Delayed hypoglossal nerve palsy associated with occipital condyle fracture

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A rare case of delayed hypoglossal nerve palsy associated with occipital condyle fracture is reported. A 24-year-old man accidentally fell from his bicycle and sustained a blow to the left temple. He was alert and oriented in the emergency department. On neurological examination, he was able to stick out his tongue. Because of his complaint of headache and neck pain, brain computed tomography (CT) scan and cervical spine radiographs were obtained. Both imaging studies were considered normal, and he was discharged. A week later, however, he returned to our clinic complaining of tongue deviation and persistent neck pain. A CT scan of the craniocervical junction revealed occipital condyle fracture of the right side involving the hypoglossal canal, and the fracture was apparently responsible for the hypoglossal nerve palsy. Since the fracture was considered stable biomechanically, he was treated conservatively with the use of a rigid cervical collar. His neck pain subsided gradually and tongue deviation resolved within 4 months of injury. Occipital condyle fractures are not as rare as had been believed earlier, and may occur even after low-energy trauma. The possibility of occipital condyle fractures should be considered when treating patients with mild head injuries who complain of persistent neck pain, even if their cervical spine series appear normal.
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