Association of torsional dystonia, mainly involving the neck and upper extremities, with gastroesophageal reflux disease. During paroxysmal dystonic posture crisis, opisthotonos may be present.
Incidence is unknown, although there is some suggestion that it occurs in fewer than 1% of children with gastroesophageal reflux. Occurs mainly in neurologically healthy male children.
Torsional dystonia occurs shortly after feeding for 1 to 3 minutes (commonly mistaken for seizures). A relationship with feeding may suggest a diagnosis of Sandifer Syndrome.
No particular anesthetic consideration is known. However, the disorder should be known because of its possible confusion with seizures. Modified rapid sequence induction is recommended for these patients because of gastric reflux. Postoperative administration of antacid medication is useful.
SR: Sandifer syndrome posturing: Relation to abdominal wall contractions, gastroesophageal reflux, and fundoplication. Dig Dis Sci
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