Semin Neurol 2009; 29(1): 053-065
DOI: 10.1055/s-0028-1124023
© Thieme Medical Publishers

Multiple Cranial Neuropathies

Craig G. Carroll1 , William W. Campbell2
  • 1Department of Neurology, Naval Medical Center, Portsmouth, Virginia
  • 2Department of Neurology, Uniformed Services University of Health Sciences, Bethesda, Maryland
Further Information

Publication History

Publication Date:
12 February 2009 (online)

ABSTRACT

Patients presenting with multiple cranial neuropathies are not uncommon in neurologic clinical practice. The evaluation of these patients can often be overwhelming due to the vast and complicated etiologies as well as the potential for devastating neurologic outcomes. Dysfunction of the cranial nerves can occur anywhere in their course from intrinsic brainstem dysfunction to their peripheral courses. The focus of this review will be on the extramedullary causes of multiple cranial neuropathies as discussion of the brainstem syndromes is more relevant when considering intrinsic disorders of the brainstem. The goals are to provide the reader with an overview of those extramedullary conditions that have a predilection for causing multiple cranial nerve palsies. In turn, this will serve to provide a practical and systematic approach to allow for a more targeted diagnostic evaluation of this, often cumbersome, presentation.

REFERENCES

  • 1 Campbell W W. Brainstem and multiple cranial nerve syndromes. In Campbell WW Dejong's The Neurologic Examination. 6th ed. Philadelphia; Lippincott Williams and Wilkins 2005: 277-296
  • 2 Keane J R. Multiple cranial nerve palsies.  Arch Neurol. 2005;  62 1714-1717
  • 3 Beal M F. Multiple cranial nerve palsies: a diagnostic challenge.  N Engl J Med. 1990;  322 461-463
  • 4 Davis L. Subacute and chronic meningitis.  Continuum Lifelong Learning in Neurol. 2006;  12(2) 27-57
  • 5 Cohen B A. Chronic meningitis.  Curr Neurol Neurosci Rep. 2005;  5 429-439
  • 6 Reik Jr L, Burgdorfer W, Donaldson J O. Neurologic abnormalities in Lyme disease without erythema chronicum migrans.  Am J Med. 1986;  81 73-78
  • 7 Anderson N E, Willoughby E W. Chronic meningitis without predisposing illness: a review of 83 cases.  Q J Med. 1987;  63 283-295
  • 8 Thwaites G E, Tran T H. Tuberculous meningitis: many questions, too few answers.  Lancet Neurol. 2005;  4 160-170
  • 9 Leonard J M, Dez Prez R M. Tuberculous meningitis.  Infect Dis Clin North Am. 1990;  4 769-787
  • 10 Davis L E, Rastogi K R, Lambert L C, Skipper B J. Tuberculous meningitis in the southwest United States: a community-based study.  Neurology. 1993;  43 1775-1778
  • 11 Juncos J L, Beal M F. Idiopathic cranial polyneuropathy: a fifteen year experience.  Brain. 1987;  110 197-211
  • 12 Girkin C A, Perry J D, Miller R N, Reich S G. Pachymeningitis with multiple cranial neuropathies and unilateral optic neuropathy secondary to Pseudomonas aeruginosa: Case report and review.  J Neuroophthalmol. 1998;  18 196-200
  • 13 Marra C M. Human immunodeficiency virus. In: Scheld WM, Whitley RJ, Marra CM Infections of the Central Nervous System. 3rd ed. Philadelphia; Lippincott Williams &Wilkins 2004: 271-286
  • 14 Calado S, Canas N, Viano-Baptista M, Ribeiro C, Mansinho K. Multiple cranial neuropathy and HIV-2.  J Neurol Neurosurg Psychiatry. 2004;  75 660-661
  • 15 Mayo D R, Booss J. Varicella zoster-associated neurologic disease without skin lesions.  Arch Neurol. 1989;  46 313-315
  • 16 Landgren M, Kyllerman M, Bergstrom T, Dotevall L, Ljungstrom L, Ricksten A. Diagnosis of Epstein-Barr virus-induced central nervous system infections by DNA amplification from cerebrospinal fluid.  Ann Neurol. 1994;  35 631-635
  • 17 Masdeu J C, Small C B, Weiss L, Elkin C M, Llena J, Mesa-Tejada R. Multifocal cytomegalovirus encephalitis in AIDS.  Ann Neurol. 1988;  23 97-99
  • 18 Ceriotto M, Zala C, Brandariz S et al.. Trypanosoma cruzi encephalitis (Chagas' disease) in a patient with HIV infection. Abstract presented at: XI International Conference on AIDS; 1996; July 7–12; Vancouver (abstract no. Tu.B.2211)
  • 19 Gullapalli D, Phillips II L H. Neurologic manifestations of sarcoidosis.  Neurol Clin. 2002;  20 59-83
  • 20 Hoitsma E, Farber C G, Drent M, Sharma O P. Neurosarcoidosis: a clinical dilemma.  Lancet Neurol. 2004;  3 397-407
  • 21 Stern B J. Neurological complications of sarcoidosis.  Curr Opin Neurol. 2004;  17 311-316
  • 22 Scott T F. Neurosarcoidosis: progress and clinical aspects.  Neurology. 1993;  43 8-12
  • 23 Akman-Demir G, Serdaroglu P, Tasci B. Clinical patterns of neurological involvement in Behcet's disease: evaluation of 200 patients.  Brain. 1999;  122 2171-2181
  • 24 Siva A, Altintas A, Saip S. Behcet's syndrome and the nervous system.  Curr Opin Neurol. 2004;  17 347-357
  • 25 Nishino H, Rubino F A, DeRemee R A, Swanson J W, Parisi J E. Neurological involvement in Wegener's granulomatosis: an analysis of 324 consecutive patients at the Mayo Clinic.  Ann Neurol. 1993;  33 4-9
  • 26 Nadeau S E. Neurologic manifestations of systemic vasculitis.  Neurol Clin. 2002;  20 123-150
  • 27 Case Records of the Massachusetts General Hospital (Case 8–1995).  N Engl J Med. 1995;  332 730-737
  • 28 Younger D S. Neurovasculitis.  Continuum Lifelong Learning in Neurol. 2005;  11(1) 11-42
  • 29 Katzenstein A L, Carrington C B, Liebow A A. Lymphomatoid granulomatosis: a clinicopathologic study of 152 cases.  Cancer. 1979;  43 360-373
  • 30 Mori K, Iijima M, Koike H et al.. The wide spectrum of clinical manifestations in Sjögren's syndrome-associated neuropathy.  Brain. 2005;  128(pt 11) 2518-2534
  • 31 Lewis S. Neurologic complications of Sjögren's syndrome and rheumatoid arthritis.  Continuum Lifelong Learning in Neurol. 2008;  14 120-144
  • 32 Nadeau S E. Neurologic manifestations of connective tissue disease.  Neurol Clin. 2002;  20 151-178
  • 33 Touze E, Blanche P, Zuber M. A 35 year history of recurrent multiple cranial neuropathy due to primary Sjögren's syndrome.  J Neurol. 1999;  246 968-969
  • 34 Masson C, Boukriche Y, Colombani J M. Inflammatory hypertrophic cranial pachymeningitis.  Presse Med. 2001;  30 411-416
  • 35 Hamilton S R, Smith C H, Lessell S. Idiopathic hypertrophic cranial pachymeningitis.  J Clin Neuroophthalmol. 1993;  13 127-134
  • 36 Kyle R A, Dyck P J. Amyloidosis and neuropathy. In: Dyck PJ, Thomas PK Peripheral Neuropathy. 3rd ed. Philadelphia; WB Saunders 1993: 1294-1309
  • 37 Van Gerpen J A, Goudreau J L, Dodick D W, Gertz M A. Amyloidosis presenting with intractable epistaxis and multiple cranial neuropathies.  Neurology. 2000;  55 1755-1756
  • 38 Demopoulos A. Leptomeningeal metastasis.  Curr Neurol Neurosci Rep. 2004;  4 196-204
  • 39 Kim L, Glantz M J. Neoplastic meningitis.  Curr Treat Options Oncol. 2001;  2 517-527
  • 40 Chamberlain M C. Neoplastic meningitis.  J Clin Oncol. 2005;  23 3605-3613
  • 41 Lachance D H, O'Neill B P, MacDonald D R et al.. Primary leptomeningeal lymphoma: report of three cases, diagnosis with immunocytochemical analysis, and review of the literature.  Neurology. 1991;  41 95-100
  • 42 Davila G, Duyckaerts C, Lazareth J P, Poisson M, Delattre J Y. Diffuse primary leptomeningeal gliomatosis.  J Neurooncol. 1993;  15 45-49
  • 43 Mokri B, Silbert P L, Schievink W I et al.. Cranial nerve palsy in spontaneous dissection of the extracranial internal carotid artery.  Neurology. 1996;  46 356-359
  • 44 Eshbaugh C G, Siatkowski R M, Smith J L et al.. Simultaneous, multiple cranial neuropathies in diabetes mellitus.  J Neuroophthalmol. 1995;  15 219-224
  • 45 Asher S W. Multiple cranial neuropathies, trigeminal neuralgia, and vascular headaches in sickle cell disease, a possible common mechanism.  Neurology. 1980;  30 210-211
  • 46 Shapiro F. Osteopetrosis. Current clinical considerations.  Clin Orthop Relat Res. 1993;  (294) 34-44
  • 47 Poncelet A. The neurologic complications of Paget's disease.  J Bone Miner Res. 1999;  14 88-89
  • 48 Manni J J, Scaf J J, Huygen P LM, Cruysberg J RM, Verhagen W IM. Hyperostosis cranialis interna: a new hereditary syndrome with cranial-nerve entrapment.  N Engl J Med. 1990;  322 450-454
  • 49 Bone I, Hadley D M. Syndromes of the orbital fissure, cavernous sinus, cerebellopontine angle, and skull base.  J Neurol Neurosurg Psychiatry. 2005;  76(Suppl III) iii29-iii38
  • 50 Polo A, Manganotti P, Zanette G, De Grandis D. Polyneuritis cranialis: clinical and electrophysiological findings.  J Neurol Neurosurg Psychiatry. 1992;  55 398-400
  • 51 Fishman R A. Composition of the cerebrospinal fluid. In: Fishman RA Cerebrospinal Fluid in Diseases of the Nervous System. 2nd ed. Philadelphia; WB Saunders Company 1992: 194
  • 52 Mikami T, Minamida Y, Yamaki T, Koyanagi I, Nonaka T, Houkin K. Cranial nerve assessment in posterior fossa tumors with fast imaging employing steady-state acquisition (FIESTA).  Neurosurg Rev. 2005;  28 261-266
  • 53 Okumura Y, Suzuki M, Takemura A et al.. Visualization of the lower cranial nerves by 3D-FIESTA.  Nippon Hoshasen Gijutsu Gakkai Zasshi. 2005;  61 291-297
  • 54 Cheng Y S, Zhou Z, Peng W J, Tang F. Three-dimensional-fast imaging employing steady-state acquisition and T2-weighted fast spin-echo magnetic resonance sequences on visualization of cranial nerves III–XII.  Chin Med J (Engl). 2008;  121 276-279
  • 55 Volcy M, Toro M E, Uribe C S, Toro G. Primary angiitis of the central nervous system: report of five biopsy-confirmed cases from Colombia.  J Neurol Sci. 2004;  227 85-89
  • 56 Sylaja P N, Cherian P J, Das C K et al.. Idiopathic hypertrophic cranial pachymeningitis.  Neurol India. 2002;  50 53-59
  • 57 Jinnah H A, Dixon A, Brat D J, Hellmann D B. Chronic meningitis with cranial neuropathies in Wegener's granulomatosis. Case report and review of the literature.  Arthritis Rheum. 1997;  40 573-577
  • 58 Cheng T M, O'Neill B P, Scheithauer B W et al.. Chronic meningitis; the role of meningeal or cortical biopsy.  Neurosurgery. 1994;  34 590-595
  • 59 Anderson N E, Willoughby E W, Synek B J. Leptomeningeal and brain biopsy.  Aust N Z J Med. 1995;  25 703-706
  • 60 Thompson III G R, Lavalle III C E, Everett D. Unusual manifestations of histoplasmosis.  Diagn Microbiol Infect Dis. 2004;  50 33-41
  • 61 Smith J E, Aksamit A J. Outcome of chronic idiopathic meningitis.  Mayo Clin Proc. 1994;  69 548-556

Craig G CarrollD.O. 

Head, Department of Neurology, Naval Medical Center Portsmouth

620 John Paul Jones Circle, Portsmouth, VA 23708

Email: craig.carroll@med.navy.mil