Collet-Sicard syndrome as an initial presentation of prostate cancer: a case report

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.