sign of syphilitic aortitis, de Musset sign rarely develops in children with Marfan syndrome.

Endocrine and Metabolic Disturbances

A gross tremor of the head and hands may occur in endocrine and metabolic disturbances such as hypomagnesemia,78 hypocalcemia (including hypoparathyroidism), uremia, and thyrotoxicosis.158 These findings may also be seen in untreated phenylketonuria and in citrullinemia.158

Nasopharyngeal Disorders

Torticollis has been described under the rubric “nasopharyngeal torticollis” in many acute and chronic upper respiratory infections, including pharyngitis, tonsillitis, sinusitis, and otitis media.128 The SCM on the affected side is frequently in painful spasm, and the underlying cervical lymph nodes are usually enlarged.128

Organic Acidurias

Torticollis may be seen in dystonic metabolic conditions, such as gluteric aciduria, that are accompanied by severe motor and language disability.137

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