Grisel syndrome: pathophysiological evidence from magnetic resonance imaging findings

Area of Science:

• Orthopedics
• Pediatric Rheumatology
• Neuroradiology

Background:

• Grisel syndrome involves non-traumatic atlantoaxial subluxation post-head/neck infection.
• Its exact pathophysiology remains unclear despite being described in 1830.

Purpose of the Study:

• To present a case of Grisel syndrome following acute lymphadenitis.
• To support the hypothesis of inflammation-induced cervical ligament laxity as the key pathology.

Main Methods:

• Dynamic computed tomography (CT) and magnetic resonance imaging (MRI) were used for diagnosis.
• Radiologic findings of rotary atlantoaxial subluxation and ligament inflammation were analyzed.

Main Results:

• A 9-year-old male presented with sudden torticollis and atlantoaxial subluxation after acute lymphadenitis.
• Dynamic CT and MRI revealed rotary atlantoaxial subluxation and surrounding cervical spinal ligament inflammation.
• Follow-up MRI showed complete resolution of subluxation and inflammation after 3 weeks.

Conclusions:

• Inflammation-induced laxity of cervical ligaments is a likely cause of Grisel syndrome.
• Radiologic evidence supports this hypothesis in pediatric cases.
• Early diagnosis and management are crucial for favorable outcomes.