Torticollis چاپ
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پنجشنبه, 19 فروردین 1389 ساعت 12:48
Torticollis is one of a broader category of disorders that exhibit flexion, extension, or twisting of muscles of the neck beyond their normal position
In torticollis your neck tends to twist to one side. The condition can either develop slowly if you have a family history of the disorder, acutely from trauma, or as an adverse reaction to medications

When the disorder occurs in people with a family history, it is referred to as spasmodic torticollis. The characteristic twisting of the neck is initially spasmodic and begins between ages 31-50 years. If you leave the condition untreated, it likely will become permanent

Bending or twisting your neck too far can lead to acute torticollis. This condition appears with few symptoms, although often you will appear uncomfortable and will hold your head straight or rotated to one side. It will hurt to move your head to the opposite side. Your neck muscles on the side that hurts often are tender to the touch. The doctor will check your nerve and motor function to rule out spinal cord injury

Certain drugs of abuse such as ketamine, amphetamines, and cocaine as well as commonly prescribed neuroleptic drugs such as prochlorperazine (Compazine), haloperidol (Haldol), and chlorpromazine (Thorazine) can cause acute dystonia (a lack of normal muscle control). This is a condition that involves the sudden onset of involuntary contractions of the muscles of the face, neck, or back. In addition to bending of the head to one side (acute torticollis), you may experience deviation of the eyes / oculogyric crisis / and protrusion of the tongue / buccolingual crisis


Torticollis Symptoms

* Because spasmodic torticollis is an abnormal contraction of the muscle in one side of the neck, people will appear with their head turned to one side. Neck muscles and those between the neck and shoulder will be tense and tender

* People with acute torticollis will be unwilling to turn their head to one side or may have their head turned slightly away from the side of discomfort


When to Seek Medical Care

In general, acute torticollis is not life threatening. If symptoms are limited to muscle stiffness and pain, see your doctor in at least a day

If you injure your neck but cannot reach your doctor, go immediately to a hospital's emergency department. Other medical conditions may appear to be torticollis and will need immediate medical attention. For example, anyone who experiences spasms of the neck muscles involved with swallowing or breathing or symptoms that might involve the central nervous system should be evaluated

The following symptoms suggest injury or irritation to the central nervous system

* Trouble breathing or swallowing

* Pins-and-needles feeling or numbness in your arms and legs

* Urinary hesitancy, urinary or fecal incontinence

* Weakness in your arms and legs

* Impaired speech

* Difficulty walking


Torticollis Treatment

Treatment for torticollis is targeted to relax the contracted neck muscles involved. These treatments include medication, physical devices, botulinum toxin, and surgery. In most people, torticollis resolves in several days to a few weeks. A few people will develop continuing neck problems for months to years. Persistent neck muscle spasms may require referral to a neurologist or surgeon



* If you have spasmodic torticollis that was caused by trauma or by medications, the doctor may prescribe muscle relaxants and anti-inflammatory drugs. These agents usually relieve the symptoms completely within a few days. Common medications to treat acute, spasmodic torticollis include benztropine (Cogentin) or diphenhydramine (Benadryl). These medications are usually given into the muscle or through the vein. The doctor may add muscle relaxant or benzodiazepines such as Ativan or Valium. The medications are continued in their oral form for 48-72 hours to avoid recurrent symptoms. Ice packs and massage therapy may also be used for relief if desired

* If you have chronic neck muscle spasms, a neurologist may give you a local injection of botulinum A toxin. This toxin comes from Clostridium botulinum bacteria. It acts locally to prevent muscle contraction in the muscles where it is injected. The toxin often can stop torticollis from progressing and can lead to complete recovery



Surgery is reserved only for a few selective cases. In this treatment, some of the upper neck nerves are selectively severed to prevent muscle contraction. Surgical treatment often helps, but frequently your neck will return to its twisting position after several months



Authors and Editors
Author: Rick Kulkarni, MD, Assistant Professor of Medicine, David Geffen UCLA School of Medicine; Director of Informatics, Department of Emergency Medicine, UCLA/Olive View-UCLA Medical Center

Editors: Ruben Olmedo, MD, Chief, Division of Toxicology, Clinical Assistant Professor, Department of Emergency Medicine, Mount Sinai Medical Center; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; James Ungar, MD, Medical Director, Chair Department of Emergency Medicine Santa Rosa Memorial Hospital


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آخرین بروز رسانی در چهارشنبه, 25 فروردین 1389 ساعت 17:48
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