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NEUROIMAGING
Year : 2019  |  Volume : 14  |  Issue : 3  |  Page : 173-174
 

External occipital protuberance projecting as downward curved horn presenting with intractable occipital pain: Report of a first case


Department of Neurosurgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India

Date of Submission09-Jun-2018
Date of Decision09-Jun-2018
Date of Acceptance12-Aug-2019
Date of Web Publication27-Sep-2019

Correspondence Address:
Dr. Guru Dutta Satyarthee
Department of Neurosurgery, Room No. 714, Neurosciences Centre, All India Institute of Medical Sciences (AIIMS), New Delhi.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpn.JPN_94_18

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   Abstract 

External occipital protuberance is normal anatomical entity, rarely it may show hyperostosis and may get prominent and causing pain and examination reveals presence of tender bony swelling. However, such occurrence is extremely uncommon.


Keywords: Hornlike curved external occipital protuberance, management, pain, surgical intervention


How to cite this article:
Satyarthee GD. External occipital protuberance projecting as downward curved horn presenting with intractable occipital pain: Report of a first case. J Pediatr Neurosci 2019;14:173-4

How to cite this URL:
Satyarthee GD. External occipital protuberance projecting as downward curved horn presenting with intractable occipital pain: Report of a first case. J Pediatr Neurosci [serial online] 2019 [cited 2019 Oct 23];14:173-4. Available from: http://www.pediatricneurosciences.com/text.asp?2019/14/3/173/267992




A 14-year-old boy presented with pain localized in the occipital region along with the presence of slowly growing curved bony mass for five years. He used to have difficulty in combing and sleeping in supine posture He consulted physicians but pain persisted. Local examination revealed the presence of a non-tender, stony hard swelling of approximately 1.2cm in length and curved conical in shape, located over the occipital protuberance region with a downward projection, overlying skin was freely mobile and can be pinched from the underlying mass form, unassociated with dermal sinus or discharge [Figure 1]. X-ray of skull, lateral view, showed the presence of downward pointing external occipital tubercle [Figure 2]. He is advised surgical excision in view of intractable pain and currently awaiting surgical intervention.
Figure 1: Clinical photograph showing markedly bulging external occipital protuberance with inflamed skin (arrow corrections made in the manuscript)

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Figure 2: X-ray of skull (lateral view) showing downward pointing external occipital tubercle

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The external occipital protuberance represents a normal anatomical prominence. However, excessive hornlike prominence is uncommon. Superior nuchal lines run laterally on both sides from external occipital protuberance and provides origin of trapezius muscle in its medial part. Our patient might be getting pain due to the impingement of trapezius muscle.[1] The third occipital nerve courses approximately 3 mm laterally in relation of external occipital protuberance, and the proposed hypothesis for persistent intractable pain includes a combination of factors.[2] However, such hornlike extra-large external protuberance causing localized occipital neuralgia is not reported in the Western literature, and to the best of our knowledge, it represents first case of its kind.



Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Bogduk N. The anatomy of occipital neuralgia. Clin Exp Neurol 1981;17:167-84.  Back to cited text no. 1
    
2.
Tubbs RS, Mortazavi MM, Loukas M, D’Antoni AV, Shoja MM, Chern JJ, et al. Anatomical study of the third occipital nerve and its potential role in occipital headache/neck pain following midline dissections of the craniocervical junction. J Neurosurg Spine 2011;15:71-5.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2]



 

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