Which combination of signs might you observe if a child with Down syndrome has symptomatic atlantoaxial instability?

• A. Neck pain, torticollis, abnormal reflexes, gait changes
• B. Fever and rash
• C. Cough and wheeze
• D. Visual disturbances only

Answer: (A)

In Down syndrome, there’s an increased risk of atlantoaxial instability because the ligaments that stabilize the upper cervical spine can be lax. When this instability becomes symptomatic, the signs are neurologic and related to the neck rather than systemic illness. Neck pain and a protective abnormal neck position (torticollis) reflect irritation or instability at the C1–C2 level. Abnormal reflexes point to possible involvement of the spinal cord or brainstem from compression, and gait changes show how motor control can be affected by cervical cord impingement. These features together signal a cervical spine problem specific to the instability, rather than an infection or respiratory issue. Fever with rash, cough and wheeze, or visual disturbances alone don’t fit this scenario, which is why the observed combination is the best match for symptomatic atlantoaxial instability in a child with Down syndrome.