An 8-yr-old present to ED with torticollis, what could it be
The present case has been reported in the Annals of Emergency Medicine.

An 8-year-old girl with no significant medical history presented to the emergency department with 3 days of fever, nontraumatic left-sided neck pain, and sore throat.

Physical examination was significant for torticollis, tenderness along the left posterior side of the neck, and bilateral anterior cervical lymphadenopathy. CT of the neck (sagittal view) demonstrating uneven widening of the odontoid space and leftward rotation of C1 on C2 (arrows).

The patient was diagnosed with Grisel’s syndrome, a rare condition of nontraumatic subluxation of the atlantoaxial joint.

Case highlights:-
- Grisel’s syndrome should be entertained as a diagnosis in all cases of torticollis, but especially for individuals in whom symptoms are not resolving.

- Radiographs are typically not helpful. CT demonstrating lateral displacement of C1 on C2 vertebrae establishes the diagnosis.

- MRI may be useful in visualizing inflamed soft tissue of the neck.

- Mild cases are treated with broad-spectrum antibiotics and stabilization with a soft collar. With delayed diagnosis, treatment may require a traction brace.

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