Syndromes with involvement of multiple cranial nerves: An overview

Dear Editor,

We read the article entitled “Retropharyngeal soft-tissue mass with multiple cranial neuropathies” on the esteemed “Ibnosina Journal of Medicine and Biomedical Sciences” with great interest. Bennour et al. reported a case of a middle-aged male who presented with hemifacial pain. Later, the patient developed lesions from the third to the twelfth cranial nerves. A diagnosis of inflammatory pseudotumor of the retropharynx infiltrating the base of the skull and extending to the cavernous sinus was made.[[1]]

Herein, we would like to provide a table [[Table 1]] and a figure [[Figure 1]] to better comprehend the syndromes with the involvement of multiple cranial nerves.[[2]],[[3]],[[4]],[[5]] Any process that affects the intracranial region may lead to lesions in more than one cranial nerve. In some conditions, a group of nerves can be affected in a specific anatomical region or following some anatomical pattern.[[2]] Throughout the years, many studies showed patterns of lesions and the discoverers entitled these patterns with their own names; some of these eponyms are present in [[Table 1]]. These syndromes usually develop gradually and their clinical presentation may be complex, which explains their late diagnosis not being infrequent.[[4]]

Table 1: Syndromes with involvement of multiple cranial nerves

Figure 1: Schematic diagram of the jugular foramen syndromes. 1: Vernet (IX, X, and XI); 2: Collet-Sicard (IX, X, XI, and XII); 3: Jackson (X, XI, and XII); 4: Villaret (IX, X, XI, and XII + ICP); 5: Tapia (X, XI, and XII + ICP); 6: Schmidt (X and XI); 7: Avellis (X). ICP: Internal carotid plexus

We included the Avellis', Jackson's, and Schmidt's syndromes to the table and figure. Some authors believe that these syndromes belong to the brainstem syndrome because they can also appear due to the vascular lesions to the medulla. However, it is worthy of mentioning that epidemiological studies showed that they more commonly occur due to extramedullary lesions.[[2]] With this background, we can assume that the syndrome presented by Bennour et al. is Garcin's.[[1]] Therefore, we believe that the knowledge of these eponyms can help in the clinical practice to prompt localize the lesion, give a probabilistic etiological diagnosis, and avoid unnecessary examinations.

Author contributions

JPR and ALFC contributed equally. The figure was drawn by JPR.

Compliance with ethical principles

Not applicable.

Conflict of Interest

There are no conflicts of interest.

Financial support and sponsorship

Nil.

• References

• 1 Bennour AM, Dughman AA, Elkhashmee A. Retropharyngeal soft-tissue mass with multiple cranial neuropathies. Ibnosina J Med Biomed Sci 2019;11:185-7.
• 2 Campbell WW. Brainstem and multiple cranial nerve syndromes. Dejong's the Neurologic Examination. 7th ed. Philadelphia: Lippincott Williams and Wilkins; 2013. p. 335-56.
• 3 Barker RA, Scolding N, Rowe D, Larner AJ. The AZ of Neurological Practice: A Guide to Clinical Neurology. United Kingdom: Cambridge University Press; 2005. p. 367.
• 4 Gutiérrez Ríos R, Castrillo Sanz A, Gil Polo C, Zamora García MI, Morollón Sánchez-Mateos N, Mendoza Rodríguez A. Collet-Sicard syndrome. Neurologia 2015;30:130-2.
• 5 Keane JR. Combined VI and XII cranial nerve palsies: A clival syndrome. Neurology 2000;54:1540-1.

Publication History

Received: 30 December 2019

Accepted: 31 December 2019

Article published online:
07 July 2022