz M, Bison B, Krauss J, Kortmann R, Timmermann B, Thomale U, Albert MH, Hernáiz Driever P, Witt O, Gnekow AK. Favorable prognosis in pediatric brainstem low‐grade glioma: Report from the German SIOP‐LGG 2004 cohort. Int J Cancer 2019; 146:3385-3396. [PMID: 31613986 DOI: 10.1002/ijc.32734] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 09/16/2019] [Accepted: 09/27/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Johannes Holzapfel
- Swabian Children's Cancer Center University Hospital Augsburg Augsburg Germany
| | - Daniela Kandels
- Swabian Children's Cancer Center University Hospital Augsburg Augsburg Germany
| | - René Schmidt
- Institute of Biostatistics and Clinical Research, University of Muenster Münster Germany
| | - Torsten Pietsch
- Institute of Neuropathology, DGNN Brain Tumor Reference Center, University Bonn Bonn Germany
| | - Monika Warmuth‐Metz
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Wuerzburg Wuerzburg Germany
| | - Brigitte Bison
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Wuerzburg Wuerzburg Germany
| | - Jüergen Krauss
- Section of Pediatric Neurosurgery University Hospital Wuerzburg Wuerzburg Germany
| | | | - Beate Timmermann
- Department of Particle Therapy University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), German Cancer Consortium (DKTK) Essen Germany
| | | | - Michael H. Albert
- Dr. von Hauner Children's Hospital, Ludwig‐Maximilians Universitaet Munich Germany
| | - Pablo Hernáiz Driever
- Department of Pediatric Oncology/Hematology Charité Universitaetsmedizin Berlin, Corporate member of Freie Universitaet Berlin, Humboldt‐Universitaet zu Berlin, and Berlin Institute of Health Berlin Germany
| | - Olaf Witt
- Hopp Children's Cancer Center Heidelberg (KiTZ) German Cancer Research Center (DKFZ) and Heidelberg University Hospital Heidelberg Germany
| | - Astrid K. Gnekow
- Swabian Children's Cancer Center University Hospital Augsburg Augsburg Germany
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15
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Berlot R, Bhatia KP, Kojović M. Pseudodystonia: A new perspective on an old phenomenon. Parkinsonism Relat Disord 2019; 62:44-50. [PMID: 30819557 DOI: 10.1016/j.parkreldis.2019.02.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 01/30/2019] [Accepted: 02/11/2019] [Indexed: 12/28/2022]
Abstract
Pseudodystonia represents a wide range of conditions that mimic dystonia, including disorders of the peripheral nervous system, spinal cord, brainstem, thalamus, cortex and non-neurological conditions such as musculoskeletal diseases. Here, we propose a definition of pseudodystonia and suggest a classification based on underlying pathophysiological mechanisms. We describe phenomenology of different forms of pseudodystonia and point to distinctions between dystonia and pseudodystonia as well as challenging issues that may arise in clinical practice. The term pseudodystonia can be used to describe abnormal postures, repetitive movements or both, in which results of clinical, imaging, laboratory or electrophysiological investigations provide definite explanation of symptoms which is not compatible with dystonia. Pseudodystonia can be classified into non-neurological disorders of the musculoskeletal system, disorders of sensory pathways, disorders of motor pathways and compensatory postures in other neurological diseases. Presence of associated neurological findings in the affected body part is the key towards diagnosis of pseudodystonia. Additional supporting features are the presence of fixed postures, the absence of sensory trick, acute mode of onset and severe pain. Worsening on eye closure, traditionally considered typical for pseudodystonia, is not always present and can also appear in dystonia. It is challenging to separate dystonia and pseudodystonia in patients with thalamic lesions or corticobasal syndrome, where abnormal postures coexist with sensory loss. Many cases of pseudodystonia are treatable. Therefore, it is essential to consider pseudodystonia in a differential diagnosis of abnormal postures until a detailed neurological examination rules it out.
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Affiliation(s)
- Rok Berlot
- Department of Neurology, University Medical Centre Ljubljana, Zaloška 2, 1000, Ljubljana, Slovenia
| | - Kailash P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Maja Kojović
- Department of Neurology, University Medical Centre Ljubljana, Zaloška 2, 1000, Ljubljana, Slovenia.
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16
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Abstract
Painful torticollis in children requires specific attention. Grisel syndrome is diagnosed on suspicion in patients with recent or history of ongoing upper respiratory tract infections and in patients with restriction of movement or deformity following oto-rhino-laryngologic surgery. Pediatricians should be aware of this condition because early diagnosis and intervention are critical for prognosis in Grisel syndrome.
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Affiliation(s)
- Nukhet Aladag Ciftdemir
- Department of Pediatrics, Trakya University Faculty of Medicine,Balkan Yerleskesi, Edirne 22030, Turkey
| | - Tuba Eren
- Department of Pediatrics, Trakya University Faculty of Medicine,Balkan Yerleskesi, Edirne 22030, Turkey
| | - Mert Ciftdemir
- Department of Orthopaedics and Traumatology, Trakya University Faculty of Medicine,Balkan Yerleskesi, Edirne 22030, Turkey
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17
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Hanrahan J, Frantzias J, Lavrador JP, Bodi I, Zebian B. Posterior fossa arachnoid cyst causing torticollis and gastro-oesophageal reflux in an infant. Childs Nerv Syst 2018; 34:2519-2523. [PMID: 30062591 PMCID: PMC6224018 DOI: 10.1007/s00381-018-3917-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 07/18/2018] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Arachnoid cysts (ACs) account for a small proportion of all intracranial lesions. They are often incidental but can become symptomatic and even cause a threat to life. Symptoms are usually due to direct compression of neural elements and/or raised intracranial pressure. CASE REPORT We report the case of an infant with an enlarging posterior fossa arachnoid cyst (PFAC) causing torticollis and gastro-oesophageal reflux (GOR), the combination of which had been previously unreported in this context. Endoscopic fenestration and cyst decompression were followed by complete resolution of the symptoms. We discuss the possible mechanisms of torticollis and GOR in this context.
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Affiliation(s)
- John Hanrahan
- Faculty of Life Sciences and Medicine, King's College London, London, UK.
| | | | | | - Istvan Bodi
- Department of Clinical Neuropathology, King’s College Hospital, London, UK
| | - Bassel Zebian
- Department of Neurosurgery, King’s College Hospital, London, UK
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18
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Young MD, Young JL. Conservative Care of Pediatric Acquired Torticollis: A Report of 2 Cases. J Chiropr Med 2017; 16:252-256. [PMID: 29097957 DOI: 10.1016/j.jcm.2017.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 03/23/2017] [Accepted: 03/28/2017] [Indexed: 01/19/2023] Open
Abstract
Objective The purpose of this case report is to describe the conservative management of 2 cases of acquired torticollis in children under 3 years of age. Clinical Features Both patients awoke with painful, stiff, twisted necks the day after play in a bouncy house. Range of motion was limited, and hypertonic muscles were palpated. Their neurologic and physical evaluation was consistent with a diagnosis of acquired torticollis of musculoskeletal origin. Intervention and Outcomes Both children were treated with chiropractic care that consisted of light myofascial release, use of an Activator instrument, and home stretching. Patients improved in pain and range of motion immediately posttreatment and returned to normal ranges in 1 or 2 visits. Conclusion Chiropractic care provided relief for these 2 young patients with acquired torticollis.
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Affiliation(s)
- Morgan D Young
- Research Department, Palmer College of Chiropractic West, San Jose, California
| | - Jessie L Young
- Los Gatos Chiropractic and Wellness Center, Los Gatos, California
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19
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Lee K, Chung E, Lee BH. A comparison of outcomes of asymmetry in infants with congenital muscular torticollis according to age upon starting treatment. J Phys Ther Sci 2017; 29:543-547. [PMID: 28356651 PMCID: PMC5361030 DOI: 10.1589/jpts.29.543] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 12/14/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to compare the outcomes of asymmetry in infants
with congenital muscular torticollis (CMT) according to the age when treatment was
started. [Subjects and Methods] 102 infant CMT patients under the age of 6 months were
selected. The subjects were divided into a group that started treatment before six weeks
(n=55) and a group that started treatment after six weeks (n=47). Asymmety was evaluated
by determining the difference in the thickness of the two sternocleidomastoid muscles
(DTSM) using ultrasonography, head tilt (HT) based on a physical examination, and the
torticollis overall assessment (TOA). Patients received ultrasound and massage therapy for
30 minutes, in conjunction with passive stretching exercises, 3 times a week. [Results]
Following the intervention, the DTSM, HT and TOA showed significant differences in the two
groups. The DTSM of the group that started treatment before six weeks was significantly
better than that of the group that started treatment after six weeks. [Conclusion] The
results of this study suggest that early intervention is more effective than later
intervention.
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Affiliation(s)
- KyeongSoo Lee
- Graduate School of Physical Therapy, Sahmyook University, Republic of Korea
| | - EunJung Chung
- Department of Physical Therapy, Andong Science College, Republic of Korea
| | - Byoung-Hee Lee
- Department of Physical Therapy, Sahmyook University, Republic of Korea
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20
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Zhong N, Xu W, Meng T, Yang X, Yan W, Xiao J. The surgical strategy for eosinophilic granuloma of the pediatric cervical spine complicated with neurologic deficit and/or spinal instability. World J Surg Oncol 2016; 14:301. [PMID: 27923375 PMCID: PMC5141639 DOI: 10.1186/s12957-016-1063-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 11/25/2016] [Indexed: 11/18/2022] Open
Abstract
Background Various therapeutic approaches have been proposed for the treatment of pediatric patients with eosinophilic granuloma (EG) of the cervical spine. Our aim was to discuss and present our experience with the individualized surgical intervention of pediatric cervical EG complicated with neurologic deficits and/or spinal instability. Methods We retrospectively analyzed the clinical data of 19 children who were diagnosed with cervical EG comor spinal/or spinal instability (evaluated by the Spinal Instability Neoplastic Score, SINS ≥ 7) and treated surgically in our institution. Results Lesions involved C1–2 in 7 patients and C3–7 in 12 patients. Anterior tumor resection combined with posterior pedicle screw fixation, anterior approach of excision and instrumentation, and posterior tumor resection combined with pedicle screws instrumentation were selected according to the different locations of tumors. Frankel scale and Oucher scale improved significantly after surgery. There was no morphologic alteration of the neck at follow-up. Conclusions Surgery can significantly improve the neurologic status and symptoms. Surgical decision-making must be individually tailored to minimize the influence of surgery on spine growth.
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Affiliation(s)
- Nanzhe Zhong
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Wei Xu
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Tong Meng
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Xinghai Yang
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Wangjun Yan
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Jianru Xiao
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China.
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21
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Two Different Life-Threatening Cases: Presenting with Torticollis. Case Rep Pediatr 2016; 2016:7808734. [PMID: 27957374 PMCID: PMC5124474 DOI: 10.1155/2016/7808734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 10/12/2016] [Accepted: 10/19/2016] [Indexed: 11/17/2022] Open
Abstract
Acquired torticollis can be the result of several different pathological mechanisms. It is generally related to trauma, tumors, and inflammatory processes of the cervical muscles, nerves, and vertebral synovia. Although upper respiratory tract and neck inflammation are common causes of acute febrile torticollis in children, diseases with as yet undefined relationships may also result in torticollis. This is the case of spinal arachnoid cyst and pneumonia.
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22
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The ABCs (Airway, Blood Vessels, and Compartments) of Pediatric Neck Infections and Masses. AJR Am J Roentgenol 2016; 206:963-72. [DOI: 10.2214/ajr.15.15812] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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23
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Walton JM, Darr A, George A. An unusual case of an oesophageal foreign body presenting as torticollis. Ann R Coll Surg Engl 2016; 98:e40-2. [PMID: 26890847 PMCID: PMC5226167 DOI: 10.1308/rcsann.2016.0076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2015] [Indexed: 01/01/2023] Open
Abstract
Oesophageal foreign bodies (FBs) are commonly encountered in an otolaryngology setting. The majority of such cases remain in the paediatric population, where obtaining an accurate history of events is challenging. Oesophageal FBs present in a variety of ways other than dysphagia, which may result in delayed presentation, diagnosis and subsequent treatment. Where an ingested FB is a battery, early removal is advocated owing to the potential for significant complications, a problem highlighted by a patient safety alert issued by NHS England. A common paediatric presentation, torticollis has a multitude of potential underlying causes. We present an unusual case of torticollis in a two-year old girl, subsequently revealed to be caused by an ingested button battery.
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Affiliation(s)
- J M Walton
- Northampton General Hospital NHS Trust , UK
| | - A Darr
- Walsall Healthcare NHS Trust , UK
| | - A George
- University Hospitals of North Midlands NHS Trust , UK
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