What is it? Case 1, 1988. Head tilt in a young girl associated with neck pain and limitation of neck movement
✍ Scribed by Heidi Shale; Stanley Fahn; Donald B. Calne
- Publisher
- John Wiley and Sons
- Year
- 1988
- Tongue
- English
- Weight
- 288 KB
- Volume
- 3
- Category
- Article
- ISSN
- 0885-3185
No coin nor oath required. For personal study only.
✦ Synopsis
PRESENTATION OF CASE
History
This 7-year-old girl had been well until she awoke with right posterior neck pain and a head tilt to her right shoulder. She had no recent infections, had not received any medications, and did not have a history of head or neck trauma. Her pediatrician prescribed amoxicillin and Dimetapp for serous otitis media on the right side, but the pain and head tilt persisted. Cervical spine X-ray films were normal.
She was hospitalized 1 month after the onset of her symptoms and was treated symptomatically with traction and a cervical collar, Valium, and aspirin, without relief. A bone scan and computed tomography (CT) scan of her head and neck (not available to us) were normal and results of a mono spot were negative. Past medical history was significant for recurrent otitis media and myringotomies at age 1 year. Family history was unremarkable.
When seen at the Neurological Institute of New York 2 months after onset of her symptoms, the examination was significant for generalized neck discomfort and focal pain localized immediately below the right mastoid region in the vicinity of the upper sternocleidomastoid muscle. Light palpation in this region resulted in increased discomfort and crying. There was firmness of the soft tissues, mild spasm of the sternocleidomastoid muscle, and shoddy matted lymph nodes in the posterior cervical chain. She preferred to wear a cervical collar and when the Case report and videotape were submitted by Heide Shale and Stanley Fahn.