Skip to main content

Advertisement

SpringerLink
Log in

Torticollis secondary to posterior fossa and cervical spinal cord tumors: report of five cases and literature review

  • Original Article
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

Torticollis is either congenital or acquired in childhood. Acquired torticollis is not a diagnosis but rather a sign of an underlying disorder. The causes of acquired torticollis include ligamentous, muscular, osseous, ocular, psychiatric, and neurologic disorders and may be a symptom of significant abnormalities of the spinal cord and brain, such as spinal syrinx or central nervous system neoplasia. Torticollis is rarely considered to be an initial clinical presentation of posterior fossa and cervical spinal cord tumors. We report five cases of pediatric tumors with torticollis at the onset: an astrocytoma originating from the medulla oblongata, another presumptive astrocytoma of the spinal cord located between C1 and C6 cervical vertebrae (not operated), an ependymoma located throughout the whole cervical spinal cord extending into the bulbomedullary junction, an astrocytoma originating from the bulbus and extending into the posterior fossa, and another case of a eosinophilic granuloma located extradurally through the anterior and posterior portions of the vertebral bodies from C3 to C7 producing the collapse of the sixth cervical vertebra. All five cases were seen in children, aged between 3 and 12 years. All these cases reflect the misinterpretation of this neurological sign and the lack of association with the possibility of spinal or posterior fossa tumor. This delay in the diagnosis of these diseases led to progressive neurological deterioration and to the increase in the tumor size, which made surgical intervention difficult and the prognosis unfavorable. Although torticollis secondary to tumors is rarely seen, it is necessary to be kept in mind in the differential diagnosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Armstrong D, Pickrell K, Fetter B, Pitts W (1965) Torticollis: an analysis of 271 cases. Plast Reconstr Surg 35:14–25

    Article  PubMed  CAS  Google Scholar 

  2. Bertram C, Madert J, Eggers C (2002) Eosinophilic granuloma of the cervical spine. Spine 27:1408–1413

    Article  PubMed  Google Scholar 

  3. Boisen E (1979) Torticollis caused by an infratentorial tumor: three cases. Br J Psychiatry 134:306–307

    Article  PubMed  CAS  Google Scholar 

  4. Brain WR (1926) On the rotated or “cerebellar” posture of the head. Brain 49:61–76

    Article  Google Scholar 

  5. Bussieres A, Cassidy JD, Dzus A (1994) Spinal cord astrocytoma presenting as torticollis and scoliosis. J Manipulative Physiol Ther 17:113–118

    PubMed  CAS  Google Scholar 

  6. Cammarota A, Gershanik OS, Garcia S, Lera G (1995) Cervical dystonia due to spinal cord ependymoma: involvement of cervical cord segments in the pathogenesis of dystonia. Mov Disord 10:500–503

    Article  PubMed  CAS  Google Scholar 

  7. Caress JB, Nohria V, Fuchs H, Boustany RM (1996) Torticollis acquired in late infancy due to a cerebellar gangliocytoma. Int J Pediatr Otorhinolaryngol 36:39–44

    Article  PubMed  CAS  Google Scholar 

  8. Constantini S, Houten J, Miller DC, Freed D, Ozek MM, Rorke LB, Allen JC, Ebstein FJ (1998) Intramedullary spinal cord tumors in children under the age of 3 years. J Neurosurg 88:935–937

    Google Scholar 

  9. Cruysberg JR, Draaijer RW, Snijders-Bosman PW (1998) Two children with a rare etiology of torticollis: primitive neuroectodermal tumor and Grisel’s syndrome (in Dutch). Ned Tijdschr Geneeskd 142:1573–1574

    PubMed  CAS  Google Scholar 

  10. Duran E, Chacon JR (2001) Spasmodic torticollis and vertebral hemangioma. Rev Neurol 32:60–62

    PubMed  CAS  Google Scholar 

  11. Giufree R, Di Lorenzo N, Fortuna A (1981) Cervical tumors of infancy and childhood. J Neurosurg Sci 25:259–264

    Google Scholar 

  12. Gupta AK, Roy DR, Conlan ES, Crawford AH (1996) Torticollis secondary to posterior fossa tumors. J Pediatr Orthop 16:505–507

    PubMed  CAS  Google Scholar 

  13. Jankovic J, Patel SC (1983) Blepharospasm associated with brainstem lesions. Neurology 33:1237–1240

    PubMed  CAS  Google Scholar 

  14. Kahn ML, Davidson R, Drummond S (1991) Acquired torticollis in children. Orthop Rev 20:667–674

    PubMed  CAS  Google Scholar 

  15. Kiwak KJ (1984) Establishing an etiology for torticollis. Postgrad Med 75:126–134

    PubMed  CAS  Google Scholar 

  16. Kiwak KJ, Deray MJ, Shields WD (1983) Torticollis in three children with syringomyelia and spinal cord tumor. Neurology 33:946–948

    PubMed  CAS  Google Scholar 

  17. Korngold HW (1959) Acute torticollis in pediatric practise. Am J Dis Child 98:756–764

    CAS  Google Scholar 

  18. Krauss JK, Seeger W, Jankovic J (1997) Cervical dystonia associated with tumors of the posterior fossa. Mov Disord 12:443–447

    Article  PubMed  CAS  Google Scholar 

  19. LeDoux MS, Brady K (2003) Secondary cervical dystonia associated with structural lesions of the central nervous system. Mov Disord 18:60–69

    Article  PubMed  Google Scholar 

  20. Lee MS, Marsden CD (1994) Movement disorders following lesions of the thalamus or subthalamic region. Mov Disord 9:493–507

    Article  PubMed  CAS  Google Scholar 

  21. Manzoni D, Pompeiano O, Bruschini L, Andre P (1999) Neck input modifies the reference frame for coding labyrinthine signals in the cerebellar vermis: a cellular analysis. Neuroscience 93:1095–1107

    Article  PubMed  CAS  Google Scholar 

  22. Marmor MA, Beauchamp GR, Maddox SF (1990) Photophobia, epiphora, and torticollis: a masquerade syndrome. J Pediatr Ophthalmol Strabismus 27:202–204

    PubMed  CAS  Google Scholar 

  23. Marsden CD, Obeso JA, Sarranz JJ, Lang AE (1985) The anatomical basis of symptomatic hemidystonia. Brain 108:463–483

    Article  PubMed  Google Scholar 

  24. O’Brien DF, Caird J, Kennedy M, Roberts GA, Marks JC, Allcutt DA (2001) Posterior fossa tumors in childhood. Evaluation of presenting clinical features. Ir Med J 94:52–53

    PubMed  CAS  Google Scholar 

  25. Pasaoglu A, Patiroglu TE, Orhon C, Yildizhan A (1988) Cervical spinal intramedullary myxoma in childhood. Case report. J Neurosurg 69:772–774

    Article  PubMed  CAS  Google Scholar 

  26. Pollack IF (1999) Pediatric brain tumors. Semin Surg Oncol 16:73–90

    Article  PubMed  CAS  Google Scholar 

  27. Shafrir Y, Kaufman BA (1992) Quadriplegia after chiropractic manipulation in an infant with congenital torticollis caused by a spinal cord astrocytoma. J Pediatr 120:266–269

    Article  PubMed  CAS  Google Scholar 

  28. Siebold C, Kleine JF, Gionti L, Tchelidze T, Buttner U (1999) Fastigial nucleus activity during different frequencies and orientations of vertical vestibular stimulation in the monkey. J Neurophysiol 82:34–41

    PubMed  CAS  Google Scholar 

  29. Sohn JM, Park CH, Park HS, Kim JJ, Kim YE (2001) Anterior cervical corpectomy and fusion using miniplate and screws in a 7-year-old child with eosinophilic granuloma of the cervical spine. Spine 26:1193–1196

    Article  PubMed  CAS  Google Scholar 

  30. Suchowersky O, Calne DB (1988) Non-dystonic causes of torticollis. Adv Neurol 50:501–508

    PubMed  CAS  Google Scholar 

  31. Taboas-Perez RA, Rivera-Reyes L (1984) Head tilt: a revisit to an old sign of posterior fossa tumors. Bol Asoc Med P R 76:62–65

    PubMed  CAS  Google Scholar 

  32. Tachdjian MO, Matson DD (1965) Orthopaedic aspects of intraspinal tumors in infants and children. J Bone Joint Surg Am 47:223–248

    PubMed  CAS  Google Scholar 

  33. Thompson GH, Scoles PV (2000) Bone and joint disorders. In: Behrman RE, Kleigman RM, Jenson HB (eds) Nelson’s textbook of pediatrics, 16th edn. Saunders, Philadelphia, pp 2089–2090

    Google Scholar 

  34. Turgut M, Akalan N, Bertan V, Erbengi A, Eryilmaz M (1995) Acquired torticollis as the only presenting symptom in children with posterior fossa tumors. Childs Nerv Syst 11:86–88

    Article  PubMed  CAS  Google Scholar 

  35. Visudhiphan P, Chiemchanya S, Somburanasis R, Dheandhanoo D (1982) Torticollis as the presenting sign in cervical spine infection and tumor. Clin Pediatr 21:71–76

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatric Neurology, Erciyes University Medical School, Kayseri, Turkey

    Sefer Kumandaş, Hüseyin Per & Hakan Gümüş

  2. Department of Neurosurgery, Erciyes University Medical School, Kayseri, Turkey

    Bülent Tucer & Ali Kurtsoy

  3. Department of Pediatric Radiology, Erciyes University Medical School, Kayseri, Turkey

    Ali Yikilmaz & Abdülhakim Coşkun

  4. Department of Pathology, Erciyes University Medical School, Kayseri, Turkey

    Olgun Kontaş

  5. Pediatrik Nöroloji Bölümü Talas, Erciyes Üniv. Týp Fakültesi, Kayseri, Turkey

    Hüseyin Per

Authors
  1. Sefer Kumandaş
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hüseyin Per
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hakan Gümüş
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bülent Tucer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ali Yikilmaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Olgun Kontaş
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Abdülhakim Coşkun
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ali Kurtsoy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hüseyin Per.

Additional information

Comments

Ralf Becker, Seesen, Germany

The authors report on a series of five patients presenting with torticollis caused by different underlying pathologies affecting the lower brain stem. This is nothing new for experienced neurosurgeons and neurologists. However, this series and the literature review demonstrate again that knowledge about clinical presentation of mass lesions of the posterior fossa and the cervical spine and the multiple etiologies of torticollis are not very well established in general practice. Therefore, we have to alert our colleagues in general and pediatric practice again and again. Especially the symptomatic treatment of torticollis without adequate prior neuroradiological examination may lead to hazardous complications. In every child with new onset of abnormalities in posture, gait and muscle tone pathologies in the central nervous system have to be ruled out before starting such symptomatic therapies. In nearly every case the dystonic symptoms will be relieved completely with the removal of the mass lesion.

Joachim K. Krauss, Hannover, Germany

In this study the authors report on five children with “acquired torticollis” in whom tumors of the posterior fossa and the cervical spinal cord were detected. The aim of the present study was to attract attention to the fact that tumors can be the underlying cause of acquired torticollis and can easily be overlooked. Indeed, in patients with tumors presenting with atypical symptoms appropriate diagnostic measures may be delayed. It is unclear whether or not the authors use the term “torticollis” as a synonym for cervical dystonia or not. Many of the previous references cited by the authors suffer from the same problem, and this issue would deserve further consideration. Often, what is being described as “torticollis” in children is not an expression of cervical dystonia but rather pseudodystonia presenting as an abnormal posture secondary to a variety of underlying reasons including compensatory ocular or vestibular mechanisms, head tilt secondary to irritation of the dura, or alterations of CSF flow.

Marc Sindou, Lyon, France

The authors have to be acknowledged for reporting cases of acquired torticollis revealing or associated with posterior fossa or cervical spinal cord tumors. Such a clinical presentation can be misleading, although at least some degree of neck stiffness or torticollis is relatively frequent in space-occupying lesions at the occipitocervical junction and calls for MRI examination. Concerning mechanisms, we think that these “symptomatic” presentations of torticollis should be considered as “positive” symptoms/signs of accessory spinal nerve dysfunction, which is concordant and logical with the topography of these lesions.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kumandaş, S., Per, H., Gümüş, H. et al. Torticollis secondary to posterior fossa and cervical spinal cord tumors: report of five cases and literature review. Neurosurg Rev 29, 333–338 (2006). https://doi.org/10.1007/s10143-006-0034-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10143-006-0034-8

Keywords

Search

Navigation