12 The mechanisms of injury include motor vehicle accidents, falls, pedestrian impacts, hang-gliding, skateboarding, diving injuries, waterskiing accidents, and an equestrian accident. The residual sequela was slurred speech after an 18 month duration of follow up.įractures of the atlas are rare and comprise only 2% of all spinal injuries. He underwent external immobilisation with neck collar and reduction by traction. Brain magnetic resonance imaging (MRI) demonstrated basilar invagination and rupture of the transverse ligament, without other anomalies such as Arnold-Chiari malformations, syringomyelia, syringobulbia, or hydrocephalus (fig 1B, C). Computed tomography of his skull base revealed a two part atlas fracture: one fracture through the right sided anterior arch and the other fracture through the left sided posterior arch (fig 1A). An open mouth roentgenogram showed bilateral displacement of the lateral masses of the first cervical vertebra, with reference to the superior articular surface of the second cervical vertebra. The sternomastoid strength could not be checked because of neck immobilisation to prevent further cervical spine injury. Neck rotation could not be performed owing to neck pain and neck muscle guarding. The laryngoscopic examination showed right vocal cord palsy and pooling of secretions on the right side. Physical examination revealed posterior cervical tenderness, a limited range of neck motion, absent gag reflex on the right side, the soft palate pulling to the left side, insensate oropharyngeal wall on the right side, tongue deviation to the right side, and mild weakness of the right trapezius muscle. Slurred speech, hoarseness, difficulty in swallowing, and easy choking took place rapidly. The patient had felt suboccipital discomfort and neck pain since then. Three days before his admission, he was hit by a car while riding a motorcycle and was flung on to the ground. He had no previous systemic disorders except for a mild left hearing impairment of several years’ duration. 11 We review the literature and will briefly discuss the probable mechanisms contributing to Collet-Sicard syndrome.Īn 18 year old man with the chief complaint of neck pain, hoarseness, and dysphagia was admitted to the Chang Gung Memorial Hospital, Taiwan in November 1999. Compression of the greater occipital nerve causes suboccipital paresthesia or pain. The classic presentations of atlas fractures include neck pain, cervical muscle spasm, reduced range of neck motion, and head tilt.
Any neurological sequelae could be attributed to spinal cord damage or vertebral artery compromise rather than cranial nerve injury. This has been suggested to be a result of a greater transverse and sagittal diameter of the spinal canal at the first cervical spine, in addition to the mechanism of the lateral masses sliding away from the cord. 11 Jefferson fractures are bursting injuries of the atlas, which rarely cause neurological deficits. 3– 10 There is only one reported case of atlas Jefferson fracture causing Collet-Sicard syndrome in the English language literature of the Medline database from 1966 to 2003. 1, 2 This rare syndrome has been attributed to tumours of the skull base, coiling and dissections of the internal carotid artery, multiple myeloma, vasculitis, carotid fibromuscular dysplasia, shotgun injuries, idiopathic cranial polyneuropathy, atlas fractures, and occipital condyle fractures. This report discusses the correlation between the anatomical lesions and clinical features of this patient.Ĭollet-Sicard syndrome refers to unilateral lesions of cranial nerves (CN) IX, X, XI, and XII. However, when associated with a rare condition-congenital basilar invagination-atlas fractures can compromise the space and make CN IX–XII more vulnerable to compression injury. Atlas burst fractures rarely cause neurological deficits because of a greater transverse and sagittal diameter of the spinal canal at the atlas, and a tendency of the lateral masses to slide away from the cord after injury. Normally, lower cranial nerves (CN IX–XII) pass through a space between the styloid process and the atlas transverse process. Computed tomography of his skull base revealed a two part atlas Jefferson fracture. An 18 year old man with congenital basilar invagination developed multiple lower cranial nerve (CN) palsies including CN IX to XII after a traffic accident.
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