Occipital condyle syndrome

Review the clinical features of occipital condyle syndrome.

Occipital condyle syndrome consists of unilateral occipital region pain associated with ipsilateral 12th cranial nerve paresis. It is typically due to metastasis to the skull base and is underdiagnosed.

We report a retrospective case series of 11 patients (8 men, 3 women), aged 32 to 72 years.

Eleven cases of occipital condyle syndrome were identified. All patients complained of severe occipital region pain. In addition, 2 patients complained of ipsilateral ear or mastoid pain, 2 noted associated vertex pain, and 2 had frontal region pain. Six of the 11 cases involved the right side. In all patients, the occipital pain was ipsilateral to the 12th nerve paresis. All patients were mildly dysarthric, and 3 had dysphagia. In 7 of the 11 patients, occipital region pain preceded the hypoglossal paresis by several days to 10 weeks. On examination, tenderness to palpation of the occipital region was noted in all patients. All 11 patients had unilateral hypoglossal paresis. Skull films were abnormal in 2 of 5 patients for whom they were obtained, and tomograms were abnormal in 1 of 2 patients. High-quality computed tomography, bone scanning, and magnetic resonance imaging were abnormal in all cases in which they were performed. Nine patients had a known primary malignancy. The most common malignancies were breast cancer in women (2 of 3) and prostate cancer in men (4 of 8). In 2 patients, occipital condyle syndrome was the initial manifestation of a metastatic lesion. Radiation therapy was the treatment of choice for the occipital region pain.

Occipital condyle syndrome is a rare, but stereotypic syndrome. Early detection has important therapeutic implications. Evaluation of the craniovertebral junction with special attention to the occipital condyles should be a routine part of all brain and cervical spine radiologic examinations, and the possibility of occipital condyle syndrome, particularly when patients have persistent occipital pain and a history of cancer, should be considered.