title: A case of bilateral lower cranial nerve palsies after base of skull trauma with complex management issues: case report and review of the literature.
abstract: BACKGROUND
  Fractures of the skull base can cause lower cranial nerve palsies because of involvement of the nerves as they traverse the skull. A variety of syndromes have been described, often involving multiple nerves. These are most commonly unilateral, and only a handful of cases of bilateral cranial nerve involvement have been reported.
  
  
  METHODS
  We describe a 64-year-old man with occipital condylar fracture complicated by bilateral palsies of IX and X nerves associated with dramatic physiological derangement causing severe management challenges. Apart from debilitating postural hypotension, he developed dysphagia, severe gastrointestinal dysmotility, issues with airway protection as well as airway obstruction, increased oropharyngeal secretions and variable respiratory control.
  
  
  CONCLUSIONS
  This is the first report of a patient with traumatic bilateral cranial nerve IX and X nerve palsies. This detailed report and the summary of all 6 previous case reports of traumatic bilateral lower cranial nerve palsies illustrate clinical features, treatment strategies, and outcomes of these rare events.
authors.affiliation: Department of Neurology, Princess Alexandra Hospital, Brisbane Qld, Nambour General Hospital, Nambour, Qld, Australia. alex_lehn@health.qld.gov.au
authors.forename: Alexander Christoph
authors.initials: AC
authors.lastname: Lehn
authors.forename: Jennie
authors.initials: J
authors.lastname: Lettieri
authors.forename: Rohan
authors.initials: R
authors.lastname: Grimley
mesh_terms: D000472:Alkalosis, Respiratory / Q000209:etiology; D003389:Cranial Nerve Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D003680:Deglutition Disorders / Q000209:etiology; D005767:Gastrointestinal Diseases / Q000209:etiology; D006801:Humans; D007024:Hypotension, Orthostatic / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009777:Occipital Bone / Q000473:pathology; D012887:Skull Fractures / Q000150:complications*; D014057:Tomography, X-Ray Computed