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Analysis of 979 Cases

James R. Keane, MD

Arch Neurol. 2005;62:1714-1717.

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 III (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-Barré 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.

Author Affiliations: Department of Neurology, University of Southern California Medical School, Los Angeles.