Grisel’s syndrome refers to non-traumatic subluxation of the atlanto-axial joint. It can evolve into a medical emergency if untreated.
It is most often seen in children but can be seen at any age.
It usually is seen with retropharyngeal abscess, cellulitis or other infection in the region of the atlanto-axial joint. The original infection may be local or systemic, and it may be iatrogenic following otolaryngeal surgery.
The infection affects the supporting ligaments, allowing the atlas (C1) and axis (C2) to have increased mobility. If there is enough laxity then there may be subluxation at the joint.
Clinical findings:
(1) evidence of infection with fever
(2) neck pain
(3) very painful torticollis
Laboratory findings may include:
(1) positive culture
(2) elevated marker of inflammation (C-reactive protein)
The diagnosis requires exclusion of trauma.
Complications:
(1) radiculopathy
(2) quadriplegia (from damage to spinal cord)
(3) death
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