infant congenital muscular torticollis link to CCSVI?

A forum to discuss Chronic Cerebrospinal Venous Insufficiency and its relationship to Multiple Sclerosis.

infant congenital muscular torticollis link to CCSVI?

Postby Cece » Mon Dec 06, 2010 3:07 pm

I have been trying to sort out if there could be a link between CCSVI and congenital muscular torticollis of infancy. This is when the sternocleidomastoid muscle has a fibrosis in it and the baby holds its neck in a twisted position to the left (or the right) and rotated down to the side. Often it is considered a result of trauma during the birth but in some cases it runs in families and may be due to another cause. In my family, two of my three children were affected by this (thankfully it resolved with stretching during infancy).

Here is something I've found:
http://www.ncbi.nlm.nih.gov/pubmed/1310455
Clin Orthop Relat Res. 1992 Feb;(275):258-62.

Delayed recognition of a vascular complication, carotid artery aneurysm, 60 years after operation for muscular torticollis. A case report.
Korovessis P, Michalopoulos B, Vassilakos P.

Orthopaedic Department, General Hospital Agios Andreas, Patras, Greece.

Abstract
An extremely rare vascular complication, carotid artery aneurysm, developed 60 years after a torticollis operation. The patient's internal jugular vein was completely obstructed proximal to the subclavian vein. There was an associated incomplete obstruction of the ipsilateral common carotid artery on the right aspect of the neck--the site where resection of the whole sternocleidomastoid muscle had been performed when she was one year old. The patient had audible bruits over the right common carotid at the base of her neck but no signs of occlusive cerebrovascular disease. The diagnosis was made mainly with use of technetium radionuclide angiography. To the authors' knowledge, this is the first such report in the English or German literature.

PMID: 1310455 [PubMed - indexed for MEDLINE]

IJV obstructed proximal to the subclavian vein - I haven't got access to the full document, but what sort of obstruction was this? Could it have been obstructed from birth, undiscovered at the time of the treatment? This is where many CCVSI obstructions are found.

From this:
http://emedicine.medscape.com/article/939858-overview
Pathophysiology

An end-arterial branch of the superior thyroid artery supplies the middle part of the sternocleidomastoid muscle. Obliteration of this end artery may be responsible for the development of muscle fibrosis. As an alternative, primary trauma that temporarily and acutely obstructs the veins may lead to intravascular clotting in the obstructed venous tree. In infants, this clotting is evidenced by the development of a sternocleidomastoid mass, which eventually disappears and is replaced by fibrous tissue.

I can't find out which veins they're talking about here. Could an obstructed venous tree, not as a result of trauma but of inherited internal jugular obstructions, lead to the development of a sternocleidomastoid mass? Either way, intravascular clotting doesn't sound good either.

Any thoughts?
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Postby CuriousRobot » Mon Dec 06, 2010 4:32 pm

Interesting.

Image

Proximal means near... so the obstruction is occurring near the subclavian. I would interpret it as the stenosis being lower down on the IJV, very close to the subclavian.
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Postby Cece » Tue Dec 07, 2010 9:38 am

that's a great illustration, CuriousRobot

That spot low in the IJV near the subclavian is where the (malformed) valves are.

A different paper:
Clinical Orthopaedics & Related Research:
October 2006 - Volume 451 - Issue - pp 274-278
doi: 10.1097/01.blo.0000223991.26529.45
Section III: Regular and Special Features
Case Reports: Cervical Myelopathy from Atlantal Hypoplasia and Torticollis
Park, Moon-Soo MD*; Lee, Hwan-Mo MD†; Hahn, Soo-Bong MD†; Riew, K Daniel MD‡

....
In the second group, contraction of the sternocleidomastoid muscle results in torticollis.
Abnormalities of the internal jugular veins, including jugular vein thrombosis and vertebrojugular
fistulae also may cause torticollis.
5,12,18 Our patient had enlargement of the left internal
...
http://tinyurl.com/2uboefb

This snippet is coming up in google scholar, I'm a little confused if this is in fact in the paper or if it is as relevant as it sounds. The link goes to the abstract, which doesn't include this snippet.

The procedure in which they surgically snip the sternocleidomastoid muscle to release it, as a treatment for torticollis, reminds me of CTOS.
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