During the examination of patients with cervical spine pathology, there arises a need for differential diagnosis with other diseases that have similar clinical and paraclinical manifestations: Grisel’s syndrome, acute traumatic muscular torticollis, anomalies (basilar impression, assimilation of the atlas, hypoplasia and aplasia of the odontoid process of the 2nd cervical vertebra, partial or complete synostosis, etc.), epilepsy, space-occupying lesions, intracranial hypertension, and chronic inflammatory processes.
Grisel’s disease is a functional block of the atlas that occurs suddenly against the background of inflammatory changes in the paravertebral tissues.
Radiological signs of Grisel’s disease include widening of the joint space, thickening of the shadow of prevertebral tissues and nasopharyngeal tissues. Rotation of the atlas is rarely observed, unlike traumatic dislocations. Clarifying the diagnosis helps a thorough study of the patient’s history and detection of inflammatory changes or their traces in the paravertebral tissues.
Acute traumatic muscular torticollis is characterized by tension of the relevant muscles and their sharp tenderness on palpation. At the same time, radiological signs of displacement are absent.
Congenital muscular torticollis as a cause of atlanto-axial subluxation does not pose difficulties for diagnosis (history, clinical picture — presence of a shortened, thickened sternocleidomastoid muscle, facial asymmetry). Despite the similarity in clinical presentation of old atlanto-axial subluxations and developmental anomalies of the upper cervical spine, their differential diagnosis is not difficult when radiographic data are properly conducted and analyzed by a qualified specialist.
The purpose of EEG examination was not only to identify vascular changes but also to perform differential diagnosis for other diseases. When a brain tumor is superficially located, EEG shows a focus of low-amplitude activity, sometimes leading to electrical silence. In paroxysmal courses of early manifestations of cerebral circulatory insufficiency, syncope-like states often occur, which need differentiation from epilepsy-like fainting; EEG registration of paroxysmal activity indicates epilepsy.
To exclude space-occupying lesions or hypertension-related complaints, all children underwent echoencephalography according to accepted methodology. Fundus examination was also performed for the same purpose. According to M.K. Mikhailov (1986), suspicion of intracranial hypertension can only be based on radiological signs: suture separation, thinning of diploë, pronounced “finger-like” impressions, osteoporosis of the sella turcica, flattening of the skull base, and enhancement of diploic channel patterns. These symptoms should be combined with neurological, ophthalmological data, cranioscopy, or M-echo.
To exclude chronic inflammatory or rheumatic processes, blood tests are conducted for leukocytosis, C-reactive protein, sialic acids, total protein and its fractions. Electrocardiography is done as indicated.
