title: Twiddler syndrome with a twist: a cause of vagal nerve stimulator lead fracture.
abstract: Twiddler syndrome is uncommon in children and most commonly described as causing lead retraction with implanted cardiac pacemakers and defibrillators. We report an uncommon case of a child repeatedly "twiddling" a vagal nerve stimulator to the point of lead fracture. The findings of Twiddler syndrome illustrated here apply to all implanted devices and show the complication of lead fracture in addition to the more commonly reported complication of lead retraction. This case highlights the need to be aware of the radiographic findings of this phenomenon in children with implanted vagal nerve stimulators due to the perceived increased risk of "twiddling" in pediatric and developmentally delayed patients.
authors.affiliation: Division of Pediatric Radiology, Cincinnati Children's Hospital, 3333 Burnet Ave, Cincinnati, OH, 45229, USA, andrew.trout@cchmc.org.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Trout
authors.forename: David B
authors.initials: DB
authors.lastname: Larson
authors.forename: Francesco T
authors.initials: FT
authors.lastname: Mangano
authors.forename: Cornelia H
authors.initials: CH
authors.lastname: Gonsalves
mesh_terms: D002648:Child; D020878:Device Removal; D003937:Diagnosis, Differential; D004567:Electrodes, Implanted / Q000009:adverse effects*; D004868:Equipment Failure; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D011859:Radiography; D012640:Seizures / Q000175:diagnosis / Q000517:prevention & control*; D013577:Syndrome; D055536:Vagus Nerve Stimulation / Q000009:adverse effects* / Q000295:instrumentation*