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Neuropediatrics 2021; 52(05): 403-405
DOI: 10.1055/s-0040-1722684
Short Communication

Posttraumatic Delayed Jugular Foramen Syndrome in a Toddler

Cristina Toledo-Gotor
1   Pediatric Neurology Unit, Department of Pediatrics, San Pedro Hospital, Logroño, Spain
2   Pediatric Neurology Unit, Department of Pediatrics, Navarra Health Service Hospital, Pamplona, Spain
,
Nerea Gorría
2   Pediatric Neurology Unit, Department of Pediatrics, Navarra Health Service Hospital, Pamplona, Spain
,
Miren Oscoz
3   Department of Pediatrics, Navarra Health Service Hospital, Pamplona, Spain
,
Katia Llano
4   Pediatric Acquired Brain Injury Unit, Navarra Health Service Hospital, Pamplona, Spain
,
Pablo Rodríguez-de la Fuente
5   Pediatric Imaging Diagnostic Unit, Navarra Health Service Hospital, Pamplona, Spain
,
Sergio Aguilera-Albesa
2   Pediatric Neurology Unit, Department of Pediatrics, Navarra Health Service Hospital, Pamplona, Spain
6   NavarraBioMed Research Group, Navarra Health Service, Pamplona, Spain
› Author Affiliations Funding All authors stated that there were no specific financial interests, relationship, and affiliations relevant to the subject of the manuscript.
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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

Patient Consent

Obtained.




Publication History

Received: 28 July 2020

Accepted: 23 October 2020

Article published online:
28 January 2021

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