Ann Rehabil Med.  2013 Oct;37(5):713-716. 10.5535/arm.2013.37.5.713.

Grisel Syndrome: Pathophysiological Evidence from Magnetic Resonance Imaging Findings

• Park SH
• Park SH
• Lee SH

• KMID: 2266590
• DOI: http://doi.org/10.5535/arm.2013.37.5.713

Abstract

Grisel syndrome is a condition of uncertain etiology characterized by a non-traumatic atlantoaxial subluxation following an infection in the head and neck region. Although first described in 1830, the exact pathophysiology of Grisel syndrome remains unclear. We present a case of atlantoaxial subluxation after acute lymphadenitis diagnosed with a dynamic computed tomography (CT) and magnetic resonance imaging (MRI). A previously healthy 9-year-old male patient presented with torticollis of sudden onset. Dynamic CT and MR imaging showed rotary atlantoaxial subluxation and inflammation surrounding the cervical spinal ligaments. A follow-up MRI of the cervical spine, taken 3 weeks after the onset of symptoms, showed a complete resolution of subluxation and inflammation surrounding the cervical spinal ligaments. In this case report, we support the hypothesis that an inflammation-induced laxity of the cervical ligaments is the pathologic key to Grisel syndrome using radiologic findings.

Keyword

Lymhadenitis; Atlantoaxial joint; Torticollis

MeSH Terms

Atlanto-Axial Joint
Child
Follow-Up Studies
Head
Humans
Inflammation
Ligaments
Lymphadenitis
Magnetic Resonance Imaging*
Magnetics*
Magnets*
Male
Neck
Spine
Torticollis

Figure

• 

  Fig. 1 (A) This dynamic computed tomography (CT) study demonstrates the rotary atlantoaxial subluxation with an anterior displacement of atlas relative to axis, corresponding to a Fielding type 2 subluxation. Rotation of the neck reveals asymmetric movement of the odontoid process. (B) Rotated to left side. (C) Rotated to right side. (D) The three-week follow-up CT scan shows complete resolution of atlantoaxial subluxation.

• 

  Fig. 2 The initial T2-weighted magnetic resonance imaging (MRI) study shows enhancement of atlantodental interval (A) and superior articular facet of axis (B). Repeated MRI, 16 days later, shows disappearance of signal change in atlanto-dental joint (C) and superior facet articulation of axis (D).

• 

  Fig. 3 (A) The initial sagittal T2-weighted magnetic resonance imaging view shows enhancement of tissue surrounding the dens. (B) Repeat study shows resolution of the same.

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