InfectionMedically treated paravertebral Brucella abscess presenting with acute torticollis: case report☆
Introduction
Atlantoaxial rotatory subluxation is rather an uncommon entity in which the main feature is either subluxation or dislocation of the atlas on the axis [7], [8], [20]. It is typically seen in children following otolaryngeal entities such as pharyngitis, nasopharyngitis, adenotonsillitis, tonsillar abscess, parotitis, cervical abscess, and otitis media [2], [5], [7], [8], [12], [13], [22], [24]. This deformity needs individualized treatment modalities depending upon radiologic grade, timing of the diagnosis, and the etiology.
Here the authors present a case with acute torticollis. On initial radiographs, type 2 AARS was diagnosed. Cervical MRI of the patient revealed paravertebral (retropharyngeal) abscess from C1 through C5, which was caused by Brucella. This is a unique case of upper cervical brucellosis, diagnosed while searching for the differential diagnosis of AARS.
Section snippets
Case report
A 6-year-old boy presented with a painful and stiff neck that started suddenly 4 days previously. He had no history of trauma. At physical examination, his head rotated to the left with the chin tilted to the right (cock-robin). Neck movement was restricted and painful in the direction of the deformity. His neurologic examination was normal. Plain radiograms showed an increased and subluxation of C1 over C2. Atlantoaxial rotatory subluxation was confirmed with CT of the atlantoaxial joint and
Discussion
Atlantoaxial rotatory subluxation is usually seen in children, following otitis media, pharyngitis, viral infections, retropharyngeal abscess, tonsillectomy, pharyngoplasty, retropharyngeal inflammation, or minor trauma, and some of them with unknown etiology [2], [5], [7], [8], [12], [13], [22], [24]. In the pediatric age group, atlantoaxial subluxation secondary to retropharyngeal abscess is a well described but rare event. However, to our best of knowledge, no case has been reported
Conclusions
Patients with torticollis who had AARS should not be underestimated. The most important point is that delayed diagnosis affects the prognosis and treatment protocol and is a major cause of recurrence and instability on AARS. Brucellosis should be kept in mind as the etiology of upper cervical paravertebral abscess. The authors recommend a trial of medical treatment with adequate dosages for a reasonable length of time and immobilization before considering surgical intervention in spinal
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Cited by (0)
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This case was first reported at the 13th World Congress of Neurological Surgery in Marrakech, Morocco, 2005.