A 6-year-old child presents with fever, neck stiffness, and torticollis following an upper respiratory tract infection. X-ray shows increased prevertebral soft tissue shadow. MRI confirms a prevertebral abscess. This is diagnosed as Grisel's syndrome. What is the pathophysiological mechanism of atlantoaxial subluxation in this condition?

• A Direct spread of infection to the atlantoaxial joint
• B Pathological fracture of the odontoid process
• C Septic arthritis of the C1-C2 joint
• D Inflammatory laxity of the transverse ligament due to adjacent retropharyngeal inflammation ✓

Explanation

Grisel's syndrome is a non-traumatic atlantoaxial subluxation caused by inflammatory laxity of the transverse ligament of the atlas. This results from adjacent retropharyngeal or nasopharyngeal inflammation (often post-adenotonsillectomy or URI) that spreads via the pharyngeal venous plexus to the cervical ligaments, causing softening and laxity. It is not direct joint infection, septic arthritis, or fracture. The condition responds to antibiotics and cervical immobilization.

Reference: Scott-Brown's Otorhinolaryngology, Head and Neck Surgery, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.