[Downloaded free from http://www.neurologyindia.com on Tuesday, May 22, 2018, IP: 103.248.156.222] Correspondence
Idiopathic intracranial hypertension presenting as stiff neck and torticollis Sir, I read the recent editorial[1] and the two articles[2,3] on false localizing signs in idiopathic intracranial hypertension (IIH), with great interest. In this context, I would like to document an interesting false localizing sign - stiff neck and torticollis as a presentation of IIH in a prepubertal child. A nine year-old boy presented with a history of an insidious onset of tilt of head to the right side (torticollis), of one-week duration [Figure 1]. He had a mild, diffuse headache of one-month duration. Physical examination showed torticollis to the right. The neck muscles were stiff and tight, with limited voluntary and passive
motions in all directions. The ocular fundus examination showed bilateral papilledema. There was mild left lateral rectus palsy. The cranial magnetic resonance imaging (MRI) and MR venogram were normal. A lumbar puncture revealed an opening pressure of 270 mm H2O, and the cerebrospinal fluid biochemistry and cell count were normal. A diagnosis of idiopathic intracranial hypertension (IIH) was considered and the child was started on mannitol and acetazolamide. Over the next two days, the neck rigidity and pain disappeared and neck movements were fully restored [Figure 2]. Acetazolamide was continued and follow up evaluation after one month showed marked alleviation of the papilledema. Stiff neck and torticollis is one of the rare presenting features of IIH in prepubertal children. In a retrospective review of 10 prepubertal patients with IIH, the presenting symptom was stiff neck in four patients, all under 11 years of age.[4] The exact mechanism of stiff neck and torticollis in IIH is unknown. The possible explanation is tonsillar herniation with irritation of the upper cervical nerves. IIH should be added to the list of disorders that may present with reversible torticollis.
Kondanath Saifudheen Department of Neurology, Medical College, Calicut, Kerala, India E-mail:
[email protected]
References Figure 1: Picture of patient shows torticollis (before anti-edema treatment)
1. 2. 3. 4.
Menon RN, Radhakrishnan K. Idiopathic intracranial hypertension: Are false localising signs other than abducens nerve palsy acceptable? Neurol India 2010;58:683-4. Wattamwar PR, Baheti NN, Radhakrishnan A. Idiopathic intracranial hypertension presenting as unilateral papilledema. Neurol India 2010;58:818-9. Rezazadeh A, Rohani M. Idiopathic intracranial hypertension with complete oculomotor palsy. Neurol india 2010;58:820-21. Cinciripini GS, Donahue S, Borchert MS. Idiopathic intracranial hypertension in prepubertal pediatric patients: Characteristics, treatment and outcome. Am J Ophthalmol 1999;127:178-82. Access this article online Quick Response Code:
Website: www.neurologyindia.com PMID: *** DOI: 10.4103/0028-3886.73765
Figure 2: Patient after two days of anti-edema treatment -resolution of torticollis
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Accepted on: 09-11-2010
Neurology India | Nov-Dec 2010 | Vol 58 | Issue 6
