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[Acquired torticollis in hospitalized children]
A Blankstein1, F Pavlotsky, H Roizin
1Dept. of Orthopedics, Chaim Sheba Medical Center, Tel Hashomer.
Insights
Pediatric torticollis, excluding congenital cases, is often caused by trauma or upper respiratory infections. This study analyzed 36 hospitalized children, finding distinct seasonal patterns and associated symptoms for each cause.
Area of Science:
- Pediatric Orthopedics
- Pediatric Neurology
- Infectious Diseases
Context:
- Torticollis in children, excluding congenital cases, presents diverse etiologies requiring differential diagnosis.
- Understanding the underlying causes is crucial for effective management and treatment strategies.
- This study focuses on hospitalized pediatric patients to characterize non-congenital torticollis.
Purpose:
- To investigate and categorize the diverse pathological mechanisms underlying acquired torticollis in hospitalized children.
- To identify the most common causes, associated symptoms, and seasonal variations in pediatric torticollis.
- To differentiate clinical presentations between traumatic, infectious, neurological, and ocular origins of torticollis.
Summary:
- A review of 36 hospitalized children with torticollis (excluding congenital) revealed trauma (39%) and upper respiratory tract infection (36%) as primary causes.
- Girls were more frequently affected by traumatic torticollis, while boys predominated in infection-related cases.
- Other causes included ocular issues (superior-oblique muscle palsy), neurological disorders (astrocytoma, leukodystrophy), post-burn eschar, and idiopathic cases, with a notable seasonal trend for infectious and traumatic origins.
Impact:
- Findings highlight the importance of considering trauma and infections in the differential diagnosis of pediatric torticollis.
- The study identifies key clinical features and seasonal patterns that can aid in prompt diagnosis and management.
- Results contribute to a better understanding of acquired torticollis, informing clinical practice and future research directions.
Abstract:
Torticollis results from various pathological mechanisms, and its elucidation depends on identifying diseases of musculoskeletal, neural and ocular tissues. This study characterized the underlying diseases of children hospitalized with torticollis, excluding congenital torticollis. Records of 36 children with torticollis seen during 4 years were reviewed and categorized according to presumed etiology. Most could be classified into 2 categories: in 39% it was due to trauma and in 36% to upper respiratory tract infection. Most girls were in the first group and most boys in the second group. There were 3 cases of ocular torticollis due to superior-oblique muscle palsy, 1 with a post-burn eschar, 2 with neurological disorders (intramedullary cervical astrocytoma and leukodystrophy with macrencephaly), and in 3 no associated cause was found. There was a clear seasonal trend with 58% of cases presenting from November through February, 33% from April through July, and the rest, of neurological or ocular origin, during the rest of the year. In cases of post-traumatic torticollis 21% had neurological symptoms such as weakness of the limbs, headaches or incontinence. Only a few had prior upper respiratory tract infection. All children whose torticollis was assigned to infection had had fever. Only 8% had had neurological complaints or vomiting, half of whom presented with fever exceeding 37.5 degrees C. 46% had restriction of movement and 38% had tenderness. In over 60% of those in this group there were signs of an upper respiratory tract infection, such as lymphadenopathy or a white blood cell count exceeding 15,000/microliter, 3 patients with recurrent torticollis were diagnosed as having severe neurological diseases. Mean hospitalization time was 4 days (range 1-28). Hospitalization periods were similar for all kinds of patients and treatment by traction or fixation did not affect this period.