The main innervation to these muscles is from cranial nerve XI (the accessory nerve) but the second, third and fourth cervical nerves are also involved. Pathologies in these blood and nerve supplies can lead to torticollis. Diagnosis
Evaluation of a child with torticollis begins with history taking to determine circumstances surrounding birth and any possibility of trauma or associated symptoms. Physical examination reveals decreased rotation and bending to the side opposite from the affected muscle. Some say that congenital cases more often involve the right side, but there is not complete agreement about this in published studies. Evaluation should include a thorough neurologic examination, and the possibility of associated conditions such as developmental dysplasia of the hip and clubfoot should be examined. Radiographs of the cervical spine should be obtained to rule out obvious bony abnormality, and MRI should be considered if there is concern about structural problems or other conditions. Ultrasonography can be used to visualize muscle tissue, with a colour histogram generated to determine cross-sectional area and thickness of the muscle.Evaluation by an optometrist or an ophthalmologist should be considered in children to ensure that the torticollis is not caused by vision problems (IV cranial nerve palsy, nystagmus-associated "null position," etc.). Differential diagnosis for torticollis includes
Cranial nerve IV palsy
Spasmus nutans
Sandifer syndrome
Myasthenia gravis
Cerebrospinal fluid leakCervical dystonia appearing in adulthood has been believed to be idiopathic in nature, as specific imaging techniques most often find no specific cause.
Tafenoquine, sold under the brand name Krintafel among others, is a medication used to prevent and to treat malaria. With respect to acute malaria, it is used together with other medications to prevent relapse by Plasmodium vivax. It may be used to prevent all types of malaria. It is taken by mouth.Common side effects include vomiting, headache, and dizziness. Other side effects may include methemoglobinemia, trouble sleeping, and anaphylaxis. In people with G6PD deficiency, red blood cell breakdown may occur. Use in pregnancy is not recommended. Tafenoquine is in the 8-aminoquinoline family of medications. How it works is unclear but it is effective both in the liver and bloodstream. A possible mechanism of action and other novel perspectives have been published.Tafenoquine was approved for medical use in Australia and in the United States in 2018. Tafenoquine is related to primaquine. Medical use
Prevention
Tafenoquine may be used to prevent all types of malaria. For this use 200 mg 3 days before travel then 200 mg per week until one week after travel is recommended. Treatment
Tafenoquine is used for eliminating the hypnozoite stage of Plasmodium vivax and Plasmodium ovale that is responsible for relapse of these malarial infections, even when the blood stages are successfully cleared. Primaquine for 14 days can also be used for this. The advantage of tafenoquine is that it has a long half-life (2–3 weeks) and therefore a single treatment is sufficient. For this use, a single dose of 300 mg is recommended.