Presentation
Patient with advanced-stage colon adenocarcinoma present with progressive dysphagia and dislalia. Soft palate deviation, abduction of the vocal cord, and muscular weakness of the left upper extremity.
Patient Data
The left petroclivial region shows abnormal intensity with soft tissue enhancement.
CT images through the base of the skull show lytic lesions of the left occipital condyle with soft tissue mass.
Case Discussion
Metastasis in the base of the skull affects the petroclival region, hypoglossal, and jugular canal, causing palsy of the IX, X, XI, and XII cranial nerve.
Collet-Sicard Syndrome is a rare diagnosis defined by unilateral or bilateral paralysis of the IX, X, XI, and XII cranial nerve.
Symptoms from IX, X, XI, and XII cranial nerve palsy include dysphagia, shoulder asymmetry, and tongue protrusion.
A Pubmed search of Collet-Sicard syndrome from 1961 to 2021 yielded 103 results. Two cases of Collet Sicard syndrome caused by colon carcinoma. The most common etiology includes metastasis from prostate and breast cancer; others include jugular paraganglioma, multiple myeloma, trauma, vascular lesions, and iatrogenic complications.
Clinical exam and CT/ MRI findings with lesions involving the skull base. MRI is the preferred method with CT to evaluate lytic lesions since they may not be as evident in the MRI. Contrast MRI or CT is useful in internal carotid artery aneurism or dissections.
Co Author: Dr. Javier Salguero.
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