TORTICOLLIS

TORTICOLLIS: Excerpt from Differential Diagnosis in Primary Care

Torticollis is relatively infrequent; when seen in the adult it is thought to be “supratentorial.” There are, however, organic diseases that actually may be responsible. The best approach to recalling these instantly is anatomic, beginning with the muscle and proceeding along the nerve pathways to the brain and “supratentorium.”

1. Muscle. These may be divided into intrinsic and extrinsic lesions.
2. A. Intrinsic. Hematomas of the sternocleidomastoid muscle follow trauma, but congenital torticollis is thought to be due to injury or hematoma of the muscle at birth. Another intrinsic lesion is cervical fibromyositis. In this condition, the head is usually held in one position.
3. B. Extrinsic. Cervical ribs, scars of the neck, tonsillitis, dental abscess, or cervical adenitis may cause torticollis.
4. Nerve and nerve root. Conditions of the spinal column such as cervical spondylosis, tuberculosis of the cervical vertebrae, dislocation or fracture of the cervical spine, and cord tumors can cause this disorder.
5. CNS. Tumors of the brainstem and cerebellum can cause torticollis. Some cases are due to postinfectious encephalitis and cerebral palsy. Drugs such as phenothiazines and l-Dopa may be the culprits.
6. Supratentorium. Spasmodic torticollis would seem to fall into this category. I have seen cases begin while a patient is under the pressure of litigation for an occupational injury, especially if he or she is wearing a cervical collar. Hysteria may also cause torticollis.

Approach to the Diagnosis

A radiograph of the cervical spine and a thorough neurologic examination are axiomatic before one considers the problem to be psychogenic. A Minnesota Multiphasic Personality Inventory (MMPI) will help to support the diagnosis of psychoneurosis, depression, and even malingering. Referral to a psychiatrist may be best if the patient is willing.

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Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins MD, FACP
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins MD, FACP Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

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