Post-traumatic Collet–Sicard syndrome: personal observation and review of the pertinent literature with clinical, radiologic and anatomic considerations

Abstract

The p-CSS is caused by force directed through the top of the head. We suppose that the nerve injuries are due to their laceration caused by a displacement of a condyle fragment or to their compression and stretching when they pass between the lateral mass of the atlas and the styloid process. These modalities of trauma explain the better clinical results in patients affected by C1 fractures. Conservative treatment is the option of choice. Surgical option, when choosed, is not considered to fix nerve damages.

Treatment of Atlas Fractures: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU)

“…Rarely, the patient may present with torticollis or a “cock-robin” deformity from a C1 fracture. A neurological deficit due to a spinal cord injury linked to an atlas fracture is very rare, 5 but has been described (eg, “Collet-Sicard syndrome” 6 ). Additionally, symptoms associated with a hypoperfusion of the basilar supply territory like nausea, vomiting, tinnitus, impaired vision, and drop attacks are possible due to a potential vertebral artery lesion or posttraumatic thrombosis.…”

Unexpected death after occipital condylar fracture

“…Cranial nerve palsies are among the most frequently described injuries with an incidence as high as 31% according to some authors [ 15 ]. Nerve injury may range from an isolated cranial nerve palsy [ 11 , 13 ] to uni- or bilateral complete 9th through 12th cranial nerve palsies (the so-called Collet-Sicard syndrome) [ 5 ].…”

“…More specifically, through the hypoglossal canal at the occipital condylar base pass the hypoglossal nerve (XIIth nerve), a meningeal branch of the ascending pharyngeal artery, and an emissary vein, while through the jugular foramen (lateral to the occipital condyle and hypoglossal canal) pass cranial nerves IX, X, and XI, the posterior meningeal artery, the inferior petrosal sinus, and the sigmoid sinus on its way to the internal jugular vein bulb [ 6 , 8 , 10 ]. Vascular and cranial nerve injuries in patients with an OCF are likely caused by displacement of the fractured condylar fragment in close vicinity to these fragile neurovascular structures [ 5 ]. Alternatively, venous oozing from a fractured skull base may cause increased local pressure by accumulation of fluids from the neighboring vessels due to an osmotic pressure gradient across the hematoma capsule (hygroscopic effect).…”

Isolated unilateral vocal fold palsy: a rare complication of base of skull trauma

“…Medially, hypoglossal nerve (CN XII) exits the base of skull through the hypoglossal foramen. Injury to the four lower cranial nerves IX, X, XI and XII, eponymously named Collet‐Sicard Syndrome, is reported in 14 cases of blunt cranial trauma . Other reported cases of unilateral vagus nerve paralysis secondary to trauma involve combinations of two or more of the lower cranial nerves .…”

“…Injury to the four lower cranial nerves IX, X, XI and XII, eponymously named Collet‐Sicard Syndrome, is reported in 14 cases of blunt cranial trauma . Other reported cases of unilateral vagus nerve paralysis secondary to trauma involve combinations of two or more of the lower cranial nerves . Axial loading is the most common mechanism of injury and in all except one case a fracture of the occipital condyle or C1 vertebra is described.…”