Multiple Cranial Nerve Lesions

CLINICAL DIAGNOSTIC MANUAL

Multiple cranial nerve lesions represent a complex neurological condition that can result in a wide range of symptoms depending on the affected nerves. This condition can be caused by various etiologies, including tumours, aneurysms, infections, and inflammatory disorders.

Simultaneous involvement of several cranial nerves can lead to significant difficulties in vital functions such as vision, hearing, balance, facial movement, and swallowing. Accurate identification of the underlying cause is essential for proper management and requires thorough clinical evaluation, advanced imaging techniques, and neurophysiological studies.

Condition	Clinical Symptoms and Signs	Suspected Diagnosis	Confirmatory Diagnosis
Pituitary tumour	Headache, visual disturbances (bitemporal hemianopsia), hormonal imbalances, cranial nerve palsy	Clinical history, physical exam	Brain MRI, hormonal studies
Anterior communicating artery aneurysm	Sudden severe headache, loss of consciousness, visual disturbances, cranial nerve palsy	Clinical history, neurological exam	Cerebral angiography, contrast-enhanced MRI or CT
Posterior carotid artery aneurysm	Severe headache, double vision, ptosis, cranial nerve palsy	Clinical history, neurological exam	Cerebral angiography, contrast-enhanced MRI or CT
Gradenigo syndrome	Ear pain, otorrhoea, diplopia, VI cranial nerve palsy, signs of middle ear infection	Clinical history, otologic and neurological exam	Skull base MRI or CT, ear cultures
Facial canal lesion	Facial paralysis, facial pain, taste disturbances, hyperacusis	Clinical history, neurological exam	Skull base MRI, EMG
Cerebellopontine angle lesion	Hearing loss, tinnitus, vertigo, facial paralysis, headache	Clinical history, neurological exam, audiometry	Contrast-enhanced brain MRI
Jugular foramen syndrome	Hoarseness, difficulty swallowing, IX, X, and XI cranial nerve palsy, loss of gag reflex	Clinical history, neurological exam	Skull base MRI, EMG
Wallenberg syndrome	Vertigo, nausea, vomiting, swallowing difficulty, IX and X cranial nerve palsy, ataxia	Clinical history, neurological exam	Brain MRI, cerebral angiography
Weber syndrome	Contralateral hemiparesis, III cranial nerve palsy, ptosis, mydriasis	Clinical history, neurological exam	Brain MRI