A rare cervical complication of Kawasaki disease: a retrospective study of clinical and radiological features
Year: 2025
Type: article
Study design: Observational Study
Abstract: Background: Grisel's syndrome (GS) is a rare cervical complication of Kawasaki disease (KD). Evidence from larger cohorts remains limited. We aimed to characterize the clinical and imaging features of KD with GS, identify factors associated with GS, and examine relationships between atlantoaxial instability metrics and local pharyngeal findings. Methods: We conducted a single-center retrospective cohort study involving children with KD treated between 2015 and 2023. KD was diagnosed according to the American Heart Association guidelines. GS was confirmed by clinical and imaging criteria. We collected demographics, clinical features, laboratory indices, and cervical imaging metrics, including the anterior atlanto-dental interval (AADI), lateral atlanto-dental interval (LADI), and retropharyngeal space (RS). GS versus non-GS groups were compared using appropriate parametric/nonparametric and categorical tests. Variables with P<0.10 in univariable analyses were entered into multivariable logistic regression to identify factors associated with GS. Within the GS subset, we stratified by AADI and evaluated correlations among AADI, RS, and cervical lymph-node size. Results: 47.0%, P<0.001). They also showed higher neutrophil percentage, ESR, creatinine, and urea nitrogen (all P<0.05). Multivariate analysis identified age, ESR, and creatinine as independent predictors of GS. Excluding age, female sex, lymphadenopathy, and neutrophil percentage remained significant. Patients with higher AADI (>2.57 mm) had larger lymph nodes and thicker RS. AADI correlated positively with lymph node size and RS, suggesting local inflammation contributes to atlantoaxial instability in KD-associated GS. Conclusions: GS is an uncommon complication of KD that occurs more often in older children and female patients. Imaging markers of atlantoaxial instability correlate with retropharyngeal crowding and nodal enlargement, while systemic inflammatory indices show limited associations. Early recognition and targeted cervical imaging may aid timely diagnosis and management.
Authors: Chunyi Yan, Jinquan Liu, Xiaoliang Liu, Fuqiang Liu, Zexi Li, Yarui Cui, Nanjun Zhang, Bowen Li, Yimin Hua, Kaiyu Zhou, Shuran Shao, Chuan Wang
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7117646428