Villatoro et al. Journal of Medical Case Reports 2011, 5:315 http://www.jmedicalcasereports.com/content/5/1/315 was added and a monthly dose of zoledronic acid was subsequently included. The PSA value during the diag- nostic process, prior to the start of antiandrogen ther- apy, was 71.9 ng/mL. After three months of treatment, our patient was able to swallow normally, but the dysphonia remained. The rightward displacement of the palate, the lowering of the right shoulder and the atony of the right side of the tongue (paresis of cranial nerves XI and XII) remained unaltered. The latest PSA value was 0.11 ng/mL. Discussion The clinical presentation of metastasis to the temporal bone is uncommon, and few cases have been reported. Nevertheless, its incidence is probably greater than com- monly estimated because of the number of cases that remain undiagnosed. The multi-symptom nature of metastatic bone disease tends to produce more incapaci- tating symptoms than those associated with diseases of the temporal bone. Various retrospective series of patients presenting with this syndrome have been reported in the literature. Vázquez et al. described 21 cases, of which 71% were secondary to neoplasia (57% from paraganglioma and 14% by the direct extension of carcinoma of the cavum) [1]. Imamura et al. reviewed the potential mechanisms responsible for metastatic dissemination to the temporal bone. Of the six patients studied, three cases presented hematogenous dissemination (hepatocellular carcinoma, non-microcytic lung cancer and adenocarcinoma of unknown origin), two cases were the consequence of direct invasion by carcinoma of the head and neck, and one case was caused by leptomeningeal carcinomatosis (carcinoma of transitional cell carcinoma of the renal pelvis) [4]. Gloria-Cruz et al. selected 212 corpses of patients with non-disseminated neoplasias for an autop- sical study of the temporal bone. These authors identi- fied 47 patients with metastasis in the temporal bone, and the involvement was bilateral in 62% of these cases. The most frequently occurring site was the petrous apex, and the hematogenous pathway was the normal route of dissemination [5,6]. The management of Collet-Sicard syndrome consists of treating the cause that originates. In this case, therapy over primary tumor, followed by other measures such as the use of steroids or radiotherapy to help reduce edema and, thus, alleviate symptoms that can be limiting for the patient [7]. Conclusions The medical literature contains various descriptions of patients with disseminated prostate cancer who pre- sented with Collet-Sicard syndrome; however, in almost every case, this diagnosis was already known when Page 3 of 3 neurological symptoms began [7-12]. Apart from our patient, only one other case has been reported where metastasis to the temporal bone was the first recognized symptom of the disease [12]. It is important to consider the possibility of the existence of prostate cancer when a patient with an unusual clinical presentation is first seen, in view of the fact that first-line hormonal treat- ment may control the disease for months or years. Consent Written informed consent was obtained from the patient for publication of this case report and any accompany- ing images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Author details 1Unidad Oncologia Médica, Autovia A-7, km 187, Hospital Costa del Sol, Marbella, 29603, Spain. 2Servicio Medicina Interna, Autovia A-7, Km 187, Hospital Costa del Sol, Marbella, 29603, Spain. Authors’ contributions CR made substantial contributions to the design, and the acquisition and interpretation of data. AR revised the manuscript critically for important intellectual content. RV was a major contributor in writing the manuscript. All authors read and approved the final manuscript. Competing interests The authors declare that they have no competing interests. Received: 7 October 2010 Accepted: 14 July 2011 Published: 14 July 2011 References 1. Vázquez BV, Saynes MFJ, Hernández VG: Sindrome de Agujero Rasgado posterior. Casuística y manejo. An Orl Mex 2002, 47:4-8. 2. Belal A Jr: Metastatic tumours of the temporal bone. A histopathological report. J Laryngol Otol 1985, 99:839-846. 3. Syms MJ, Singson MT, Burgess LP: Evaluation of lower cranial nerve deficits. Otolaryngol Clin North Am 1997, 30:489-463. 4. Imamura S, Murakami Y: Secondary malignant tumor of the temporal bone. A histopathologic study and review of the world literature. Nippon Jibiinkoka Gakkai Kaiho 1991, 94:924-937. 5. 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Wilson H, Johnson DH: Jugular foramen syndrome as a complication of metastatic cancer of the prostate. South Med J 1984, 77:92-93. 12. Onishi A, Shida K: Case of Collet-Sicard syndrome due to metastasis of prostatic cancer. Naika 1970, 26:755-757. doi:10.1186/1752-1947-5-315 Cite this article as: Villatoro et al.: Collet-Sicard syndrome as an initial presentation of prostate cancer: a case report. Journal of Medical Case Reports 2011 5:315.