Causes Of Lower Cranial Nerve Palsies

Lower cranial nerve palsies seldom occur in isolation. Investigations include CT or MR imaging of the skull base. If negative, specific tests for systemic causes and EMG (for nerve and muscle disease) may be required.

Skull base/intracranial

Basal skull tumours -

meningioma, neurofibroma, metastasis, epidermoid, nasopharyngeal carcinoma Bone lesions -

osteomyelitis (in diabetics, consider pseudomonas), chordoma Basal meningitis (especially tuberculous) Carcinomatous meningitis

Glomous jugulare tumour (chemodectoma) Brain stem

Infarction Demyelination Motor neuron disease Syringobulbia Poliomyelitis Intrinsic tumours, e.g. astrocytoma

Neck

Penetrating injury Neck operations

Lower cranial nerve syndromes I Tumours

Jugular foramen syndrome:

lesion involving the IX, X, and XI cranial nerves.

Collei-Sicard syndrome: lesion (usually extracranial) involving the IX, X, XI and XII cranial nerves.

Villaret's syndrome: lesion of the retropharyngeal space involving the IX, X, XI and XII cranial nerves and the cervical sympathetic (Horner's syndrome).

Drg Neuron Bone

Systemic causes

Diabetes

Meningovascular syphilis Sarcoidosis

Systemic lupus erythematosus

Polyneuritis cranialis

Multiple cranial nerve palsies of unknown aetiology which spontaneously remit. The diagnosis is dependent upon exclusion of other possible causes. Occasionally it occurs in association with or as a variant of postinfectious polyneuropathy.

Myasthenia gravis may present with a weakness of the bulbar musculature (sec page 464).

Recurrent laryngeal nerve lesions

Mediastinal disease Operative damage Aortic aneurysm

Systemic causes

Diabetes

Meningovascular syphilis Sarcoidosis

Systemic lupus erythematosus

Polyneuritis cranialis

Multiple cranial nerve palsies of unknown aetiology which spontaneously remit. The diagnosis is dependent upon exclusion of other possible causes. Occasionally it occurs in association with or as a variant of postinfectious polyneuropathy.

Myasthenia gravis may present with a weakness of the bulbar musculature (sec page 464).

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