Eine ungewöhnliche Diagnose im Erwachsenenalter

We report on a 54-year-old patient who complained of neck stiffness for about a week and immobility of the head. A few weeks ago, there had been an infection of the upper respiratory tract. In the course of stabbing pain occurred nuchal with radiation into the ear and cervical with a pain intensity of up to 10 (NRS) and odynophagia. She was admitted to a neurological clinic. There was no photo- or phonophobia, nausea, vomiting or focal neurological deficit. A CT scan of the head and CTA initially excluded infarction, bleeding and dissection. The duplex sonography was inconspicuous. In an MRI of the neck, a pronounced fluid collection prevertebral over the segments HWK 1 – 5 was noticed. Subsequently, the transfer to our clinic took place. The clinical examination showed a state after tonsillectomy on both sides, enorally prominent lateral strands on both sides , reddening of the pharyngeal mucosa and massive pain while palpation of the transverse and longitudinal ligaments cervical right. The inpatient admission for intravenous antibiotic therapy and analgesia took place, whereby the symptoms were quickly completely resolved. In 1930, Pierre Grisel defined the syndrome as atlanto-axillary instability with increased flexibility of the ligamentous apparatus caused by inflammation of the head and neck area. Mainly occurring as a complication after surgical interventions in the naso-/oropharynx in children, Grisel’s syndrome can also be present in adults. In 15% of cases, neurological deficits are also present. Therapeutically, antibiotics, immobilization of the head and, depending on the extent, neurosurgical interventions are recommended.

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Artikel online veröffentlicht:
27. Juni 2023