Multiple cranial nerve palsies - Analysis of 979 cases

Background: To my knowledge, no large series of multiple cranial neuropathies is available. Objectives: To examine the seats and causes of multiple cranial neuropathies in a large group of inpatients. Design: Personal case series. Setting: Wards of a large municipal hospital and affiliated rehabilitation hospital. Patients: A consecutive series of 979 unselected inpatients with simultaneous or serial involvement of 2 or more different cranial nerves. Results: Cranial nerves VI (565 cases), VII (466 cases), V (353 cases), and 111 (339 cases) were most commonly affected. The locations and causes were diverse, with cavernous sinus (252 cases), brainstem (217 cases), and individual nerves (182 cases) being the most frequent sites, and tumor (305 cases), vascular disease (128 cases), trauma (128 cases), infection (102 cases), and the Guillain-Barr and Fisher syndromes (91 cases total) being the most frequent causes. Recurrent cranial neuropathy was uncommon (43 cases, 106 episodes, 136 nerves), with diabetes mellitus (14 cases), self-limited unknown causes (14 cases), and idiopathic cavernous sinusitis (10 cases) being the usual causes. Conclusion: While the locations and causes of multiple cranial neuropathy are highly diverse, the fact that tumor composes more than one quarter of cases places a premium on prompt diagnosis.