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Clinical Problem Solving: Radiology
November 2003

Radiology Quiz Case—Diagnosis

Arch Otolaryngol Head Neck Surg. 2003;129(11):1248-1249. doi:10.1001/archotol.129.11.1247

Grisel syndrome is atlantoaxial subluxation that is caused by an infectious process of the nasopharynx. The infectious process leads to cervical inflammation that produces laxity of the transverse spinal ligaments. The present case demonstrates an unusual association of cervical vertebral osteomyelitis and spinal epidural abscess. The common symptoms of Grisel syndrome include neck pain, nuchal rigidity, dysphagia, fever, and trismus. There are several classic physical findings, one of which is torticollis. There is often tenderness in the area of C1 and C2, and elevation of the shoulder toward the side of the C1-C2 articular facet dislocation may occur.1 Rhinolalia may result from partial obstruction of the nasopharynx by the displaced anterior arch of the atlas.2 Sudek sign is a palpable spinous process of C2 at the opposite side of the dislocation.3 Neurologic findings of cord compression are present in 10% of patients.1

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