title: Nontraumatic atlantoaxial rotatory subluxation: grisel syndrome. Case report and literature review.
abstract: Study Design Case report and literature review. Objective To describe a case of nontraumatic atlantoaxial rotatory subluxation (Grisel syndrome) and to review clinical and radiologic aspects, physiopathology, and treatment of this lesion. There is no well-established protocol in the management of patients without spontaneous reduction. The authors discuss the available strategies to achieve reduction and when to operate on these patients. Methods Case presentation of a 7-year-old patient who presented with torticollis ∼1 week after the onset of an upper airway infection. There was no history of head or neck trauma. Computed tomography demonstrated atlantoaxial rotatory subluxation and a normal atlantodental interval. Results The patient was treated with nonsteroidal anti-inflammatory drugs and antibiotics and by progressively increasing the soft cervical collar height. Clinical reduction of the subluxation occurred after 48 hours. He wore the rigid collar for 6 weeks. At that moment, the patient was completely asymptomatic and follow-up cervical spine radiograph demonstrated an anatomical C1-C2 relation. The patient was instructed to return to daily life activities in a gradual manner. Conclusions Grisel syndrome should be considered in the differential diagnosis of torticollis, especially in children. The management can be planned according to the classification of Fielding and Hawkins. The initial treatment involves medicines, injury reduction, and cervical spine immobilization. Surgical treatment is indicated only in cases of failure of conservative treatment, recurrences of subluxation, and irreducible subluxations.
authors.affiliation: Division of Neurocritical Care, Department of Neurosurgery Service, Hospital de Emergência e Trauma Senador Humberto Lucena, João Pessoa, Paraíba, Brazil.
authors.forename: Alécio C E S
authors.initials: AC
authors.lastname: Barcelos
authors.affiliation: Division of Neurocritical Care, Department of Neurosurgery Service, Hospital de Emergência e Trauma Senador Humberto Lucena, João Pessoa, Paraíba, Brazil.
authors.forename: Gustavo C
authors.initials: GC
authors.lastname: Patriota
authors.affiliation: Praça Vilagran Cabrita, School of Medicine Nova Esperança, João Pessoa, Paraíba, Brazil.
authors.forename: Arlindo Ugulino
authors.initials: AU
authors.lastname: Netto
keywords: Grisel syndrome; atlantoaxial rotatory subluxation
references.citation: J Bone Joint Surg Am. 1977 Jan;59(1):37-44
references.pmid: 833172
references.citation: J Laryngol Otol. 1995 Oct;109(10):1005-9
references.pmid: 7499935
references.citation: Acta Neurochir (Wien). 2001 Dec;143(12):1223-8
references.pmid: 11810386
references.citation: Laryngoscope. 2003 Jun;113(6):1047-9
references.pmid: 12782820
references.citation: J Bone Joint Surg Am. 1989 Jun;71(5):664-8
references.pmid: 2732254
references.citation: J Bone Joint Surg Am. 1984 Apr;66(4):568-74
references.pmid: 6707036
references.citation: Acta Otorhinolaryngol Ital. 2005 Aug;25(4):245-9
references.pmid: 16482983
references.citation: Can J Neurol Sci. 2009 Jan;36(1):109-13
references.pmid: 19294901
references.citation: Spine (Phila Pa 1976). 2000 Feb 15;25(4):524-6
references.pmid: 10707402
references.citation: Ear Nose Throat J. 1990 Dec;69(12):799-801
references.pmid: 2079002
references.citation: Clin Orthop Relat Res. 1989 Mar;(240):141-52
references.pmid: 2645074
references.citation: Eur J Pediatr. 2013 Jan;172(1):119-21
references.pmid: 23064729
references.citation: Spine (Phila Pa 1976). 2005 Aug 1;30(15):E444-9
references.pmid: 16094264
references.citation: Eur Arch Otorhinolaryngol. 2010 Sep;267(9):1467-73
references.pmid: 20390289
references.citation: Laryngoscope. 2002 Aug;112(8 Pt 1):1445-9
references.pmid: 12172260
references.citation: J Neurosurg Pediatr. 2012 Jun;9(6):573-85
references.pmid: 22656246
references.citation: Int J Pediatr Otorhinolaryngol. 2007 Dec;71(12):1823-7
references.pmid: 17706297
references.citation: Spine (Phila Pa 1976). 2008 Mar 1;33(5):E156-60
references.pmid: 18317184
references.citation: Childs Nerv Syst. 2003 Jun;19(5-6):342-7
references.pmid: 12783261
references.citation: Oral Oncol. 2005 Nov;41(10):966-70
references.pmid: 16223695
references.citation: J Clin Neurosci. 2002 Jan;9(1):81-4
references.pmid: 11749026
references.citation: Spine (Phila Pa 1976). 1998 Oct 15;23(20):2174-9
references.pmid: 9802157
references.citation: Am J Otolaryngol. 2002 Jan-Feb;23(1):60-5
references.pmid: 11791252