Grisel's Syndrome
Introduction
Grisel’s syndrome is a non-traumatic subluxation of the atlantoaxial joint, primarily affecting children. The atlantoaxial joint, located between the atlas (C1) and axis (C2), is stabilised by key ligaments, including the transverse ligament, which prevents excessive rotation. The syndrome occurs when these ligaments become lax due to inflammation, typically following upper respiratory infections such as pharyngitis or otitis media, or after surgeries in the head and neck such as tonsillectomy or adenoidectomy. The inflammation leads to loosened ligaments, particularly the transverse ligament, allowing the joint to slip out of place. This hypermobility, coupled with children's relatively immature cervical anatomy, makes them particularly vulnerable to Grisel’s syndrome [1][2] [3]
Clinical Presentation
Patients with Grisel’s syndrome often present with painful torticollis, neck stiffness, and restricted range of motion. These symptoms are often linked to recent upper respiratory infections, or surgeries involving the head and neck.[1] [4]While the condition predominantly affects children, particularly those under the age of 12, it can also be seen in adults [2][3]
Diagnostic Procedures
Diagnosis is based on clinical signs and confirmed through radiological imaging. Cervical spine X-rays and CT scans help assess the extent of atlantoaxial subluxation, while MRI provides further details on soft tissue and ligament involvement. Imaging should be utilised for patients with persistent neck pain and stiffness, especially following surgeries involving the head and neck. [2][3][4]
Management / Interventions
Early recognition and conservative treatment are key to a positive outcome [2]. Initial treatment often includes cervical immobilisation and anti-inflammatory medications. Delays in diagnosis or failure of conservative treatment may lead to severe complications, requiring surgical intervention. In some cases, untreated subluxation can result in permanent deformities or neurological complications, including quadriplegia [3]
Differential Diagnosis
Grisel’s syndrome should be differentiated from other causes of torticollis, such as congenital muscular torticollis, traumatic neck injuries, or cervical abscesses [2]. Additionally, ocular and neurological disorders, such as ocular motility dysfunctions, should be considered in the differential diagnosis of patients presenting with torticollis[2] [3]
References
- ↑ 1.0 1.1 Reddy KN, Baig SM, Batra M, Colodner K, Madubuko U, Korban A, Pandya Shah S. Grisel’s syndrome: a case report on this rare pediatric disease and its anesthetic challenges. BMC anesthesiology. 2020 Dec;20:1-4.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Allegrini D, Autelitano A, Nocerino E, Fogagnolo P, De Cillà S, Rossetti L. Grisel’s syndrome, a rare cause of anomalous head posture in children: a case report. BMC ophthalmology. 2016 Dec;16:1-4.
- ↑ 3.0 3.1 3.2 3.3 3.4 Bocciolini C, Dall’Olio D, Cunsolo E, Cavazzuti PP, Laudadio P. Grisel’s syndrome: a rare complication following adenoidectomy. Acta otorhinolaryngologica italica. 2005 Aug;25(4):245.
- ↑ 4.0 4.1 Pini N, Ceccoli M, Bergonzini P, Iughetti L. Grisel’s syndrome in children: two case reports and systematic review of the literature. Case reports in pediatrics. 2020;2020(1):8819758.
- ↑ Babu A, Grisel syndrome. Case study, Radiopaedia.org (Accessed on 21 Sep 2024) https://doi.org/10.53347/rID-10723