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| Year : 2000 | Volume
: 48
| Issue : 1 | Page : 93-4 |
Fracture occipital condyle with isolated 12th nerve paresis.
Devi BI, Dubey S, Shetty S, Jaiswal VK, Jayakumar PN
How to cite this article:
Devi B I, Dubey S, Shetty S, Jaiswal V K, Jayakumar P N. Fracture occipital condyle with isolated 12th nerve paresis. Neurol India 2000;48:93 |
Occipital condyle fractures are usually associated with severe head and cervical injuries. They may be missed, unless looked for with proper tomographic imaging. Palsy of the lower cranial nerves may draw one's attention to the associated fracture of the occipital condyle, in a case of either major or minor head or cervical spine injury. We describe a case of isolated 12th nerve palsy in a patient of minor head and cervical spine injury.
A 37 year old man fell from a height of 10 feet. Before striking the ground, he hit against a fence on the left side of neck. He was treated at an out side hospital, where he regained consciousness after few hours. The speech was noticed to be slurred and he had pain in left side of neck. On presentation to our OPD service, he had pain and swelling in the left side of the neck, inability to move the bolus of food in the mouth while eating and slurring of speech. Examination revealed a conscious, alert and oriented patient with deviation of the tongue to the right and mild slurring of speech especially for labials. There was tenderness on the left side of the neck behind the angle of jaw, with painful restriction of neck movements. There was no other abnormality. He underwent a CT scan with 3D reconstruction of the skull base and CV junction. This revealed a fracture of occipital condyle with extension of the fracture into the condylar canal. (Figure 1).
He was managed with analgesics, immobilisation with cervical orthoses, physiotherapy exercises of tongue and speech rehabilitation. Six months later he had no further deficit, and speech was relatively normal. The tongue movements had improved, he could eat and swallow without problem.
Diagnosis of fracture of the occipital condyle requires a high index of suspicion and high resolution tomography.[1] Paralysis of 9th, 10th 11th and 12th nerves is known as 'Collect Sicard Syndrome' and may occur following minor head trauma.[2],[3] The hypoglossal canal, through which the 12th nerve exits is medial to the jugular foramen. An isolated injury to the 12th nerve due to fracture of occipital condyle can occur if the fracture line or fragment is slightly medial to the jugular foramen. In the case described by Orbay et al,[4] late hypoglossal nerve palsy due to minor head injury and fracture occipital condyle was explained on the basis of compressing callus. The presence of callus could also explain presistent deficits at 15 months. Our patient, in contrast, had early manifestation of the hypoglossal palsy, which was noticed once he recovered from head concussion. The palsy in this patient may have been due to axonopathy since he recovered gradually and completely.
Management of occipital condyle fracture may be conservative or operative, depending upon the degree of instability from associated atlantoaxial complex.[5] There was no instability in our patient. He made rapid improvement on cervical collar and analgesics. It may be worthwhile to include the craniovertebral junction in cases with CT scan in severe head injury with or without cervical spine injury.
| 1. | Bolender NB, Cumwess LD, Wendling L: Fracture of the occipital condyle. Am J Radiol 1978; 131: 729-731.  |
| 2. | Hashimoto T, Watanabe O, Takase M et al: Collect Sicard syndrome after minor head trauma. Neurosurgery 1988; 23: 367-370. |
| 3. | Mohanty SK, Barrios M, Fishbone H et al: Irreversible injury of cranial nerves 9 through 12 (Collect Sicard Syndrome). J Neurosurg 1973, 38: 86-88 |
| 4. | Orbay T, Aykol S, Seckin Z et al: Hypogiossal nerve palsy following fracture of occipital condyle. Surg Neurol 1989; 31: 402-404. |
| 5. | Tuli S, Tator HC, Fehlings G et al: Occipital Condyle Fracture. Neurosurg 1997; 41: 368-377. |
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