EP 102. Case presentation: A patient with an uncommon cause of a spasmodic torticollis

A 46 years old female patient consulted an orthopedic surgeon for neck pain. An osteopathic maneuver with a vigorous neck extension was performed. The day after she developed a clinical picture very similar to a spasmodic torticollis. The pain increased and the patient herself sought help in our emergency department after reporting episodes of a globussensation. The neurological examination revealed a delayed gag-reflex but did not show any other pathologic findings. A dissection of the brain supplying arteries could soon be excluded by a cervical MRI. However, with this MR-study we discovered a collection of fluid in the atlanto-axial joint and a prevertebral T2-hyperintensity extending over four cervical segments (vertebra 2 to 5). The CT of the cervical spine excluded a fracture. Apart from the osteopathic manipulation a trauma was not reported by the patient. A follow-up examination confirmed our suspicion of a prevertebral hematoma that most presumably was caused by the osteopathic treatment. With this poster we want to stress the potential life-threatening hazards of such maneuvers.