Posttraumatic Delayed Jugular Foramen Syndrome in a Toddler

Area of Science:

• Pediatric Neurology
• Neurotraumatology
• Skull Base Anatomy

Background:

• Lower cranial nerve palsies are typically linked to occipital condyle fractures in older individuals.
• Mechanisms of cranial nerve deficits in infants following head trauma are not well-described.

Observation:

• A 33-month-old boy experienced delayed onset of hoarseness and refusal to drink after blunt head trauma.
• Physical examination revealed paralysis of the left VII, IX, X, and XI cranial nerves.
• Imaging showed a left petrous bone fracture involving the jugular foramen and a left cerebellar tonsil contusion.

Findings:

• The infant developed a rare posttraumatic "jugular foramen syndrome" with unilateral cranial nerve involvement.
• Neuroimaging suggested a focal contusion from a coup-contrecoup injury, ruling out occipital condyle fracture.
• Symptoms improved with methylprednisolone treatment, though mild muscle deficits persisted.

Implications:

• This case underscores the importance of comprehensive evaluation, including physical examination, anatomical correlation, and neuroimaging, for diagnosing rare pediatric head trauma complications.
• Delayed cranial nerve palsies in infants after blunt trauma warrant investigation for jugular foramen syndrome.
• Prompt diagnosis and management are essential for improving outcomes in pediatric neurotrauma.