Not all cases of neck pain with/without torticollis are benign: unusual presentations in a paediatric accident and emergency department.

N eck pain in children is not an uncommon presenting complaint in a paediatric accident and emergency department. Sheffield has a population of approximately 97 000 children of whom 33 874 attended the accident and emergency department at the children’s hospital in a one year period from 1998 to 1999. Of these, about 817 had pain in the neck region as part of their presenting complaint. Neck pain in adults is often a manifestation of degenerative disease of the spine whereas in children the commonest causes are trauma and infections. There are other less common but more sinister underlying causes of neck pain. The aim of this paper is to highlight these unusual conditions which present as neck pain. Most junior doctors term muscular spasm in the neck region as torticollis. Not all kinds of unusual neck posturing and pain, however, are due to torticollis and not all cases of torticollis are benign. 2 This differentiation is important in the clinical work up of these patients. We describe five patients who attended the accident and emergency department at our hospital with a presenting complaint of neck pain. These cases highlight the importance of careful evaluation of neck pain in children to prevent delay in diagnosis of less common but more serious underlying conditions. The clinical features in the history and/or examination which should raise suspicion of a less benign cause of the neck pain are highlighted with an asterix (*).