Villatoro et al. Journal of Medical Case Reports 2011, 5:315 http://www.jmedicalcasereports.com/content/5/1/315 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Collet-Sicard syndrome as an initial presentation of prostate cancer: a case report Rosa Villatoro1*, Carlos Romero2 and Antonio Rueda1 Abstract Background: Collet-Sicard syndrome is caused by lesions at the base of the skull affecting the lower cranial nerves. It is associated with various etiologies of tumoral and other origin. Although this syndrome has been reported previously in the literature, most cases are diagnosed as part of primary disease follow-up. This case is unusual because of the diagnosis of bone metastasis secondary to prostate cancer. Case presentation: We present the case of a 70-year-old Caucasian man with a three-week history of headache and maxillary pain on the right side together with paresis of the low cranial nerves. This study was carried out with a computed tomography (CT) scan of the larynx and neck and MRI, which revealed a bone lesion at the base of the skull affecting the right occipital condyle and part of the right side of the basilar bone. On the basis of differential diagnosis, a fibrous dysplasia, Paget’s disease or metastasis was considered. Finally, and after other studies were performed, a diagnosis of bone metastasis secondary to prostate cancer was established. Conclusions: We think that this case is curious because it involved an initial presentation of metastatic prostate cancer. It is important this should be considered in the differential diagnosis when a patient with unusual clinical findings is first seen in view of the fact that first-line hormonal treatment may control the disease for months or years. Background Collet-Sicard syndrome is caused by lesions at the base of the skull affecting the lower cranial nerves, which pro- duces dysphonia, displacement of the palate, and atony of the trapezius muscle and sternocleidomastoid, as well as anesthesia of the larynx, pharynx and soft palate. It is asso- ciated with various etiologies of tumoral and other origins. The differential diagnosis is important. Among the non- tumoral factors causing Collet-Sicard syndrome, the most common are traumatic events (fractures at the base of the skull, aneurisms, and so on), inflammatory processes (osteomyelitis, Paget’s disease, and so on) or other altera- tions such as diabetes mellitus or porphyrias [1]. However, considering a potential tumor cause in the differential diagnosis is important. Collet-Sicard syndrome may be diagnosed based on clinical history, a physical examination or imaging studies such as computed tomography (CT) and MRI scans [1]. * Correspondence: villatororoldan@gmail.com 1Unidad Oncologia Médica, Autovia A-7, km 187, Hospital Costa del Sol, Marbella, 29603, Spain Full list of author information is available at the end of the article The site most frequently affected is the petrous apex, although the external auditory canal, the middle ear and the mastoid apophysis can also be involved [2]. The symptoms vary depending on the location of occurrence, producing effects ranging from loss of hearing to tinnitus or disorders of cranial nerve VIII, the jugular foramen or the anterior condylar canal. The latter is the site described in our patient’s case [3]. Case presentation We report the case of a 70-year-old Caucasian man, with no significant clinical background, who presented to our casualty department with a three-week history of head- ache and maxillary pain on the right side, together with the recent appearance of dysphonia and dysphagia for solids. No urinary disorder was reported. A neurological examination revealed a paresis of cranial nerves IX and X, manifested by the displacement of the soft palate to the right and difficulty swallowing. Paresis of cranial nerves XI and XII was also observed, indicated by the lowering of the right shoulder and hypotonia of the right trapezius muscle, and was accompanied by displacement © 2011 Villatoro et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.