by John Kenyon, CNA » Wed Dec 17, 2008 10:44 pm
Hello -
First we need to know if your son has had this head-tilt since birth or if this arose acutely more recently. Having had the tilt/turn since birth would make the problem more likely torticollis, but it's still difficult to strike a differential diagnosis without a thorough neurological workup, largely because infants can't, as you've mentioned, tell us all that's going on. They also tend to assume the position that's comfortable, so the problem is more difficult to correct by coaching.
While 4th nerve palsy is, in fact, occasionally mistaken for torticollis, a neurologist can usually tell the difference by a simple 3-step test. If this isn't conclusive there are other, more sophisticated ways of figuring this out. Acquired torticollis is often due to something very simple, whereas 4th nerve palsy is far more often due to trauma (could be birth trauma, but if the problem arose later, there would normally have been a memorable event to account for trauma that would have caused this problem). Exposure to a cool draft is one of the more common and overlooked causes of simple torticollis.
If you could tell us if this has been present since birth it might be helpful, but the most useful way to differentiate would be to have this evaluated by a pediatric neurologist, and then only if the condition persists for a long time.
I hope this is helpful. Please follow up with us as needed.
John Kenyon, EMT, CCT
Non-invasive cardiology tech, Emergency and Critical Care technician, Critical Incident Stress Mgmt. specialist
