title: Torticollis in children: an alert symptom not to be turned away.
abstract: OBJECTIVE
  The aim of this study is to investigate the spectrum of underlying disease in children with torticollis.
  
  
  METHODS
  We investigated the spectrum of underlying disease and to evaluate the clinical features of the children presented with torticollis in the last 2 years.
  
  
  RESULTS
  Of the 20 children (13 girls and 7 boys with the mean age of 8 years, ranging 2 months-12 years), eight of them have craniospinal pathologies (cerebellar tumors in three, exophytic brain stem glioma, eosinophilic granuloma of C2 vertebra, neuroenteric cyst of the spinal cord, Chiari type 3 malformation, arachnoid cysts causing brainstem compression, and cerebellar empyema), followed by osseous origin in five (congenital vertebral anomalies including hemivertebrae, blocked vertebra, and segmentation anomalies), two muscular torticollis (soft tissue inflammation due to subclavian artery catheterization, myositis ossificans with sternocleidomastoid muscle atrophy), and ocular (congenital cataract and microphthalmia), Sandifer syndrome, paroxysmal torticollis, retropharyngeal abscess each in one patients were detected. Ten patients underwent surgery; two patients received medical therapy for reflux and benign paroxysmal torticollis; and one patient with torticollis due to muscle spasm and soft tissue inflammation was treated with physiotherapy.
  
  
  CONCLUSIONS
  Various underlying disorders from relatively benign to life-threatening conditions may present with torticollis. The first step should be always a careful and complete physical examination, which must include all systems. Imaging must be performed for ruling out underlying life-threatening diseases in children with torticollis, particularly, if acquired neurological symptoms exist. Besides craniospinal tumors, ophthalmological problems and central nervous system infections should also be kept in mind. Moreover, early diagnosis of these disorders will reduce mortality and morbidity. Therefore, alertness of clinicians in pediatric and pediatric neurosurgery practice must be increased about this alert symptom.
authors.affiliation: Faculty of Medicine, Department of Neurosurgery, Erciyes University, Kayseri, Turkey, fettahtumturk@yahoo.com.
authors.forename: Abdulfettah
authors.initials: A
authors.lastname: Tumturk
authors.forename: Guldemet
authors.initials: G
authors.lastname: Kaya Ozcora
authors.forename: Ayse
authors.initials: A
authors.lastname: Kacar Bayram
authors.forename: Murat
authors.initials: M
authors.lastname: Kabaklioglu
authors.forename: Selim
authors.initials: S
authors.lastname: Doganay
authors.forename: Mehmet
authors.initials: M
authors.lastname: Canpolat
authors.forename: Hakan
authors.initials: H
authors.lastname: Gumus
authors.forename: Sefer
authors.initials: S
authors.lastname: Kumandas
authors.forename: Ekrem
authors.initials: E
authors.lastname: Unal
authors.forename: Ali
authors.initials: A
authors.lastname: Kurtsoy
authors.forename: Huseyin
authors.initials: H
authors.lastname: Per
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods*; D013116:Spinal Cord / Q000473:pathology; D013122:Spinal Diseases / Q000150:complications*; D014103:Torticollis / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*