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Forum Name: Neurology Topics

Question: torticollis or 4th nerve palsy?


 leenie82 - Sat Nov 01, 2008 11:48 pm

My son(hes 5 months old) was diagnosed with torticollis. I was wondering if it could be 4th nerve palsy? I heard it has commonly been mis-diagnosed as torticollis. His eyes seem to be normal but he is to young tell me if he see's double. one side of his face is fuller than the other, the fuller side being on the opposite direction of his tilted head.I just want to make sure he is properly diagnosed. what are some other signs I can look for in a 5 month old?
 John Kenyon, CNA - Wed Dec 17, 2008 10:44 pm

User avatar 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.
 tysmama - Tue Nov 10, 2009 9:12 pm

My son was diagnosed with Torticollis at the age of 6 months old. He is going on two this November and was just diagnosed with 4th Nerve Palsy. I have had him in Physical therapy since the age of six months and have seen tremendous improvement in rotation and tilt. I asked his PCP and physical therapist about his eyes and the tilting having an effect on his eyes and they kept on telling me that at his age he will grow out of it. Well, he needs surgery on his eye. I don't think that many people are aware of the effects of torticollis, or 4th nerve palsy. They both go hand in hand if not caught early.

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