[Occipital condyle syndrome as the first symptom of a metastatic hepatocellular carcinoma. Two case reports]

Rev Neurol. 2018 Mar 1;66(5):154-156.
[Article in Spanish]

Abstract

Introduction: Occipital condyle syndrome consists of the presence of unilateral occipital headache exacerbated by moving the head and is accompanied by paralysis of the ipsilateral hypoglossal nerve. One of its causes is infiltration of the base of the skull by bone metastases, especially those affecting the hypoglossal nerve due to infiltration as it passes through the osseous canal.

Case reports: We report two clinical cases of occipital condyle syndrome secondary to metastatic hepatocarcinoma. The first is that of a 52-year-old male with liver cirrhosis secondary to liver pathology caused by hepatitis C virus with occipital condyle syndrome as the presenting symptom in disseminated hepatocarcinoma. The second case is that of a 56-year-old male after recurrence of hepatocarcinoma following a liver transplant, despite not fulfilling the Milan criteria.

Conclusion: Occipital condyle syndrome is an alarm symptom and requires a thorough study by means of imaging tests, since it may be the first symptom of an undetected hepatocarcinoma.

Title: Sindrome del condilo occipital como primera manifestacion de un carcinoma hepatocelular metastasico. Presentacion de dos casos.

Introduccion. El sindrome del condilo occipital consiste en la presencia de cefalea occipital unilateral que empeora con los movimientos cefalicos y se acompaña de paralisis del XII par ipsilateral. La infiltracion de la base del craneo por metastasis oseas se encuentra entre sus etiologias, especialmente las que afectan por infiltracion al nervio hipogloso en su paso a traves del canal oseo. Casos clinicos. Se presentan dos casos clinicos de sindrome del condilo occipital secundario a un hepatocarcinoma metastasico. El primero, un varon de 52 años con cirrosis hepatica secundaria a hepatopatia por virus de la hepatitis C, con sindrome del condilo occipital como sintoma inicial en un hepatocarcinoma diseminado; y el segundo, un varon de 56 años, tras recidiva de un hepatocarcinoma despues de un trasplante hepatico, a pesar de no cumplir los criterios de Milan. Conclusion. El sindrome del condilo occipital es un sintoma de alarma y requiere realizar un estudio completo mediante pruebas de imagen, puesto que puede ser la primera manifestacion de un hepatocarcinoma oculto.

Publication types

  • Case Reports

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Carcinoma, Hepatocellular / complications
  • Carcinoma, Hepatocellular / diagnosis
  • Carcinoma, Hepatocellular / secondary*
  • Carcinoma, Hepatocellular / therapy
  • Combined Modality Therapy
  • Cranial Irradiation
  • Cranial Nerve Neoplasms / complications
  • Cranial Nerve Neoplasms / diagnostic imaging
  • Cranial Nerve Neoplasms / secondary*
  • Cranial Nerve Neoplasms / therapy
  • Fatal Outcome
  • HIV Infections / complications
  • Headache Disorders / drug therapy
  • Headache Disorders / etiology*
  • Hepatitis B, Chronic / complications
  • Hepatitis C, Chronic / complications
  • Humans
  • Hypertension, Portal / etiology
  • Hypoglossal Nerve / diagnostic imaging
  • Hypoglossal Nerve / pathology*
  • Hypoglossal Nerve Diseases / etiology*
  • Liver Diseases, Alcoholic / complications
  • Liver Neoplasms / complications
  • Liver Neoplasms / diagnosis
  • Liver Neoplasms / pathology*
  • Male
  • Middle Aged
  • Neuroimaging
  • Occipital Bone / diagnostic imaging
  • Occipital Bone / pathology*
  • Palliative Care
  • Skull Base Neoplasms / complications
  • Skull Base Neoplasms / diagnostic imaging
  • Skull Base Neoplasms / secondary*
  • Skull Base Neoplasms / therapy

Substances

  • Adrenal Cortex Hormones