Acute torticollis – Unusual presentation of acute disseminated encephalomyelitis

‘Torticollis’, or ‘head tilt’, is a term used to describe a twisted or turned neck. Torticollis can be categorised as either congenital or acquired. Acquired torticollis is frequently a symptom of underlying central nervous system (CNS) pathology. In cases of acute painless torticollis, the possibility of a posterior fossa pathology must be considered and explored. Demyelinating disorders of the CNS in children are rare and include acute disseminated encephalomyelitis, neuromyelitis optica spectrum disorders and myelin oligodendrocyte glycoprotein antibody-associated disorders. This case discusses a 5-year-old female who presented with acute torticollis and was initially seen by the orthopaedics and paediatrics team. Upon further examination, focal neurological signs were observed. Magnetic resonance imaging revealed focal demyelinating changes in the brainstem. The patient was managed with immunotherapy, after which she showed improvement, which highlights the diagnostic considerations in children with acute torticollis.