Omneity® Pellets
All-In-One Vitamin & Mineral Pellet
Delayed onset vagus nerve paralysis after occipital condyle fracture in a horse.
Abstract: Occipital condylar fractures (OCFs) causing delayed onset lower cranial nerve paralysis (LCNPs) are rare. We present a 7-year-old Friesian horse with delayed onset dysphagia caused by vagus nerve (CNX) paralysis and suspicion of glossopharyngeal nerve (CNIX) paralysis developed several days after a minor head injury. Endoscopic examination revealed right laryngeal hemiplegia and intermittent dorsal displacement of the soft palate. An area of submucosal hemorrhage and bulging was appreciated over the dorsal aspect of the medial compartment of the right guttural pouch. Radiological examination of the proximal cervical region showed rotation of the atlas and the presence of a large bone fragment dorsal to the guttural pouches. Occipital condyle fracture with delayed onset cranial nerve paralysis was diagnosed. Delayed onset cranial nerve paralysis causing dysphagia might be a distinguishable sign of OCF in horses. Delayed onset dysphagia after head injury should prompt equine clinicians to evaluate the condition of the atlanto-occipital articulation and skull base.
© 2019 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.
Publication Date: 2019-09-26 PubMed ID: 31556150PubMed Central: PMC6872609DOI: 10.1111/jvim.15581Google Scholar: Lookup The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
- Case Reports
- Journal Article
Summary
This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.
This study documents a unique case, where a 7-year-old horse developed late nerve paralysis following a minor head injury, leading to difficulty in swallowing. A fracture in the occipital condyle – a protrusion connecting the skull to the spine – was determined as the cause of this condition. This specific occurrence in horses could serve as a valuable sign for veterinarians in diagnosing fractures in this region.
Background and Case Presentation
- The horse in question, a Friesian breed, presented difficulty in swallowing (dysphagia), which developed several days following a minor head injury. This led the researchers to suspect paralysis in two of the horse’s cranial nerves – the vagus nerve (CNX) and the glossopharyngeal nerve (CNIX).
- An endoscopic examination of the horse revealed a condition called right laryngeal hemiplegia and intermittent dorsal displacement of the soft palate. Laryngeal hemiplegia is typically characterized by dysfunction in the larynx, while dorsal displacement of the soft palate is a shifting of soft tissue in the upper part of the throat.
- In addition, a submucosal hemorrhage (Bleeding under the mucosal lining) and raised area were identified on the dorsal (upper) aspect of the medial compartment of the right guttural pouch, which is an air-filled space in the horse’s head.
Diagnosis and Findings
- A radiological examination was performed in the upper neck region of the horse. It revealed a misalignment of the atlas – the topmost vertebra of the spine which enables head movement – and a large bone fragment located above the guttural pouches.
- Based on these observations, the case was diagnosed as an occipital condyle fracture paired with a delayed onset of cranial nerve paralysis. The delayed onset nerve paralysis was considered as the cause of the horse’s dysphagia.
Implications of the Research
- This research note aims at raising awareness about the potential link between cranial nerve paralysis and occipital condyle fractures in horses. It especially highlights the significance of evaluating the atlanto-occipital articulation (ie., joint between the skull and spine) and skull base in horses exhibiting dysphagia following a head injury.
- The onset of cranial nerve paralysis causing difficulty in swallowing may serve as a noticeable symptom of occipital condyle fracture in horses, thereby aiding in timely diagnosis and treatment.
Cite This Article
APA
Martin-Giménez T, Cruz AM, Barragán A, Montero E, Sanchez PG, Caballero G, Corradini I.
(2019).
Delayed onset vagus nerve paralysis after occipital condyle fracture in a horse.
J Vet Intern Med, 33(6), 2780-2785.
https://doi.org/10.1111/jvim.15581 Publication
Researcher Affiliations
- Veterinary Teaching Hospital, Faculty of Veterinary Sciences, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain.
- Veterinary Teaching Hospital, Faculty of Veterinary Sciences, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain.
- Department of Animal Medicine and Surgery, Faculty of Veterinary Sciences, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain.
- Pathological Anatomy Service. Faculty of Veterinary Sciences, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain.
- Pathological Anatomy Service. Faculty of Veterinary Sciences, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain.
- Veterinary Teaching Hospital, Faculty of Veterinary Sciences, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain.
- Veterinary Teaching Hospital, Faculty of Veterinary Sciences, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain.
- Veterinary Teaching Hospital, Faculty of Veterinary Sciences, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain.
- Department of Animal Medicine and Surgery, Faculty of Veterinary Sciences, Universidad Cardenal Herrera CEU, CEU Universities, Valencia, Spain.
MeSH Terms
- Animals
- Fractures, Bone / pathology
- Fractures, Bone / veterinary
- Horse Diseases / etiology
- Horse Diseases / pathology
- Horses / injuries
- Male
- Occipital Bone / injuries
- Vagus Nerve / pathology
- Vagus Nerve Injuries / pathology
- Vagus Nerve Injuries / veterinary
Conflict of Interest Statement
Authors declare no conflict of interest.
References
This article includes 25 references
- Ramirez O, Jorgensen JS, Thrall DE. Imaging basilar skull fractures in the horse: a review.. Vet Radiol Ultrasound 1998;39:391‐395.
- Feary DJ, Magdesian KG, Aleman MA, Rhodes DM. Traumatic brain injury in horses: 34 cases (1994–2004).. J Am Vet Med Assoc 2007;231:259‐266.
- Lischer CJ, Walliser U, Witzmann P, Eser MW, Ohlerth S. Fracture of the paracondylar process in four horses: advantages of CT imaging.. Equine Vet J 2005;37:483‐487.
- Huang D‐W, Tai S‐H, Hung Y‐C, Fang V‐K, Lee M‐Y, Lee E‐J. A rare occipital condyle fracture in a patient with a minor head injury.. Kaohsiung J Med Sci 2009;25:342‐346.
- Karam YR, Traynelis VC. Occipital condyle fractures.. Neurosurgery 2010;66:56‐59.
- Theodore N, Aarabi B, Dhall SS. Occipital condyle fractures.. Neurosurgery 2013;72:106‐113.
- Legros B, Fournier P, Chiaroni P, Ritz O, Fusciardi J. Basal fracture of the skull and lower (IX, X, XI, XII) cranial nerves palsy: four case reports including two fractures of the occipital condyle—a literature review.. J Trauma Acute Care Surg 2000;48:342.
- Vadivelu S, Masood Z, Krueger B. Long‐term resolution of delayed onset hypoglossal nerve palsy following occipital condyle fracture: case report and review of the literature.. J Craniovertebral Junction Spine 2017;8:149‐152.
- Ducharme N. Grade system for equine laryngeal function. In: Dixon PM, Robinson E, Wade JF, eds. Proceedings of a Workshop on Equine Recurrent Laryngeal Neuropathy. Havemeyer Foundation Monograph Series No. 11 Newmarket, UK: R & W Publications; 2003:93‐97.
- Savi FM, Brierly GI, Baldwin J, Theodoropoulos C, Woodruff MA. Comparison of different decalcification methods using rat mandibles as a model.. J Histochem Cytochem 2017;65:705‐722.
- Voigt A, Saulez MN, Donnellan CM. Nuchal crest avulsion fracture in 2 horses: a cause of headshaking: clinical communication.. J S Afr Vet Assoc 2009;80:111‐113.
- Sweeney CR, Freeman DE, Sweeney RW, Rubin JL, Maxson AD. Hemorrhage into the guttural pouch (auditory tube diverticulum) associated with rupture of the longus capitis muscle in three horses.. J Am Vet Med Assoc 1993;202:1129‐1131.
- Tyler CM, Davis RE, Begg AP, Hutchins DR, Hodgson DR. A survey of neurological diseases in horses.. Aust Vet J 1993;70:445‐449.
- Bozkurt G, Hazer B, Yaman ME, Akbay A, Akalan N. Isolated paralysis of glossopharyngeal and vagus nerve associated with type II occipital condyle fracture: case report.. Childs Nerv Syst 2010;26:719‐722.
- Finsterer J, Grisold W. Disorders of the lower cranial nerves.. J Neurosci Rural Pract 2015;6:377‐391.
- Chen CT, Liu ZH, Lee ST, Tu PH. Delayed unilateral vocal cord paralysis caused by minor head trauma.. Formos J Surg 2016;49:230‐232.
- Erman AB, Kejner AE, Hogikyan ND, Feldman EL. Disorders of cranial nerves IX and X. Seminars in Neurology Stuttgart, Germany: Thieme Medical Publishers; 2009:85.
- De Lahunta A, Glass EN, Kent M. Veterinary Neuroanatomy and Clinical Neurology‐E‐Book. St. Louis, Mo: Elsevier Health Sciences; 2014.
- Budras K‐D, Sack WO, Rock S. Anatomy of the Horse: An Illustrated Text. Hannover, Germany: Schlütersche GmbH & Co.; 2003.
- Nakagawa Y, Toda M, Shibao S, Yoshida K. Delayed and isolated oculomotor nerve palsy following minor head trauma.. Surg Neurol Int 2017;8:20.
- Goyal RK, Chaudhury A. Physiology of normal esophageal motility.. J Clin Gastroenterol 2008;42:610‐619.
- Gutierrez LV, Kocak N, Cox AG. Alimentary transit and supersensitivity after vagotomy in the rat.. Gut 1971;12:625‐628.
- Tobi M, Holtz T, Carethers J, Owyang C. Delayed gastric emptying after laparoscopic anterior highly selective and posterior truncal vagotomy.. Am J Gastroenterol 1995;90:810‐811.
- Yoo SD, Kim DH, Lee SA, Joo HI, Yeo JA, Chung SJ. Bilateral cranial IX and X nerve palsies after mild traumatic brain injury.. Ann Rehabil Med 2016;40:168‐171.
- Lehn AC, Lettieri J, Grimley R. A case of bilateral lower cranial nerve palsies after base of skull trauma with complex management issues: case report and review of the literature.. Neurologist 2012;18:152‐154.
Citations
This article has been cited 0 times.Use Nutrition Calculator
Check if your horse's diet meets their nutrition requirements with our easy-to-use tool Check your horse's diet with our easy-to-use tool
Talk to a Nutritionist
Discuss your horse's feeding plan with our experts over a free phone consultation Discuss your horse's diet over a phone consultation
Submit Diet Evaluation
Get a customized feeding plan for your horse formulated by our equine nutritionists Get a custom feeding plan formulated by our nutritionists
