Kaufman Rod
Clinic Division of Southern California, Department of Health Sciences, Southern California University of Health Sciences, Castaic, Calif, USA.
J Manipulative Physiol Ther. 2009 Feb;32(2):160-5. doi: 10.1016/j.jmpt.2008.12.008.
This case study describes a patient diagnosed with acute viral torticollis and illustrates the relevant aspects of differential diagnosis and the collaborative efforts between the chiropractic and allopathic disciplines in establishing an optimum treatment protocol provided by comanagement of the case.
A 20-year-old female student experienced a sudden onset of neck pain and inability to move her neck in conjunction with an antalgic attitude of her cervical spine in lateral flexion and rotation. Physical examination revealed an elevated temperature indicating the possibility of infection. Associated symptoms included headache, nausea, vomiting, and malaise.
The patient was initially assessed in a teaching clinic of a university medical health center for acute meningitis. A consultation was requested by the senior attending physician for an opinion by the chiropractic services of the university health center to assess the patient for nuchal rigidity and to provide treatment of the torticollis. After an evaluation of the status of the patient, a diagnosis of acute viral torticollis was established, and chiropractic manual therapy was initiated with a significant improvement in the ability of the patient to execute cervical ranges of motion without undue limitation and pain. Follow-up chiropractic care resulted in resolution of the torticollis without residual symptoms.
Acute viral torticollis occurring in a young adult with associated symptoms of fever, headache, nausea, and vomiting presents a diagnostic challenge in excluding the possibility of meningitis. Appropriate clinical and physical examination procedures are essential to exclude the latter while providing the clinician with the confidence to proceed with conservative management of the patient. Comanagement and collaborative care between the medical and chiropractic disciplines offered the patient a treatment plan with prompt resolution of symptoms.
本病例研究描述了一名被诊断为急性病毒性斜颈的患者，并阐述了鉴别诊断的相关方面以及整脊疗法和西医在共同管理该病例以制定最佳治疗方案过程中的协作努力。
一名20岁女学生突然出现颈部疼痛，颈部活动受限，颈椎向侧方屈曲和旋转时呈抗痛姿势。体格检查发现体温升高，提示有感染的可能。相关症状包括头痛、恶心、呕吐和不适。
患者最初在大学医疗健康中心的教学诊所接受急性脑膜炎评估。高级主治医师请求大学健康中心的整脊服务部门提供意见，以评估患者的颈部强直情况并治疗斜颈。对患者状况进行评估后，确诊为急性病毒性斜颈，并开始进行整脊手法治疗，患者执行颈椎活动范围时的能力有显著改善，无过度限制和疼痛。后续的整脊护理使斜颈症状得到缓解，无残留症状。
在年轻成年人中发生的伴有发热、头痛、恶心和呕吐等相关症状的急性病毒性斜颈，在排除脑膜炎可能性方面存在诊断挑战。适当的临床和体格检查程序对于排除后者至关重要，同时能让临床医生有信心对患者进行保守治疗。医学和整脊疗法学科之间的共同管理和协作护理为患者提供了一个能迅速缓解症状的治疗方案。
