Torticollis is one of the common causes of admission to the emergency department among children which can make parents worried. This could be related to many traumatic and non-traumatic conditions. ...One of the rare causes of acute onset of torticollis is atlantoaxial rotatory subluxation, which is characterized by limitation of neck rotation, increased pain by movement. It is generally associated with a past trauma history. Although it is known as a temporary and self-resolving condition, if it is not diagnosed earlier it may lead to severe rotational deformity of the cervical spine. Therefore, detecting certain causes and providing proper treatment are highly important. Physical examination and history are usually enough to make the diagnosis, yet cervical X-ray and computed tomography scan can be considered for indefinite cases. Even though treatment options depend on symptoms and the patient's general status, conservative approach with cervical collar and anti-inflammatory drugs are recommended as a first step.
We would like to present our case, a 13 year-old girl who has been diagnosed with atlantoaxial rotatory subluxation in our clinic to increase awareness of this condition which is often misdiagnosed in children.
Tortikollis, özellikle aileleri endişelendirebilmesi nedeniyle, çocuklarda yaygın acile başvuru nedenlerinden birisidir. Bu durum travmatik veya non travmatik olmak üzere pek çok durumla ilişkili olabilir. Ani başlangıçlı tortikolisin nadir nedenlerinden biri de, boyunda rotasyon kısıtlılığı ve hareketle artan ağrı ile karakterize olan atlantoaksiyel rotasyonel subluksasyondur. Genellikle geçirilmiş bir travma öyküsü ile ilişkilidir. Geçici ve kendini sınırlayan bir durum olarak bilinse de, erken tanı konmadığı takdirde ciddi rotasyon deformitelerine neden olabilmektedir. Bu sebeple, nedeni saptamak ve uygun tedaviyi sunmak oldukça önemlidir. Tanı için fizik muayene ve anamnez büyük ölçüde yeterli olsa da, arada kalınmış vakalarda direkt grafi ve bilgisayarlı tomografi göz önünde bulundurulabilir. Tedavi seçenekleri semptomlara ve hastanın genel durumuna göre değişmekle birlikte, ilk aşama olarak boyunluk kullanımı ve anti inflamatuar ilaçlarla konservatif yaklaşım önerilir.
Çocuk yaş grubunda çoğunlukla atlanan bu tanı açısından farkındalığı arttırmak adına, kliniğimizde atlantoaksiyel rotatuar subluksasyon tanısı koyduğumuz 13 yaşındaki kız hastamızı sunmak istedik.
Tortikolis je nagnut položaj glave i ograničena pokretljivost vratne kralježnice uz hipertonus mišića sternokleidomasteidousa. Nakon iščašenja kuka i deformacija stopala, jedan je od tri najčešća ...deformiteta s kojim se rađaju djeca.
U radu se prikazuje mogućnost rane dijagnoze i terapije tortikolisa, s naglaskom na važnost terapije aktivnim pokretom, kao središnje metode u liječenju, koju provodi fizioterapeut ili roditelj.
Provider: Czech digital library/Česká digitální knihovna - Institution: National Medical Library/Národní lékařská knihovna - Data provided by Europeana Collections- Cervikální dystonie je patrně ...nejčastějším typem fokální idiopatické torzní dystonie vůbec. Mimovolní dystonickou svalovou aktivitou jsou postihovány krční svaly v různé distribuci, a stav tak vede k dystonickým dyskinezím krku, které mají jako důsledek nápadné dystonické postavení hlavy. Onemocnění je v široké medicínské veřejnosti známo spíše pod názvem spastická torticollis, tak jak bylo popisováno v klasické neurologické literatuře. Nejčasteji postihovanými svaly jsou m. sternocleidomastoideus, m. splenius capitis, m. trapezius, m. semispinalis capitis a m. semispinalis cervicis, m. levator scapulae a mm. scaleni. Méně často jsou postihovány další krční svaly, jako jsou drobné svaly kraniocervikálního přechodu – mm. rectus occipitalis major et minor, m. obliquus occipitalis major et minor, m. multifidi a m. rotatores cervicis. Existuje nepřímá evidence, že se na dystonických dyskinezích krku mohou podílet i hluboké krční svaly, jako např. m. longus colli, tyto svaly však prakticky nejsou dostupné palpačnímu nebo EMG vyšetření. Na dystonické dyskinezi se mohou podílet i svaly infrahyoidní a suprahyoidní, z nich nejčastěji m. geniohyoideus a m. mylohyoideus. Svaly zapojené v dyskineze, vytvářejí dohromady tzv. svalový vzorec cervikální dystonie. Cervikální dystonie se manifestuje v zásadě ve čtyřech formách, které mají typický klinický obraz a odpovídají určitému svalovému vzorci. Dyskineze je však velmi variabilní a mohou existovat (a frekventně se také objevují ) přechodné formy, vzniklé kombinací či vzájemným překrýváním čtyř základních. Tyto zmíněné základní formy jsou torticollis, retrocollis, laterocollis and antecollis. Klinická diagnostika plně vyvinutého syndromu cervikální dystonie není (pro svou typičnost) obtížná, naopak obtížnější je diferenciální diagnóza, při které je za pomoci řady paraklinických vyšetření nezbytné vyloučit sekundární dystonii, jejíchž příčin může být celá řada. Podrobné klinické mapování syndromu se provádí za použití EMG metod, ke kterým patří především jehlová EMG, polymyografie, analýza interferenčního vzorce a turns/amplitude analýza. Lékem volby cervikální dystonie je botulotoxin A, který je aplikován lokálně do svalů, zavzatých do dyskineze, a to na základě klinického a palpačního vyšetření nebo pod EMG kontrolou. Efekt léčby trvá většinou 3 měsíce, potom je nezbytné aplikaci opakovat. Léčba může být komplikována změnou svalového vzorce dystonie nebo tvorbou neutralizačních protilátek proti botulotoxinu A, potom je nutno opakovat celý elektrodiagnostický vyšetřovací protokol a k léčbě použít jiný sérotyp botulotoxinu.- The cervical dystonia is probably the most frequently seen type of idiopathic torsion dystonia. In the case of cervical dystonia, the abnormal involuntary contraction affects neck muscles in different distribution. It leads to the dystonic dyskinesia of the neck, which results in the dystonic posture of the head. The disorder is widely known as „spastic torticollis“, and has been described under this name in the classical neurological literature. The most frequently affected muscles are sternocleidomastoid muscle, splenius capitis muscle, trapezius muscle, semispinalis capitis and cervicis muscles, levator scapule muscle and group of scalene muscles. Less frequently are affected other neck muscles, particularly muscles of the cranio-cervical area: rectus capitis maior and minor muscles, obliquus capitis maior and minor muscles, multifidi muscles and rotatores capitis muscles. There exist an indirect evidence, that deep neck muscles, as for instance longus colli muscle, can participace on the dyskinesia. However, these muscles are actually not accessible for the palpation or electromyographic (EMG) examination. Suprahyoid and infrahyoid muscles can also participate on the dystonic dyskinesia, particularly geniohyoideus muscle and mylohyoideus muscle. Muscles, which are involved in the dyskinesia, form the so-called "muscle pattern" of cervical dystonia. Cervical dystonia manifests usually in four types, which have a typical clinical pattern, and which correspond to the particular muscle pattern: torticollis, retrocollis, laterocollis and anterocollis. Nevertheless, cervical dystonia is a variable syndrome, thus the combination or overlapping of these four types might be frequent. The clinical diagnosis of fully developed syndrome is (due to its typical clinical picture) relatively easy. On the other hand, the differential diagnosis is relatively difficult. It is necessary to exclude (using all accessible paraclinical examinations) all possible causes of secondary dystonia. To further map the clinical syndrome and its characteristics, it is necessary to use EMG methods. The needle EMG, polymyography, interference pattern analysis and turns/amplitude analysis are those which are the most helpful methods to describe the detailed characteristics of cervical dystonia. Treatment of choice of cervical dystonia is botulinum toxin A (BTX). The toxin is injected into the muscles involved in the dystonic dyskinesia, either on the basis of clinical examination and palpation or with EMG guidance. The treatment effect lasts usually up to three months, then the injection must be repeated. The treatment with BTX can be complicated by the change of muscular pattern of dystonia or development of neutralising antibodies against BTX. In such a case, the diagnostic process should be repeated and another serotype of BTX should be used for the further treatment.- Petr Kaňovský- Lit. 45- All metadata published by Europeana are available free of restriction under the Creative Commons CC0 1.0 Universal Public Domain Dedication. However, Europeana requests that you actively acknowledge and give attribution to all metadata sources including Europeana
PDF
