You are here

Article Text

Article menu
Images in...
Multidetector-row computed tomography in the diagnosis of Collet–Sicard syndrome
Free
  1. L T Lucato1,
  2. R B D Passos1,
  3. C R Campos2,
  4. A B Conforto2,
  5. A M McKinney3
  1. 1
    Department of Radiology, The Clinics Hospital of the University of Sao Paulo, School of Medicine, Sao Paulo, Brazil
  2. 2
    Department of Neurology, The Clinics Hospital of the University of Sao Paulo, School of Medicine, Sao Paulo, Brazil
  3. 3
    Department of Radiology, University of Minnesota Medical School, and the Hennepin County Medical Center, Minneapolis, MN, USA
  1. ltlucato{at}uol.com.br

https://doi.org/10.1136/bcr.2007.120972

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Collet–Sicard syndrome (CSS) refers to the unilateral lesion of cranial nerves IX to XII. The cause in this case is spontaneous dissection of the internal carotid artery (ICA), for which multidetector-row computed tomography (MDCT) images were critical for diagnosis.

    CASE REPORT

    A 54-year-old man noticed an onset of headache, hoarse voice and swallowing compromise. Neurological examination disclosed left-sided palsies of cranial nerves IX to XII.

    MDCT demonstrated coiling of the cervical distal portion of left ICA (fig 1A), narrowed lumen, mural thickening, increased external diameter and a thin annular ring of enhancement (“target appearance”)1 (fig 1A, B). Signs of nerve dysfunction were also noticed (fig 2).

    Figure 1
    Figure 1 Multidetector-row CT axial images (A and B) show coiling of left internal carotid artery (A), and crescent-shaped wall thickening (arrows, A and B). Figure B better demonstrates the narrowed eccentric lumen, an increase in external diameter and a faint enhancement of the external wall. A T1-weighted magnetic resonance image (C) demonstrates the hyperintense intramural haematoma (arrow).
    Figure 2
    Figure 2 Multidetector-row CT curved coronal reconstruction shows palatal and lingual asymmetry (large arrow), some fatty replacement of the tongue muscles (small arrow) and left vocal-cord palsy (arrowhead).

    Axial T1-weighted magnetic resonance images confirmed the dissection (fig 1C).

    DISCUSSION

    Causes of CSS include skull-base tumours and fractures, ICA dissection and vasculitis.2 Near their points of exit, the lower nerves (IX to XII) lie in a narrow space even in normal conditions,3 so any adjacent lesion can cause compression.

    The role of CT in the diagnosis of ICA dissection has evolved. Early studies demonstrated arterial wall thickening,4 5 but MDCT modified the scenario.

    MDCT, in this case, was able to provide assessment not only of ICA dissection itself, but also of the effects of lower cranial nerve palsies (corroborating neurological examination), all obtained in a single sitting. Knowledge of all the diagnostic possibilities included in a single MDCT study is of paramount importance, as MDCT can be an adequate alternative to MRI in specific clinical settings or in a resource-limited environment.

    Acknowledgments

    This article has been adapted from Lucato L T, Passos R B D, Campos C R, Conforto A B, McKinney A M. Multidetector-row computed tomography in the diagnosis of Collet–Sicard syndrome Journal of Neurology, Neurosurgery and Psychiatry 2008;79:521

    REFERENCES

    1. ↵
      1. Leclerc X,
      2. Godefroy O,
      3. Salhi A,
      4. et al
      . Helical CT for the diagnosis of extracranial internal carotid artery dissection. Stroke 1996;27:461–6.
      OpenUrlAbstract/FREE Full Text
    2. ↵
      1. Hsu HP,
      2. Chen ST,
      3. Chen CJ,
      4. et al
      . A case of Collet-Sicard syndrome associated with traumatic atlas fractures and congenital basilar invagination. J Neurol Neurosurg Psychiatry 2004;75:782–4.
      OpenUrlAbstract/FREE Full Text
    3. ↵
      1. Zielinski CJ,
      2. Gunther SF,
      3. Deeb Z
      . Cranial-nerve palsies complicating Jefferson fracture. A case report. J Bone Joint Surg Am 1982;64:1382–4.
      OpenUrlPubMed
    4. ↵
      1. Zuber M,
      2. Meary E,
      3. Meder JF,
      4. et al
      . Magnetic resonance imaging and dynamic CT scan in cervical artery dissections. Stroke 1994;25:576–81.
      OpenUrlAbstract/FREE Full Text
    5. ↵
      1. Dal Pozzo G,
      2. Mascalchi M,
      3. Fonda C,
      4. et al
      . Lower cranial nerve palsy due to dissection of the internal carotid artery: CT and MR imaging. J Comput Assist Tomogr 1989;13:989–95.
      OpenUrlPubMedWeb of Science

    Footnotes

    • Competing interests: None.