# Case Report: Head injury presenting as lower cranial nerve palsy

## TL;DR

This case report describes two road traffic accident victims who developed lower cranial nerve palsy due to trauma, a rare occurrence typically linked to other causes.

## Contribution

The novelty lies in highlighting traumatic causes of lower cranial nerve palsy, which is rarely reported in clinical literature.

## Key findings

- Two patients with road traffic injuries presented with lower cranial nerve palsy involving nerves IX, X, and XI.
- Both had dislocated occipital condyle fractures and soft tissue injuries, managed conservatively with cervical collars.
- Symptoms improved gradually, emphasizing the importance of prompt diagnosis to avoid complications.

## Abstract

Lower cranial nerve palsy is a rare condition, most commonly caused by malignant skull base lesions or internal carotid artery dissection, and only rarely resulting from trauma. We report two cases of road traffic accident victims presenting with lower cranial nerve palsy involving cranial nerves IX, X, and XI. Both patients had similar clinical complaints. The most important findings were a dislocated occipital condyle fracture and suspected associated soft tissue injury. Both were treated conservatively with a rigid cervical collar. A nasogastric tube was required for the first patient during the initial recovery period due to severe dysphagia, while the second patient tolerated oral intake and did not require enteral feeding. Both patients showed gradual improvement in symptoms during hospitalization and follow-up. These injuries, with their often subtle clinical presentation, may be easily overlooked and require prompt detection to prevent complications.