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Occipital condyle fracture and lower cranial nerve palsy after blunt head trauma - a literature review and case report.

Utheim NC, Josefsen R, Nakstad PH, Solgaard T, Roise O - J Trauma Manag Outcomes (2015)

Bottom Line: The exact mechanism leading to these injuries cannot always be explained.Recognition of soft tissue injuries in patients with blunt head trauma is important.CT findings involving the craniocervical junction in these patients advocates further investigations including a thorough neurological examination and liberal use of MRI.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Division of Surgery and Neuroscience, Oslo University Hospital, Oslo, Norway.

ABSTRACT

Background: Lower cranial nerve (IX-XII) palsy is a rare condition with numerous causes, usually non-traumatic. In the literature it has been described only a few times after trauma, mostly accompanied by a fracture of the occipital condyle. Although these types of fractures have rarely been reported one could suspect they have been under-diagnosed. During the past decade they have been seen more frequently, most probably due to increased use of CT- and MRI-scanning. The purpose of this review is to increase the awareness of complications following injuries in the craniocervical region.

Methods: We based this article on a retrospective review of the medical record of a 24-year old woman admitted to our trauma center after being involved in a car accident and a review of the literature on occipital condyle fractures associated with lower cranial nerve palsy.

Results: The multitraumatized patient had suffered a dislocated occipital condyle fracture. Months later she was diagnosed with palsy to cranial nerve IX-XII. Literature review shows that occipital condyle fractures are rare as isolated injuries and are in many cases accompanied by further injuries to the cervical spine and soft tissue structures, in many cases ending with severe disability. The exact mechanism leading to these injuries cannot always be explained.

Conclusion: Recognition of soft tissue injuries in patients with blunt head trauma is important. CT findings involving the craniocervical junction in these patients advocates further investigations including a thorough neurological examination and liberal use of MRI.

No MeSH data available.


Related in: MedlinePlus

Left sided atrophy of the trapezius muscle and scapular winging (arrows).
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Fig3: Left sided atrophy of the trapezius muscle and scapular winging (arrows).

Mentions: According to the the patient she started noticing hoarseness and difficulties swallowing about six weeks after the accident. At this point she was gradually recovering from sedation and assisted breathing. After hospitalization she was admitted to the rehabilitation-unit. Due to lack of progression and weakness in her left shoulder, despite training, she was referred to an MRI-scan of the neck and thoracal region. MRI was not conclusive in terms of soft tissue injury. On the other hand it did reveal a cystic lesion anterior to the medulla with extention from C2 to Th10 (Figure 2). The lesion is most likely to be intradural and probably represents the accidental finding of an arachnoid cyst. Later neurography showed axonal injury to the left accessory nerve (XI). Three years after the accident the patient still suffers from paresis of the left trapezius and sternocleidomastoid muscle and insignificant paresis of the throat muscles. She is partly disabled due to pain in the neck and the left shoulder where she has a scapular winging (Figure 3).Figure 2


Occipital condyle fracture and lower cranial nerve palsy after blunt head trauma - a literature review and case report.

Utheim NC, Josefsen R, Nakstad PH, Solgaard T, Roise O - J Trauma Manag Outcomes (2015)

Left sided atrophy of the trapezius muscle and scapular winging (arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4403883&req=5

Fig3: Left sided atrophy of the trapezius muscle and scapular winging (arrows).
Mentions: According to the the patient she started noticing hoarseness and difficulties swallowing about six weeks after the accident. At this point she was gradually recovering from sedation and assisted breathing. After hospitalization she was admitted to the rehabilitation-unit. Due to lack of progression and weakness in her left shoulder, despite training, she was referred to an MRI-scan of the neck and thoracal region. MRI was not conclusive in terms of soft tissue injury. On the other hand it did reveal a cystic lesion anterior to the medulla with extention from C2 to Th10 (Figure 2). The lesion is most likely to be intradural and probably represents the accidental finding of an arachnoid cyst. Later neurography showed axonal injury to the left accessory nerve (XI). Three years after the accident the patient still suffers from paresis of the left trapezius and sternocleidomastoid muscle and insignificant paresis of the throat muscles. She is partly disabled due to pain in the neck and the left shoulder where she has a scapular winging (Figure 3).Figure 2

Bottom Line: The exact mechanism leading to these injuries cannot always be explained.Recognition of soft tissue injuries in patients with blunt head trauma is important.CT findings involving the craniocervical junction in these patients advocates further investigations including a thorough neurological examination and liberal use of MRI.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Division of Surgery and Neuroscience, Oslo University Hospital, Oslo, Norway.

ABSTRACT

Background: Lower cranial nerve (IX-XII) palsy is a rare condition with numerous causes, usually non-traumatic. In the literature it has been described only a few times after trauma, mostly accompanied by a fracture of the occipital condyle. Although these types of fractures have rarely been reported one could suspect they have been under-diagnosed. During the past decade they have been seen more frequently, most probably due to increased use of CT- and MRI-scanning. The purpose of this review is to increase the awareness of complications following injuries in the craniocervical region.

Methods: We based this article on a retrospective review of the medical record of a 24-year old woman admitted to our trauma center after being involved in a car accident and a review of the literature on occipital condyle fractures associated with lower cranial nerve palsy.

Results: The multitraumatized patient had suffered a dislocated occipital condyle fracture. Months later she was diagnosed with palsy to cranial nerve IX-XII. Literature review shows that occipital condyle fractures are rare as isolated injuries and are in many cases accompanied by further injuries to the cervical spine and soft tissue structures, in many cases ending with severe disability. The exact mechanism leading to these injuries cannot always be explained.

Conclusion: Recognition of soft tissue injuries in patients with blunt head trauma is important. CT findings involving the craniocervical junction in these patients advocates further investigations including a thorough neurological examination and liberal use of MRI.

No MeSH data available.


Related in: MedlinePlus