Grisel's syndrome with hematomyelia

Abstract

Grisel's syndrome is a rare condition characterized by atlantoaxial subluxation following an inflammatory process in the head and neck region. It occurs more commonly in children and usually presents with cervical pain and torticollis, in addition to symptoms of the primary infection. A case of Grisel's syndrome is discussed here who suddenly developed quadriplegia with severe respiratory compromise and ultimately diagnosed as reducible atlantoaxial subluxation with hematomyelia. Hematomyelia was extending from medulla to the third cervical vertebrae level of cord. The case was managed successfully by posterior fusion. Though the clinical improvement occurred following posterior fusion, but there was no optimum radiological reduction of the reducible atlantoaxial subluxation. This case emphasizes the importance of posterior fusion in Grisel's syndrome where an offending posterior indentation of upper cervical cord by dislocated posterior arch, if dealt with; the clinical improvement can be achieved even without sufficient anterior reduction of subluxation. The reasons of hematomyelia and nonreduction atlantoaxial subluxation are discussed here.

Keywords

Grisel's syndrome - hematomyelia - atlantoaxial subluxation - posterior fusion