January 1971

Picture of the Month

Author Affiliations

Boston; New Haven, Conn
From the departments of pediatrics and radiology, Yale University School of Medicine, New Haven, Conn.

Am J Dis Child. 1971;121(1):53-54. doi:10.1001/archpedi.1971.02100120089012

Denouement and Discussion 

Syndrome of Hiatus Hernia With Torsion Spasms and Abnormal Posturing (Sandifer's Syndrome) 

Manifestations  Major manifestations consist of hiatus hernia associated with abnormal movements or positioning of the head, neck, and upper part of the trunk. The patient may assume opisthotonic posturing. The movements of the head consist of sudden extension, continual movement from side to side, or prolonged inclination of the head to one side. The upper part of the trunk may be flexed with the head pointing downward. In bed, the patient may lie in a supine position with head and neck hyperextended over the side. At times, he appears to assume an upside down position. The movements are not due to muscle spasm and the patient may continue to carry out normal activity. Posturing is not present during sleep and may be increased during or immediately following meals. The exact etiology of these movements is

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