Abstract
Collet-Sicard syndrome, resulting from the involvement of all four lower cranial nerves, is an extremely rare condition. This case report details a 69-year-old female patient who presented with classic signs and symptoms of lower cranial nerve palsies (IX, X, XI, and XII) and was subsequently diagnosed with Collet-Sicard syndrome secondary to tuberculosis at the base of the skull. A contrast-enhanced MRI of the neck revealed bone marrow edema in the clivus, occipital condyle, and C1 vertebra, along with diffuse surrounding soft tissue swelling and collection, findings consistent with tuberculosis. The patient was treated with antitubercular therapy and steroids, along with neuromuscular and vocal rehabilitation. She showed significant improvement two months after starting antitubercular therapy and steroids. Tubercular Collet-Sicard syndrome should be suspected in patients presenting with cranial nerve palsies, elevated erythrocyte sedimentation rate, and abnormal imaging, as early recognition and treatment can lead to successful recovery.