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LETTER TO EDITOR
Year : 2017  |  Volume : 12  |  Issue : 1  |  Page : 145-146

Occipital condyle syndrome as the first sign of skull metastasis from lung cancer


Department of Neurosurgery, National Defense Medical College, Namiki, Tokorozawa, Saitama, Japan

Date of Web Publication17-Mar-2017

Correspondence Address:
Satoru Takeuchi
Department of Neurosurgery, National Defense Medical College, Namiki, Tokorozawa, Saitama
Japan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1793-5482.144154

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How to cite this article:
Takeuchi S, Osada H, Nagatani K, Shima K. Occipital condyle syndrome as the first sign of skull metastasis from lung cancer. Asian J Neurosurg 2017;12:145-6

How to cite this URL:
Takeuchi S, Osada H, Nagatani K, Shima K. Occipital condyle syndrome as the first sign of skull metastasis from lung cancer. Asian J Neurosurg [serial online] 2017 [cited 2017 Aug 24];12:145-6. Available from: http://www.asianjns.org/text.asp?2017/12/1/145/144154



Sir,

Occipital condyle syndrome (OCS) consists of unilateral occipital region pain associated with hypoglossal nerve palsy, and can be the first presentation of malignancy.[1],[2],[3],[4],[5] We herein present an extremely rare case of OCS which occurred as the first sign of skull metastasis from lung cancer.

A 64-year-old male presented with a 2-week history of dysarthria and left-sided headache. On examination, there was marked tenderness to palpitation over the left occipital region, and the tongue deviated to the left when protruded [Figure 1]a. A CT scan showed a space-occupying osteoclastic lesion, affecting the left occipital condyle and the hypoglossal canal [Figure 1]b and [Figure 1]c. The lesion demonstrated a hypointense signal on T1-weighted images [Figure 1]d. A PET-CT scan showed high uptake in the occipital bone and the right upper lobe of the lung [Figure 1]e and [Figure 1]f. A transbronchial biopsy revealed adenocarcinoma. Following the diagnosis of skull metastasis from the lung cancer, he was treated with opioid analgesics and local radiation therapy (30 Gy in 10 fractions). The pain was successfully relieved, but his hypoglossal nerve dysfunction did not improve. He received palliative systemic chemotherapy for lung cancer, and eventually died 9 months after the onset.
Figure 1: (a) Left sided hypoglossal nerve palsy; (b-d) CT scans and MR images showing a space-occupying osteoclastic lesion (asterisk) affecting the left occipital condyle and hypoglossal canal (arrows, right hypoglossal canal); and (e, f) PET-CT scans showing high uptake in the occipital bone and the right upper lobe of the lung

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Skull base metastatic cancers are often silent. Although rare, cranial nerve palsies are associated with these lesions. OCS can often be caused by prostate, breast, or rectal cancers. To the best of our knowledge, the present patient is the third case of OCS caused by skull metastasis from lung cancer.[1],[2] The overall survival from the time of diagnosis of skull metastasis is 5 months.[5] Early detection and early palliative therapy are important to improve the patient's quality of life. Routine radiological studies without consideration for OCS may lead to the oversight of these lesions. Therefore, radiological evaluations with special attention to the occipital condyles should be considered. Radiotherapy is used to treat most cases.[1],[2],[3],[4],[5] The pain can be successfully controlled with radiotherapy if it is delivered early to the patients with OCS caused by skull metastasis.[1],[3] Only a minority of patients with skull metastasis are candidates for surgical resection; however, in patients without known systemic cancer, a biopsy is useful to establish the diagnosis because OCS is not always secondary to malignant diseases.[2],[5]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Greenberg HS, Deck MD, Vikram B, Chu FC, Posner JB. Metastasis to the base of the skull: Clinical findings in 43 patients. Neurology 1981;31:530-7.  Back to cited text no. 1
    
2.
Moeller JJ, Shivakumar S, Davis M, Maxner CE. Occipital condyle syndrome as the first sign of metastatic cancer. Can J Neurol Sci 2007;34:456-9.  Back to cited text no. 2
    
3.
Morís G, Roig C, Misiego M, Alvarez A, Berciano J, Pascual J. The distinctive headache of the occipital condyle syndrome: A report of four cases. Headache 1998;38:308-11.  Back to cited text no. 3
    
4.
Capobianco DJ, Brazis PW, Rubino FA, Dalton JN. Occipital condyle syndrome. Headache 2002;42:142-6.  Back to cited text no. 4
    
5.
Laigle-Donadey F, Taillibert S, Martin-Duverneuil N, Hildebrand J, Delattre JY. Skull-base metastases. J Neurooncol 2005;75:63-9.  Back to cited text no. 5
    


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