Occipital condyle syndrome: self diagnosed

Abstract

We present the case of a 71-year-old man who presented to us with unilateral lower motor neuron hypoglossal palsy along with the characteristic occipital headache. He himself forwarded a paper on occipital condyle syndrome to the clinician who initially reviewed him. Later the patient underwent a series of investigations that confirmed the diagnosis of underlying prostatic carcinoma with widespread metastasis to bones including the base of the skull. Seven months after the diagnosis he is doing well, his headache is much better and the tongue deviation is stable. He was initially treated with tapering doses of dexamethasone and is currently receiving the depo gonadorelin analogue leuprorelin.

Figure 1

Patient’s photograph, showing deviation of the protruded tongue consistent with right lower motor neuron hypoglossal palsy.

Figure 2

Isotope bone scan from behind, showing metastasis to the skull base (black arrow) along with extensive bony metastasis.

Figure 3

MRI of head and skull base: coronal postcontrast T1 image showing abnormal signal in the right occipital condyle (white arrow) compatible with local metastasis.