Clinical question: left-sided torticollis from the age of 9 months unknown cause, abnormal alignment of her head on her neck, 1mm cuts T1/T2/Flair per Dr Frim and Dr Katzman peds conferenceSigns and Symptoms: torticollis, abnormal alignment of her head on her neck, tenderness over the paraspinal muscles in the cervical region MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:There is anterior subluxation of C1 relative to C2 and some basilar invagination. C1 is partially incorporated into the skull base. The right lateral mass of C1 is incorporated into the skull base whereas the left half of C1 appears to be hypoplastic. C2 is rotated relative to C1. The distance between the odontoid and C1 is approximately 6 mm. The anterior arch of C1 appears to be bifid anteriorly. These findings also appear to been present on the 8/13/2015 exam.The right vertebral artery appears to narrow as it courses through these anomalies and appears to have an aberrant course.The cervical vertebral bodies are appropriate in overall height.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.
1.Findings suggest a congenital anomaly in the upper cervical spine with partial incorporation of C1 to the skull base and the malformation of C1. Additionally there is rotatory subluxation of C1 and C2 and basilar invagination. There is aberrant course of the right vertebral artery. The occipital condyles have also malformed and are asymmetric. If clinically appropriate a CT of the upper cervical spine and skull base would help further define these anomalies as well as the subluxation. 