Abstract
Background Multiple lower cranial nerve palsies have been attributed to occipital condyle fractures
in older children and adults, but no clinical details of other possible mechanisms
have been described in infants.
Case Report A 33-month-old boy suffered blunt head trauma. A bilateral skull base fracture was
diagnosed, with favorable outcome during the first days after trauma. On the sixth
day, the patient began to refuse drinking and developed hoarseness. Physical examination
and additional investigations revealed paralysis of left VII, IX, X, and XI cranial
nerves. A follow-up computed tomography (CT) scan disclosed a left petrous bone fracture
involving the lateral margin of the jugular foramen, and a cranial magnetic resonance
imaging (MRI) study showed a left cerebellar tonsil contusion. He improved after methylprednisolone
was started. Three months later, he was asymptomatic, although mild weakness and atrophy
of the left sternocleidomastoid and trapezius muscles remained 1 year later.
Discussion A posttraumatic “jugular foramen syndrome” is rare in children, but it has been reported
shortly after occipital condyle fracture, affecting mainly IX, X, and XI cranial nerves.
In this toddler, delayed symptoms appeared with unilateral involvement. While an occipital
fracture was ruled out, neuroimaging findings suggest the hypothesis of a focal contusion
as a consequence of a coup-contrecoup injury.
Conclusion This exceptional case highlights the importance of gathering physical examination,
anatomical correlation, and neuroimaging to yield a diagnosis.
Keywords
lower cranial nerve palsy - skull base fracture - head injury - jugular foramen syndrome
