Palsies of the Lower Four Cranial Nerves in Association with Atlantal Fracture - Report of One Case

Lower cranial nerve palsy with dysphagia and poor gag reflex is a potentially life-threatening condition, and rarely a complication of high cervical injury. We report a 25-year-old male who sustained a minor head trauma and presented with palsies of cranial nerves IX, X, XI and XII. Atlantal fracture was found by cervical CT and he was treated accordingly with traction and immobilization. A meticulous and thorough neurological examination seems mandatory in every patient with head or cervical injury, despite the severity of the insult, so as not to miss the dangerous association of lower cranial nerve palsies.