Cranial Nerve Palsies

Cranial nerve palsies are clinical syndromes resulting from dysfunction of one or more of the twelve cranial nerves between their nuclei in the brainstem and the periphery. They may involve a single nerve, several nerves in adjacent anatomical regions or multiple cranial nerves in systemic disease.

Common etiologies include microvascular ischemia in diabetes and hypertension, intracranial aneurysms, demyelination, idiopathic Bell palsy, herpes zoster oticus, sarcoidosis, neoplastic compression, infectious meningitis, traumatic skull base injury and orbital pathology. Specific deficits include sensory loss in trigeminal neuropathy, peripheral facial palsy, hearing loss and vertigo in vestibulocochlear involvement, dysphagia and hoarseness with lower cranial nerve involvement.

Workup includes detailed neurologic examination, audiometry and ophthalmologic assessment when indicated, dedicated MRI of the brain and skull base, MR or CT angiography for suspected aneurysm, lumbar puncture in inflammatory or infectious cases and laboratory studies for systemic disease. Treatment targets the underlying cause and includes physiotherapy, pain control and rehabilitation.