Delayed Collet-Sicard syndrome after internal carotid dissection and Jefferson fracture. Case report and Review of Literature
- Department of Neurosurgery, Hôpitaux Universitaires de Marseille Nord, Aix Marseille University, Marseille, France,
- Department of Neurosurgery, Tanta University, Tanta, Gharbeya, Egypt.
Hussein Hamdi, Department of Neurosurgery, Tanta University, Tanta, Gharbeya, Egypt.
DOI:10.25259/SNI_375_2021Copyright: © 2021 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Talal Al-Shabibi1, Hussein Hamdi2, Ahmed Balaha2, Yasser Ghoraba2, Jean-Marc Kaya1. Delayed Collet-Sicard syndrome after internal carotid dissection and Jefferson fracture. Case report and Review of Literature. 27-Jul-2021;12:374
How to cite this URL: Talal Al-Shabibi1, Hussein Hamdi2, Ahmed Balaha2, Yasser Ghoraba2, Jean-Marc Kaya1. Delayed Collet-Sicard syndrome after internal carotid dissection and Jefferson fracture. Case report and Review of Literature. 27-Jul-2021;12:374. Available from: https://surgicalneurologyint.com/surgicalint-articles/10999/
Background: Lower cranial nerve palsies, or Collet-Sicard syndrome, can be caused by many different etiologies including head trauma, basilar occipital fractures, tumors, and interventions. Few reports describe different presentations of this condition, and we present here a case study to increase awareness of and add to the variable spectrum.
Case Description: A 56-year-old who had been hit while diving was admitted to our department. On examination, he was conscious without any signs of lateralization but presented with severe neck pain. CT brain and cervical spine revealed a C1 fracture with bilateral symmetrical fracture of the anterior and posterior arches (Jefferson’s fracture) and slight bilateral joint dislocation C1-C2 discreetly predominant on the left. One week later, he presented with dysarthria, dysphonia, swallowing disorder, anisocoria, tongue deviation, and palate deviation (XII, IX, and X). CT Angiography showed dissection of the internal carotid artery immediately after the carotid bulb. He has been treated conservatively with curative anticoagulants with stable symptoms. No surgical intervention had been proposed.
Conclusion: Adding to the literature, delayed Collet-Sicard syndrome and lower cranial affection can be caused by missed carotid wall hematoma following severe craniocervical trauma associated with Jefferson’s fracture.
Keywords: Collet-Sicard syndrome, Injury, Internal carotid dissection, Jefferson fracture, Lower cranial nerves
In 1915, Frederic Collet[
Very few reports in the literature are describing the situation with different presentations. Usually, the symptoms and signs are dramatic and presented soon after trauma. Consequences of intracranial or even extracranial events can contribute to nerve affection mechanisms and subsequent manifestations such as bulbar palsy, motor, sensory deficits, dysphagia, or dysphonia.[
Each single case study could add to the spectrum of this rare presentation. Some patients were treated conservatively with very good outcome and recovery or stable clinical course.[
We present here a unique case of Jefferson fracture C1 with internal carotid dissection (ICD) causing delayed lower cranial nerve affection to add to the spectrum in the literature.
A 56-year-old male had been hit while diving in a swimming pool and presented with severe post-traumatic cervical pain, with active and passive movements. On clinical examination, he was conscious and oriented without any signs of lateralization. In addition, there was no motor or sensory deficit.
X-ray cervical spine did not show any abnormalities. Computed tomography (CT) of the brain and cervical spine study showed C1 fracture; bilateral symmetrical fracture of the anterior and posterior arches of C1 (Jefferson’s fracture) with slight bilateral joint dislocation C1-C2 discreetly predominant on the left. Spine magnetic resonance imaging (MRI) showed straightness of the cervical spine, and no disturbance of the coronal statics, and no constitutional cervical ductal stenosis as a secondary stenosis. No abnormality of the medullary signal as well as paraspinal soft tissue. Cervical angioscan was not done in the first admission.
On admission, the patient was managed conservatively in the form of anxiolytics, calcium channel inhibitors, and strong opioid analgesics. No surgical intervention was required, and the clinical situation remained stable with pain improvement.
Patient was discharged 2 days after admission on conservative treatment and neck collar.
One week later, he presented with mild complaints of dysarthria, dysphagia, and dysphonia. Clinical examination found no deficit except deviated tongue and palate, without ptosis or anhydrosis. Normal blood pressure and oxygen saturation, but sinus bradycardia were observed and required intensive care unit admission.
CT angiography showed right internal carotid artery occlusive dissection and carotid wall hematoma just above the carotid bulb [
The patient was observed in the ICU for a few days before he was discharged to the service. Introduction of curative anticoagulant was conducted. No surgical intervention had been proposed. The patient remains stable.
Lower cranial nerves affection could be caused directly or indirectly by several mechanisms following different causes as shown in [
Internal carotid artery dissection and occlusion are reported following different ways of cervical and head trauma.[
The wide spectrum of etiologies, mechanism, clinical presentation, and outcome has been reported through few case reports. High-resolution imaging studies are required to precisely define the mechanism of the conditions and degree of affection. Craniocervical CT and MRI are routinely used in the reported cases, but angiography is not routinely required.[
Different management strategies can be applied including conservative and surgical intervention depending on the primary etiology. Moreover, with conservative treatments, outcome varies from good recovery[
Spontaneous internal carotid artery dissection has been reported with headache, neck pain, and Horner syndrome.[
Adding to the literature, delayed Collet-Sicard syndrome and lower cranial affection can be caused by carotid wall hematoma following severe craniocervical trauma associated with Jefferson’s fracture.
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