Murase Makoto, Yasuda Shinichi, Yahata Tadashi, Inokuchi Koichi, Sawano Makoto
Department of Emergency Medicine and Critical Care, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN.
Cureus. 2024 Sep 10;16(9):e69120. doi: 10.7759/cureus.69120. eCollection 2024 Sep.
We present a rare case of clival fracture in which the patient presented with multiple lower cranial nerve palsy (similar to Vernet syndrome or Collet-Sicard syndrome). Multiple lower cranial nerve palsy from skull base lesions includes Vernet syndrome and Collet-Sicard syndrome. Clival fracture is a rare condition, and the optimal treatment method has yet to be established. A 73-year-old man fell down a flight of stairs and was diagnosed with injuries such as traumatic intracranial hemorrhage, clival fracture, and facial bone fracture. The patient presented with bilateral cranial nerve VI, IX, X, XI, and right XII palsies caused by clival fracture but no instability at the craniocervical junction, so we performed external fixation using a halo device. The patient developed delirium in the subacute phase, which was considered to be aggravated by the halo device. We therefore safely removed the halo device on hospital day 54 after confirming porosis of the fractured clivus on computed tomography. The patient did not complain of neck pain, and paralyses of cranial nerves VI and XII had completely resolved, while those of cranial nerves IX, X, and XI had also improved, so the patient could start direct swallowing training. Clival fracture with bilateral multiple cranial nerve palsies similar to Vernet syndrome or Collet-Sicard syndrome is highly rare. Accordingly, no standard treatment has been established. A halo device can be an effective treatment for clival fracture, and the duration of fixation could be determined flexibly based on the condition of each case.
我们报告一例罕见的斜坡骨折病例，该患者表现为多发性低位颅神经麻痹（类似于韦尔内综合征或科莱-西卡尔综合征）。由颅底病变引起的多发性低位颅神经麻痹包括韦尔内综合征和科莱-西卡尔综合征。斜坡骨折是一种罕见疾病，最佳治疗方法尚未确定。一名73岁男性从一段楼梯上摔倒，被诊断为创伤性颅内出血、斜坡骨折和面部骨折等损伤。该患者因斜坡骨折出现双侧颅神经VI、IX、X、XI及右侧XII麻痹，但颅颈交界处无不稳定情况，因此我们使用头环装置进行了外固定。患者在亚急性期出现谵妄，认为是头环装置加重了病情。因此，在计算机断层扫描确认骨折斜坡骨质疏松后，我们于住院第54天安全拆除了头环装置。患者未诉颈部疼痛，颅神经VI和XII的麻痹已完全缓解，而颅神经IX、X和XI的麻痹也有所改善，因此患者可以开始直接吞咽训练。类似于韦尔内综合征或科莱-西卡尔综合征的双侧多发性颅神经麻痹的斜坡骨折极为罕见。因此，尚未确立标准治疗方法。头环装置可为斜坡骨折提供有效治疗，固定时间可根据具体情况灵活确定。
