Disorders of the lower cranial nerves

Abstract

Lesions of the lower cranial nerves (LCN) are due to numerous causes, which need to be differentiated to optimize management and outcome. This review aims at summarizing and discussing diseases affecting LCN. Review of publications dealing with disorders of the LCN in humans. Affection of multiple LCN is much more frequent than the affection of a single LCN. LCN may be affected solely or together with more proximal cranial nerves, with central nervous system disease, or with nonneurological disorders. LCN lesions have to be suspected if there are typical symptoms or signs attributable to a LCN. Causes of LCN lesions can be classified as genetic, vascular, traumatic, iatrogenic, infectious, immunologic, metabolic, nutritional, degenerative, or neoplastic. Treatment of LCN lesions depends on the underlying cause. An effective treatment is available in the majority of the cases, but a prerequisite for complete recovery is the prompt and correct diagnosis. LCN lesions need to be considered in case of disturbed speech, swallowing, coughing, deglutition, sensory functions, taste, or autonomic functions, neuralgic pain, dysphagia, head, pharyngeal, or neck pain, cardiac or gastrointestinal compromise, or weakness of the trapezius, sternocleidomastoid, or the tongue muscles. To correctly assess manifestations of LCN lesions, precise knowledge of the anatomy and physiology of the area is required.

Delayed onset vagus nerve paralysis after occipital condyle fracture in a horse

“…In the case presented here, nerve damage was hypothesized to have occurred at a point near the exit from the skull because of the evident involvement of CNX pharyngeal branches. In human patients with OCF, the accessory nerve (CNXI) is commonly implicated along with CNs IX and X (Jugular or Vernet's syndrome) . In the present case, CNXI function appeared to be intact as evidenced by the lack of electromyographic changes over the right trapezoid muscle and the absence of muscle atrophy both clinically and on postmortem examination.…”

“…In human patients, OCF can be complicated with LCNPs . Several clinical syndromes are recognized in humans depending on which CNs were simultaneously implicated . In the case described in this report, damage to the CNX could explain neurological signs such as dysphagia, right laryngeal paralysis, dysphonia, and lack of a gag reflex.…”

Delayed diagnosis of odontoid peg osteomyelitis with bilateral X and XII cranial nerve palsies

“…Osteomyelitis of the odontoid process is even rarer and requires a high degree of suspicion for diagnosis to be made 5. List of differentials for lesions involving the lower cranial nerves can be vast, involving genetic, vascular, traumatic, iatrogenic, infectious, immunological, metabolic, nutritional, degenerative or neoplastic process 6. However, lower cranial nerve palsy, when seen in combination with neck pain and fever, points the clinician in the right direction.…”

MR Neurographic Evaluation of Facial and Neck Pain: Normal and Abnormal Craniospinal Nerves below the Skull Base

“…The spectrum of causes of cranial neuropathy include iatrogenic (such as oral and dental procedures), infectious, traumatic, neoplastic, hereditary, and not uncommonly idiopathic (4). Many of these are compression or traction neuropathies, which are associated with and influence complex disorders such as chronic migraine, occipital neuralgia, and supraorbital rim syndrome (5).…”

“…The causes of these pain symptoms can be varied. Neuropathy of the extracranial nerves below the skull base is an important differential consideration (4). treated with selective nerve blocks, nerve ablation, targeted Botox (botulinum toxin; Allergan, Dublin, Ireland) injections, and surgical nerve decompression (6)(7)(8)(9)(10)(11).…”