pseudotumor cerebri These neck symptoms may be the presenting signs of the condition, but more commonly patients present with headache, vomiting, and papilledema Therefore, clinicians should inspect the optic discs of children with neck stiffness and/or torticollis Lumbar puncture and removal of cerebrospinal fluid may quickly resolve the cervical symptoms and signs Benign Paroxysmal Torticollis of Infancy Benign paroxysmal torticollis of infancy presents as recurrent episodes of head tilt sometimes accompanied by pallor, agitation, and vomiting Episodes subside spontaneously within a few hours or days Typical onset is between and months of age, and the condition tends to remit by the age of to years The etiology is unknown, and there is no effective treatment Sandifer Syndrome Sandifer syndrome describes intermittent episodes of stiffening and torticollis related to gastroesophageal reflux Children with this syndrome may have other symptoms associated with reflux including recurrent vomiting and failure to thrive Spontaneous Pneumomediastinum Spontaneous pneumomediastinum may present with neck pain and torticollis A history of severe coughing and/or retching is usually elicited Crepitus is generally palpated along the neck Spasmus Nutans Spasmus nutans is an acquired condition of childhood, characterized by nystagmus, head nodding, and torticollis Children with these findings typically become symptomatic by years The condition is generally benign and self-limited However, some children with the symptoms of spasmus nutans have underlying brain tumors Therefore, imaging of the brain is necessary Dystonic Reaction Certain drugs can cause acute dystonic reactions with torticollis These most commonly include antipsychotic and antiemetic agents (e.g., haloperidol, prochlorperazine, and metoclopramide) Treatment with diphenhydramine may be diagnostic and therapeutic Psychogenic Disorder Hysterical patients may present with torticollis This diagnosis can be made only after excluding other causes EVALUATION AND DECISION