Paralysis of the lower cranial nerves is uncommon after closed head injuries. Most cases reported are unilateral and associated with base of skull fractures, usually involving the occipital condyles. Bilateral lower cranial nerve palsy is even less common, with only a handful of cases reported in literature. A 17-year-old girl presented to us after she was involved in a side-on collision with a car while driving a scooter. She sustained traumatic brain injury requiring mechanical ventilation. Detailed neurological evaluation revealed bilateral paralysis of the IXth, Xth, and XIIth cranial nerves with no evidence of a fracture of the base of skull or brain stem injury. A traction type of injury to the nerves arising from a whiplash mechanism may have led to paralysis of the lower cranial nerves in our patient. An exhaustive review of literature revealed 11 reports of bilateral lower cranial nerve palsy associated with closed head injuries; there were only four cases without underlying fracture of the occipital condyles. Our patient made a complete recovery over a period of 4 months. A traction type of injury to the lower cranial nerves may occur due to a whiplash mechanism. This type of injury may be associated with a favorable outcome.
Coello AF, Canals AG, Gonzalez JM, Martín JJ. Cranial nerve injury after minor head trauma. J Neurosurg 2010;113:547-55.
Leventhal MR, Boydston WR, Sebes JI, Pinstein ML, Watridge CB, Lowrey R, et al. The diagnosis and treatment of fractures of the occipital condyle. Orthopedics 1992;15:944-7.
Collet FJ. On a new paralytic syndrome pharyngo - laryngeal from war injury (hemiplegia glosso- laryngo - scapular- pharyngeal). Lyon Med 1915;124:121-9.
Legros B, Fournier P, Chiaroni P, Ritz O, Fusciardi J. Basal fracture of the skull and lower (IX, X, XI, XII) cranial nerves palsy: Four case reports including two fractures of the occipital condyle – A literature review. J Trauma Acute Care Surg 2000;48:342.
Tuli S, Tator CH, Fehlings MG, Mackay M. Occipital condyle fractures. Neurosurgery 1997;41:368-76.
Helliwell M, Robertson JC, Todd GB, Lobb M. Bilateral vocal cord paralysis due to whiplash injury. Br Med J (Clin Res Ed) 1984;288:1876-7.
Spencer JA, Yeakley JW, Kaufman HH. Fracture of the occipital condyle. Neurosurgery 1984;15:101-3.
Brennan RJ, Shirley JP, Compton JS. Bilateral hypoglossal nerve palsies following head injury. J Emerg Med 1993;11:167-8.
McCleary AJ. A fracture of the odontoid process complicated by tenth and twelfth cranial nerve palsies. A case report. Spine (Phila Pa 1976) 1993;18:932-5.
Freixinet J, Lorenzo F, Hernandez Gallego J, Rodriguez Castro F, Sole J. Bilateral traumatic hypoglossal nerve paralysis. Br J Oral Maxillofac Surg 1996;34:309-10.
Lam CH, Stratford J. Bilateral hypoglossal nerve injury with occipital condylar fracture. Can J Neurol Sci 1996;23:145-8.
Shekhar H, Yoong M, Mcphillips M, Kaliaperumal C. Stock car racing related cranio-cervical junction injury presenting with bilateral hypoglossal and abducens nerve palsy: 005. Dev Med Child Neurol 2015;57:19.
Yoo SD, Kim DH, Lee SA, Joo HI, Yeo JA, Chung SJ, et al. Bilateral cranial IX and X nerve palsies after mild traumatic brain injury. Ann Rehabil Med 2016;40:168-71.
Bogduk N. The anatomy and pathophysiology of whiplash. Clin Biomech (Bristol, Avon) 1986;1:92-101.
Jaiswal AK, Sharma MS, Behari S, Lyngdoh BT, Jain S, Jain VK. Current management of odontoid fractures. Indian J Neurotrauma 2005;2:3-6.
Myssiorek D, Shalmi C. Traumatic retropharyngeal hematoma. Arch Otolaryngol Head Neck Surg 1989;115:1130-2.
Anagnostara A, Athanassopoulou A, Kailidou E, Markatos A, Eystathidis A, Papageorgiou S, et al. Traumatic retropharyngeal hematoma and prevertebral edema induced by whiplash injury. Emerg Radiol 2005;11:145-9.
Propst EJ, Prager JD, Shott SR, Koch B, Mortensen JE, Greinwald JH. Resolution of hypoglossal nerve palsy associated with retropharyngeal abscess after prompt medical and surgical treatment. Int J Pediatr Otorhinolaryngol Extra 2011;6:74-7.
Hashimoto T, Nakamura N, Richard KE, Frowein RA. Primary brain stem lesions caused by closed head injuries. Neurosurg Rev 1993;16:291-8.