A Systematic Review of Case Reports on the Neck-Tongue Syndrome

Background and Objectives: Neck-tongue syndrome (NTS) is rare, and characterized by unilateral upper neck or occipital pain and paresthesia in the ipsilateral hemisphere of the tongue due to neck movement. Treatment for NTS is mainly conservative, but the symptoms, causes, and rationale for treatment remain controversial. This study aimed to provide a framework for NTS treatment in clinical practice based on recent treatment directions. Materials and Methods: Case reports published from the past 20 years to August 2021 were searched through MEDLINE, EMBASE, and PEDro databases. Since there is no established management for NTS, the search terms were neck-tongue syndrome and case reports. The Critical Appraisal Checklist for Case Reports was used for the quality assessment of case reports. Through descriptive analysis, NTS symptoms, interventions, and results were reviewed. Results: Among the 16 studies searched, six case reports were selected and analyzed based on eight criteria. Symptoms included neck pain and ipsilateral tongue paralysis when the head was turned. As an intervention, six and four studies showed immediate symptom relief through manual therapy and exercise, respectively. Conclusions: Based on the reviewed evidence, management through physical therapy and chiropractic therapy with conservative methods such as manual therapy and exercise for patients with neck-tongue syndrome is recommended.

Treatment of Upper Cervical Spinal Cord Injury (Unstable C1-C2) by Direct Visualization and Nailing Technique and the Advantages of Early MRI

Background. The treatment of C1-C2 fractures mainly depends on fracture type and the stability of the atlantoaxial joint. Disruption of the C1-C2 combination is a big challenge, especially in avoiding vertebral artery, nerve, and vein sinus injury during the operation. Purpose. This study aims to show the benefit of using the posterior approach and pedicle screw insertion by nailing technique and direct visualization to treat unstable C1-C2 and, moreover, to determine the advantages of performing early MRI in patients with limited neck movement after trauma. Method. Between Jan 2017–Feb 2019, we present 21 trauma patients who suffered from C1, C2, or unstable atlantoaxial joint. X-ray, computed tomography (CT), and magnetic resonance image (MRI) were performed preoperatively. All the patients underwent our surgical procedure (posterior approach and pedicle screw placement by direct visualization and nailing technique). Result. The mean age was 41.1 years old, 8 females and 14 males. The average follow-up time was 2.6 years. Four patients were with C1 fracture, seven with C2 fracture, six with atlantoaxial dislocation, and four with C1 and C2 fractures. The time of MRI was between 12 hours and 48 hours; neck movement symptoms appeared between 2 days and 2 weeks. Conclusion. The posterior approach to treat the C1 and C2 fractures or dislocation by direct visualization and nailing technique can reduce the risk of the vertebral artery, vein sinus, and nerve root injuries with significant improvement. It can show a better angle view while inserting the pedicle screws. An early MRI (12–48 hours) is essential even if no symptoms appear at the time of admission, and if it is normal, it is necessary to repeat it. The presence of skull bleeding can be associated with upper neck instability.

Anesthetic management of an achondroplastic dwarf with difficult airway and kyphoscoliosis for total abdominal hysterectomy

Achondroplasia is a common form of dwarfism and possesses multiple anesthetic challenges including securing of intravenous line, monitoring and calculating drug dosage, spine abnormality, difficulty in mask ventilation and endotracheal intubation, obesity, cardiopulmonary and neurological system abnormality. There is multiple systems involvement, therefore thorough preanesthetic check ups, investigations and planning for anesthesia is important. Here we came across 36 years old female patient, achondroplasic dwarf (height- 100cm) with thoracolumbar kyphoscoliosis, fused cervical spine, short neck and restricted neck movement with mild pulmonary restrictive disease for total abdominal hysterectomy. Patient also had complained of generalized weakness and fatigue. She had a limited neck extension and short neck possesses anticipated difficult intubation, therefore we planned awake fiberoptic intubation with smaller size endotracheal tube for airway management and general anesthesia in a patient with difficult airway and spine for total abdominal hysterectomy. As the spread of the drug in regional anesthesia is unpredicted, we planned general anesthesia with awake fiberoptic intubation to avoid the risk of neurological injury while extending the neck during laryngoscopy for tracheal intubation due to restricted neck movement.

An unusual case of lead migration in occipital nerve stimulation: A case report and literature review

Background: Lead migration is a complication associated with occipital nerve stimulation (ONS). We present a rare case in which fibrosis in the stress relief loop caused lead migration in the treatment of occipital neuralgia. Case Description: A 30-year-old woman with a 5-year history of refractory occipital neuralgia, who had been under ONS therapy for 2 months, presented with a sudden onset of typical occipital neuralgia pain associated with cervical muscles spasms and myoclonus. A skull radiography showed lead migration. The patient underwent surgery for lead repositioning. During surgery, we identified extensive fibrosis throughout the stress relief loop that produced several constriction points. The fibrosis in the stress relief loop increased tension on the lead during head-and-neck movement, causing progressive migration of the lead. Conclusion: Although lead migration is a common complication of ONS, its association with fibrosis in the stress relief loop has not, to the best of our knowledge, been reported before. Lead migration can directly affect treatment outcome and it is, therefore, important to fully understand the possible mechanisms that can cause it and how to promptly manage them.

Retropharyngeal abscess causing grisel’s syndrome secondary to tuberculosis of cervical spine, a rare form of torticollis: case report

<p>Grisel’s syndrome is a rare type of non-traumatic subluxation of an atlantoaxial joint characterized by torticollis, neck pain, and reduced neck movement. The common causes of Grisel’s syndrome are head and neck infection or post-otorhinolaryngology (ORL) procedures. We are reporting a case of a 3-year-old boy with a gradual worsening of neck stiffness, neck pain, and restricted neck movement for more than one month. The patient had no history of trauma. The computerized tomographic (CT) showed a retropharyngeal abscess with a bony erosion causing atlantoaxial subluxation. The management and progress of this patient are discussed. The objective of this case report is to emphasize that Grisel’s syndrome should be considered a differential in a painful torticollis to prompt an early diagnosis and treatment to prevent serious neurological complications.</p>

A Young Boy with Neck Pain

Case Presentation: A five-year-old boy presented to our emergency department with severe posterior neck pain that was exacerbated upon neck movement. Cervical spine radiography revealed calcification in the cervical intervertebral disk 3-4. Discussion: Pediatric idiopathic intervertebral disk calcification is a benign, rare condition that might be complicated by associated severe neurological symptoms. In this case, the symptoms gradually subsided with conservative management alone.

Diagnostic Utility of New SCAT5 Neurological Screen Sub-tests

Background The Sports Concussion Assessment Tool (SCAT) is recommended to screen for concussion following head impact events in elite sport. The most recent 5th edition (SCAT5) included a ‘rapid neurological screen’ which introduced new subtests examining comprehension, passive neck movement, and diplopia. This study evaluated the additional diagnostic value of these new subtests. Methods A prospective cohort study was performed in the Pro14 elite Rugby Union competition between September 2018 and January 2020. The SCAT5 was administered by the team doctor to players undergoing off-field screening for concussion during a medical room assessment. Sensitivity, specificity, false negatives, and positives were examined for SCAT5 comprehension, passive neck movement, and diplopia subtests. The reference standard was a final diagnosis of concussion, established by serial standardised clinical assessments over 48 h. Results Ninety-three players undergoing off-field screening for concussion were included. Sensitivity and specificity of the comprehension, passive neck movement, and diplopia subtests were 0, 8, 5% and 0, 91, 97%, respectively (concussion prevalence 63%). No players had any abnormality in comprehension. No players had abnormal passive neck movement or diplopia in the absence of abnormalities in other SCAT5 sub-components. Conclusions The new SCAT5 neurological screen subtests are normal in the majority of players undergoing off-field concussion screening and appear to lack diagnostic utility over and above other SCAT5 subtests.