TORTICOLLIS AND C1-C2 ROTATORY SUBLUXATIO N - ONE CASE - USEFULNESS OF DYNAMIC CT AND 3-DIMENSIONAL CT

The authors report the rare and complex case of a girl who had been fo llowed since the age of 3 years for hydrocephalus the cause of which w as found only when she was 6-year old. The causative agent was a piloc ytic astrocytoma of the cerebellum. On April 10, 1990, she underwent s ubtotal excision of the tumour, associated with radiotherapy. Four mon ths later she developed an increasingly painful and irreductible torti colis which did not respond to tractions. Dynamic CT scans and 3-dimen sional CT scans were performed in the fourth month and provided a diag nosis of r1ght C1-C2 rotatory subluxation. There was no history of inj ury and no sign of inflammatory process. Rotatory subluxation is a ver y rare lesion difficult to diagnose, and few cases have been published , although the signs are those of classical torticolis in children. Wh en medical treatment fails, often due to belated diagnosis, the only s urgical treatment is uni- or bilateral C1-C2 arthrodesis. If the diagn osis can be made at an early stage, reduction of the rotatory luxation is usually easy and without consequences to the child. It is therefor e recommended to perform a dynamic CT scan and a 3D CT scan as soon as possible in all children with lasting painful torticolis.