Other movement disorders |
Tremor |
Tremor associated to dystonia |
Tremor happens in another body part affected by dystonia and there is no directional predominance of the movement |
Chorea |
Rhythmic and oscillatory movements |
Unpredictability |
Myoclonus |
Jerk-like movements resembling dystonic tremor |
EMG shows myoclonic features |
Tics |
Dystonic tics |
Frequently associated with premonitory sensation and relief after performance. Changeable over time. |
Systemic disorders |
Sandifer syndrome |
Opisthotonic posturing mainly involving the neck, back, and upper extremities |
Spasms occurring after feeding with pain. Videotelemetry confirms. |
Stiff person |
Axial rigidity and stiffness superimposed by spasms caused by continuous firing of the peripheral nerve axons |
EMG: continuous motor unit activity with normal morphology. |
Rheumathoid arthritis, juvenile idiopathic arthritis, and juvenile rheumatoid arthritis |
Non traumatic anteroposterior atlanto-axial subluxation |
Stiffness, pain and limited movement plus inflammatory signs (swollen, red or warm) joints |
Orthopedic |
Atlanto axial subluxation |
Loss of range of motion and increased muscle tone due to dislocation of a joint and atlanto-axial rotatory misalignment |
RX: Distance between the anterior aspect of the dens and posterior aspect of the anterior arch of the atlas is more than 3 mm |
Congenital muscular torticollis |
Unilateral shortening of the sternocleidomastoid muscle that is detected at birth or after birth |
Neck ultrasonography confirms the existence of the neck mass or hypertrophy of the sternocleidomastoid muscle |
Peripheral disorders (muscle, ligaments, vessels and bones) |
Isaacs syndrome (Neuromyotonia) |
Muscle cramps, stiffness and delayed muscle relaxation. |
EMG: grouped and complex discharges of motor units |
Myopathy |
Proximal myopathy with dropped neck |
Cervical paraspinal weakness that results in passively and correctable chin on chest deformity |
Soft nuchal mass/ Ligamentous damage |
Space occupying lesion causing neck deviation |
Cervical bulging |
Arteriovenous fistula at the craniocervical junction (or elongated vertebral artery loop and dilatation of vertebral artery) |
Compression of accessory nerve, meningeal irritation and change in bone supply affecting vestibular nuclei complex causing torticollis |
MRI reveals vascular malformation at the craniocervical junction. Other symptoms may follow the attacks of torticollis: headache, drowsiness, papilledema, corticobulbar or corticospinal signs |
Grisel’s syndrome |
Subluxations of the atlantoaxial joint from inflammatory ligamentous laxity following an infectious process |
RX reveals subluxation. Radicular and medullar signs can occur |
Central disorders |
Epilepsy |
Intermittent tonic contractions |
EEG shows epileptiform abnormalities |
Arnold Chiari malformation |
Intermittent and unusual neck posturing usually associated |
Usually associated with posterior fossa dysfunction signs and pain |
Posterior fossa tumor |
Intermittent head tilt or twist associated with vomiting and headache |
Other neurological signs such as increased intracranial pressure and localizing signs. Torticollis can be the first sign of central nervous system tumor. Brain image reveals the diagnosis |
Oculo-vestibular |
Troclear nerve palsy/ Lateral rectus palsy/ Vestibular torticollis |
Abnormal head posture adopted to improve visual acuity and maintain binocular single vision |
Eye deviation with strabismus. |