Rahul Penumaka
Collet-Sicard syndrome is a unique condition involving lesions of the skull base, which affect both the jugular foramen and the hypoglossal canal, affecting the lower cranial nerves IX, X, XI and XII. Symptoms of this pathology include loss of the palate of the posterior third of the tongue (IX nerve), vocal cord paralysis and dysphagia (X nerve), weakness in the sternocleidomastoid and trapezius (XI nerve) muscles and atrophy and paresis of the tongue muscles (XII nerve). The present report aims to describe the case in question, referring to a syndrome rare and little described in the literature. In the case of the patient reported, the conduct adopted was to perform radiotherapy sessions in order to prevent tumor progression since the surgery was contraindicated. Patient I.L.B, male, 61 years of age reported complaints of dysarthria, dysphasia and reduced tongue mobility, after an otorhinolaryngological evaluation a CT scan of the skull was requested (Figures 1A-B and 2A-B) which found an expansive, solid, hypovascular formation located in the jugular foramen and extending inferiorly to the right carotid space of probable neoplastic etiology. The main hypothesis considered is schwannoma. Subsequent referral to the neurologist and evaluation after detailed neurological examination showed a deviation of the tongue to the left side with right atrophy, impairment of the mobility of the right upper limb and paresis of the right lateral aspect of the neck. In addition to the reported symptoms, there were no alterations in other pairs of cranial nerves and other systems. In Magnetic Resonance Imaging (MRI) (Figures 3A-C and 4A-B), the neoplastic etiology for the neural sheath tumor (schwannoma) is confirmed. The next step was to refer the patient to the radiotherapy, after consulting the neurosurgeon who contraindicated surgery because of the presence of risks to damages in important brain areas and irreversible damage to the corresponding cranial nerves, which could lead to a total loss of their functions. Several radiotherapy sessions were performed without satisfactory results.
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