Cranial Neuropathies

Diseases, , ,

Here are some lists to help with the cranial neuropathies. Please see the underlying sections. Also see the section on vertigo for cranial nerve VIII diseases.

Synonyms:

Cranial neuropathy

Causes of Oculomotor nerve palsy (CN III): think of anatomy

Nuclear & fasciular:

  • Tumours: Glioma
  • Part of a brainstem stroke syndrome

Basilar area:

  • Meningitis:
    • Bacterial, Meningovascular syphilis
    • TB meningitis
    • Fungal meningitis
  • Basilar aneurysms
  • Posterior communicating artery PCOM aneurysm
  • Temporal lobe herniation (uncal herniation)

Cavernous sinus area:

  • Tumours: Intrasellar & extrasellar tumours e.g. pituitary, chordoma, meningioma, Nasopharymgeal tumours, craniopharygioma
  • Internal Carotid artery aneurysms
  • Cavernous sinus thrombosis
  • Mucormycosis

Superior orbital fissure & Orbital apex area:

  • Tumours: nasopharygeal, meningioma, hemangioma, glioma, sarcoma, Hand-Schuller-Christian disease, metastasis
  • AVMs
  • Tolosa-Hunt syndrome
  • Pseudotumour of the orbit

Others:

  • Idiopathic
  • Vascular:
    • Vasculopathy: diabetes mellitus, hypertension & atherosclerosis, giant cell arteritis
  • Wegner’s granulomatosus
  • Hodgkin’s disease, VZV, encephalitis, collagen vascular disease, Paget’s disease
  • Trauma

Causes of trochlear nerve palsy (CN IV):

Nuclear & fasciular:

  • Tumours: glioma, medulloblastoma
  • Part of a Brainstem stroke syndrome

Basilar area:

  • Meningitis:
    • Bacterial, Meningovascular syphilis
    • TB meningitis
    • Fungal meningitis
  • Basilar artery aneurysm

Cavernous sinus area:

  • Internal Carotid artery aneurysm
  • Cavernous sinus thrombosis

Superior orbital fissure & Orbital apex area:

  • Tumours: nasopharygeal, meningioma, hemangioma, glioma, sarcoma, Hand-Schuller-Christian disease, metastasis
  • AVMs
  • Tolosa-Hunt syndrome
  • Pseudotumour of the orbit

Others:

  • Idiopathic
  • Vasculopathy:
    • Atheroma, Hypertension, Diabetes mellitus
    • Giant cell arteritis
  • Trauma

Causes of abducens nerve palsy (CN VI):

Nuclear & fasciular:

  • Tumours: glioma
  • Part of a Brainstem stroke syndrome
  • Multiple sclerosis

Basilar area:

  • Meningitis:
    • Bacterial, Meningovascular syphilis
    • TB meningitis
    • Fungal meningitis
  • Basilar artery aneurysm

Petrous tip area:

  • Raised intracranial pressure ‘false localising sign’
  • Hydrocephalus
  • Mastoiditis
  • Nasophareygeal tumours, paranasal sinus tumours
  • Lateral sinus thrombosis

Cavernous sinus area:

  • Internal Carotid artery aneurysm
  • Cavernous sinus thrombosis
  • Tumours: Intrasellar & extrasellar tumours e.g. pituitary, chordoma, meningioma, Nasopharymgeal tumours, craniopharygioma

Superior orbital fissure & Orbital apex area:

  • Tumours: nasopharygeal, meningioma, hemangioma, glioma, sarcoma, Hand-Schuller-Christian disease, metastasis
  • AVMs
  • Tolosa-Hunt syndrome
  • Pseudotumour of the orbit

Others:

  • Idiopathic
  • Vasculopathy:
    • Atheroma, Hypertension, Diabetes mellitus
    • Giant cell arteritis
  • Wegner’s granulomatosus

Causes of isolated facial nerve palsy (CN VII):

Upper motor neuron lesion:

  • Stroke, most common
  • Vasculitis
  • Syphilis
  • HIV

Lower motor neuron lesion:

  • Bell’s palsy a.k.a. Idiopathic (but HSV-1 is implicated), most common
  • VZV a.k.a. Herpes zoster, Ramsay Hunt Syndrome
  • Otitis media
  • Cholesteatoma
  • Tumours:
    • Cerebellopontine angle, acoustic or facial neuroma
    • Glomus tumour
    • Parotid tumour
  • Temporal bone fracture
  • Diabetes mellitus
  • Lyme disease
  • Sarcoidosis
  • Amyloidosis
  • AIDS
  • Sjogren’s syndrome
  • Lesions of the facial nucleus (usually affects other nerves as well)

Recurrent or bilateral lower motor neuron facial palsy:

  • Base of the skull tumour e.g. Lymphoma
  • Lyme disease
  • Sarcoidosis
  • Gullian-Barre syndrome
  • If immunocompromised, VZV

DDx. of bilateral facial palsy (compare with causes of bilateral facial palsy above):

  • Myasthenia gravis

Causes of cavernous sinus syndrome:

  • Sepsis
  • Tumour
  • Carotid artery aneurysms
  • Wegener’s granulomatosis

Causes of skull base syndromes including jugular foramen syndrome:

Intracranial:

  • Neoplastic:
    • Extension of cerebellopontine angle tumour
    • Meningioma
    • Cholesteotoma
    • Neurofibroma
  • Guillain-Barre syndrome & variants
  • Chronic tuburculosis
  • Syphilis
  • Diabetes mellitus

Skull:

  • Fractured base of the skull
  • Paget’s disease

Extracranial:

  • Neoplastic:
    • Lymphoma
    • Carotid body tumour
    • Glomus jugulare turmour
    • Nasopharyngeal carcinoma
    • Metastatic Squamous cell carcionoma, others
  • Jugular vein thrombosis
  • Carotid dissection