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Congenital torticollis and saccular dysfunction: a case report
Ashley Hallberg1, Robert T Standring, Syed Ahsan
1Department of Otolaryngology–Head and Neck Surgery, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202, USA.
Insights
This study reports the first case of torticollis caused by saccular dysfunction in an infant. Abnormal vestibular tests indicated saccular dysfunction, suggesting it should be considered in persistent infant torticollis cases.
Area of Science:
- Pediatric Neurology
- Vestibular System Disorders
- Otolaryngology
Background:
- Congenital muscular torticollis is common in infants.
- Persistent cases may indicate underlying vestibular dysfunction.
- Early diagnosis is crucial for effective intervention.
Observation:
- An 18-month-old infant presented with torticollis, postural imbalance, and rotary nystagmus.
- The infant had undergone prolonged physical therapy without full resolution.
- Vestibular testing revealed abnormal cervical vestibular evoked myogenic potentials (cVEMPs) and positional vertigo.
Findings:
- The infant exhibited left-sided saccular dysfunction, indicated by low-amplitude cVEMP responses.
- Rotary-torsional nystagmus suggested positional vertigo linked to saccular dysfunction.
- This is the first reported case of torticollis attributed to saccular dysfunction.
Implications:
- Saccular dysfunction should be considered in infants with congenital torticollis unresponsive to physical therapy.
- Early detection of saccular dysfunction is vital for appropriate management in pediatric patients.
- Further research is needed to validate these findings and guide clinical practice.
Importance:
This is the first report, to our knowledge, of a child with torticollis due to saccular dysfunction.
Observation:
An 18-month-old infant with torticollis was referred for postural imbalance and observed rotary nystagmus. The infant had undergone physical therapy treatment of left torticollis for nearly 15 months. Cervical vestibular evoked myogenic potentials (cVEMPs) were recorded to assess saccular function and caloric stimulation and positional and rotational testing were performed to evaluate other vestibular receptors. The child demonstrated abnormal cVEMP findings, with a low-amplitude response on the left, which indicated left-sided saccular dysfunction. The patient's rotary-torsional nystagmus suggested positional vertigo secondary to abnormal saccular function.
Conclusions And Relevance:
This case highlights that saccular dysfunction should be considered when timely resolution of congenital torticollis is not obtained with physical therapy. Early detection of abnormal saccular function in infants and young children with CPT is necessary to ensure appropriate intervention. Further study needs to be done to confirm our findings.
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