Acute torticollis in an adolescent: case report and MRI study.

Abstract

A case report is presented. To describe a typical case of acute adolescent torticollis in which a disc lesion was detected with magnetic resonance imaging. Acute torticollis is attributed to atlantoaxial rotary fixation of unknown etiology. The current view is that the lesion is caused by synovial fold entrapment in the C1-C2 interspace. In a 15-year-old male adolescent, magnetic resonance imaging was performed a few hours after the onset of torticollis, and 3 weeks after resolution of symptoms.RESULTS Increased signal intensity compatible with a fluid collection was seen in the right uncovertebral region at C2-C3. This lesion was probably linked to a sudden disruption of the disc collagen fibers, and had caused excessive lateral pressure, pushing C2 toward the left. Magnetic resonance imaging at 3 weeks was unremarkable. The authors think that the observed disruption was a sudden and abnormal instance of a normal and, usually, very slow process of cleft formation with extension into the fibrocartilaginous core in the uncovertebral region. It is felt that this lesion may be a frequent cause of torticollis in adolescents.