eMedicine Specialties > Emergency Medicine > Neurology

Torticollis: Differential Diagnoses & Workup

Author: Kevin Tao, MD, Staff Physician, Department of Emergency Medicine, New York University/Bellevue Hospital
Coauthor(s): Christopher M McStay, MD, Assistant Professor, Department of Emergency Medicine, New York University, Bellevue Hospital Center
Contributor Information and Disclosures

Updated: Nov 5, 2009

Differential Diagnoses

C1 Fractures
Retropharyngeal Abscess
C2 Fractures
Spinal Hematoma
Cervical Spine Injuries in Sports
Torticollis
Peritonsillar Abscess
Toxicity, Neuroleptic Agents

Other Problems to Be Considered

Conversion disorder

Workup

Laboratory Studies

  • Lab studies are not particularly helpful and are dependent on underlying disorder.
  • Lab studies are useful if infection is suspected.

Imaging Studies

  • Plain cervical radiographs, CT scans, or MRI of the cervical spine may be useful to evaluate for bony trauma, suspected C1-C2 subluxation, congenital bony abnormalities, or osteomyelitis.
  • CT scan or MRI of the neck may be useful for evaluation of suspected abscesses, deep space infections, or masses.
  • CT scan or MRI of the brain may be useful to exclude suspected tumors.

Other Tests

  • Pediatric patients should have a complete eye examination.

More on Torticollis

Overview: Torticollis
Differential Diagnoses & Workup: Torticollis
Treatment & Medication: Torticollis
Follow-up: Torticollis
Multimedia: Torticollis
References
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References

  1. Macias C, Gan V. Congenital torticollis in children [database online]. Waltham, MA: UpToDate; 2007.

  2. Robin N. Congenital Muscular Torticollis. Pediatrics in Review. Oct 1996;(10):374-5.

  3. Hasegawa J, Tateda M, Hidaka H, Sagai S, Nakanome A, Katagiri K. Retropharyngeal abscess complicated with torticollis: case report and review of the literature. Tohoku J Exp Med. Sep 2007;213(1):99-104. [Medline].

  4. Harries PG. Retropharyngeal abscess and acute torticollis. J Laryngol Otol. Dec 1997;111(12):1183-5. [Medline].

  5. Sobolewski BA, Mittiga MR, Reed JL. Atlantoaxial rotary subluxation after minor trauma. Pediatr Emerg Care. Dec 2008;24(12):852-6. [Medline].

  6. Bittar RG, Yianni J, Wang S, et al. Deep brain stimulation for generalised dystonia and spasmodic torticollis. J Clin Neurosci. Jan 2005;12(1):12-6. [Medline].

  7. Claypool DW, Duane DD, Ilstrup DM, Melton LJ 3rd. Epidemiology and outcome of cervical dystonia (spasmodic torticollis) in Rochester, Minnesota. Mov Disord. Sep 1995;10(5):608-14. [Medline].

  8. Costa J, Espirito-Santo C, Borges A, et al. Botulinum toxin type B for cervical dystonia. Cochrane Database Syst Rev. Jan 25 2005;CD004315. [Medline].

  9. Denislic M, Pirtosek Z, Vodusek DB, Zidar J, Meh D. Botulinum toxin in the treatment of neurological disorders. Ann N Y Acad Sci. Mar 9 1994;710:76-87. [Medline].

  10. Duane DD. Spasmodic torticollis. Adv Neurol. 1988;49:135-50. [Medline].

  11. Gauthier S. Idiopathic spasmodic torticollis: pathophysiology and treatment. Can J Neurol Sci. May 1986;13(2):88-90. [Medline].

  12. Hakkinen A, Ylinen J, Rinta-Keturi M, Talvitie U, Kautiainen H, Rissanen A. Decreased neck muscle strength is highly associated with pain in cervical dystonia patients treated with botulinum toxin injections. Arch Phys Med Rehabil. Oct 2004;85(10):1684-8. [Medline].

  13. Havaki-Kontaxaki BJ, Kontaxakis VP, Margariti MM, Paplos KG, Christodoulou GN. Treatment of severe neuroleptic-induced tardive torticollis. Ann Gen Hosp Psychiatry. Oct 17 2003;2(1):9. [Medline].

  14. Joyce MB, de Chalain TM. Treatment of recalcitrant idiopathic muscular torticollis in infants with botulinum toxin type a. J Craniofac Surg. Mar 2005;16(2):321-7. [Medline].

  15. Lee LH, Chang WN, Chang CS. The finding and evaluation of EMG-guided BOTOX injection in cervical dystonia. Acta Neurol Taiwan. Jun 2004;13(2):71-6. [Medline].

  16. Macias C, Gan V. Acquired torticollis in children [database online]. Waltham, MA: UpToDate; 2007.

  17. Sa DS, Mailis-Gagnon A, Nicholson K, Lang AE. Posttraumatic painful torticollis. Mov Disord. Dec 2003;18(12):1482-91. [Medline].

  18. Singh S, Goyal V, Prasad K, Behari M. Cervical dystonia responsive to levodopa. Neurol India. Jun 2004;52(2):276-8. [Medline].

  19. Takeuchi N, Chuma T, Mano Y. Phenol block for cervical dystonia: effects and side effects. Arch Phys Med Rehabil. Jul 2004;85(7):1117-20. [Medline].

  20. Tonomura Y, Kataoka H, Sugie K, Hirabayashi H, Nakase H, Ueno S. Atlantoaxial rotatory subluxation associated with cervical dystonia. Spine (Phila Pa 1976). Sep 1 2007;32(19):E561-4. [Medline].

  21. Truong D, Duane DD, Jankovic J, et al. Efficacy and safety of botulinum type A toxin (Dysport) in cervical dystonia: results of the first US randomized, double-blind, placebo-controlled study. Mov Disord. Jul 2005;20(7):783-91. [Medline].

  22. van Herwaarden GM, Anten HW, Hoogduin CA, et al. Idiopathic spasmodic torticollis: a survey of the clinical syndromes and patients' experiences. Clin Neurol Neurosurg. Aug 1994;96(3):222-5. [Medline].

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Further Reading

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Keywords

torticollis, idiopathic spasmodic torticollis, IST, involuntary contractions of neck muscles, focal dystonia, congenital torticollis, birth trauma, acquired torticollis, acute wryneck, painful neck spasms, cervical muscle spasm, tonic head deviation, clonic head movements, head torsion, spasmodic torticollis, cervical osteomyelitis

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Contributor Information and Disclosures

Author

Kevin Tao, MD, Staff Physician, Department of Emergency Medicine, New York University/Bellevue Hospital
Kevin Tao, MD is a member of the following medical societies: American College of Emergency Physicians and Emergency Medicine Residents Association
Disclosure: Nothing to disclose.

Coauthor(s)

Christopher M McStay, MD, Assistant Professor, Department of Emergency Medicine, New York University, Bellevue Hospital Center
Christopher M McStay, MD is a member of the following medical societies: American College of Emergency Physicians and Wilderness Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey Glenn Bowman, MD, MS, Consulting Staff, Highfield MRI, Columbus, Ohio
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

J Stephen Huff, MD, Associate Professor, Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia Health Sciences Center
J Stephen Huff, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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