title: Grisel's syndrome, a rare cause of anomalous head posture in children: a case report.
abstract: BACKGROUND
  Anomalous head posture (AHP) or torticollis is a relatively common condition in children. Torticollis is not a diagnosis, but it is a sign of underlying disease. Grisel's syndrome (GS) is a rare condition of uncertain etiology characterized by a nontraumatic atlanto-axial subluxation (AAS), secondary to an infection in the head and neck region. It has not been considered, in ophthalmological papers, as a possible cause of AHP.
  
  
  METHODS
  A case of AAS secondary to an otitis media is studied. The children showed neck pain, head tilt, and reduction in neck mobility. The patient had complete remission with antibiotic and anti-inflammatory therapy and muscle relaxants. Signs of GS should always be taken into account during ophthalmological examination (recent history of upper airway infections and/or head and neck surgeries associated to a new onset of sudden, painful AHP with normal ocular exam). In such cases it is necessary to require quick execution of radiological examinations (computer tomography and/or nuclear magnetic resonance), which are essential to confirm the diagnosis.
  
  
  CONCLUSIONS
  GS is a multidisciplinary disease. We underline the importance of an accurate orthoptic and ophthalmological examination. Indeed, early detection and diagnosis are fundamental to achieve proper management, avoid neurological complications and lead to a good prognosis.
authors.affiliation: Eye Clinic, San Paolo Hospital, University of Milan, Via di Rudini' 8, 20142, Milan, Italy. davideallegrini@yahoo.it.|Unit of Ophthalmology, Melegnano Hospital, Vizzolo Predabissi, Milan, Italy. davideallegrini@yahoo.it.
authors.forename: Davide
authors.initials: D
authors.lastname: Allegrini
authors.affiliation: Eye Clinic, San Paolo Hospital, University of Milan, Via di Rudini' 8, 20142, Milan, Italy. aleaute@hotmail.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Autelitano
authors.affiliation: Unit of Radiology, San Paolo Hospital, University of Milan, Milan, Italy. elisabetta.nocerino85@gmail.com.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Nocerino
authors.affiliation: Eye Clinic, San Paolo Hospital, University of Milan, Via di Rudini' 8, 20142, Milan, Italy. fogagnolopaolo@googlemail.com.
authors.forename: Paolo
authors.initials: P
authors.lastname: Fogagnolo
authors.affiliation: Eye Clinic, San Paolo Hospital, University of Milan, Via di Rudini' 8, 20142, Milan, Italy. stefano_de_cilla@yahoo.co.uk.|Unit of Ophthalmology, Maggiore della Carità Hospital, Novara, Italy. stefano_de_cilla@yahoo.co.uk.
authors.forename: Stefano
authors.initials: S
authors.lastname: De Cillà
authors.affiliation: Eye Clinic, San Paolo Hospital, University of Milan, Via di Rudini' 8, 20142, Milan, Italy. lucamrossetti@libero.it.
authors.forename: Luca
authors.initials: L
authors.lastname: Rossetti
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D021621:Imaging, Three-Dimensional; D007223:Infant; D007592:Joint Diseases / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D004204:Joint Dislocations / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D009125:Muscle Relaxants, Central / Q000627:therapeutic use; D019547:Neck Pain / Q000175:diagnosis / Q000188:drug therapy; D015835:Ocular Motility Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D016910:Orthodontic Brackets; D010612:Pharyngitis / Q000175:diagnosis / Q000188:drug therapy; D011187:Posture; D014057:Tomography, X-Ray Computed; D014103:Torticollis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*
chemical_list: D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D009125:Muscle Relaxants, Central