Trauma to the cranial nerves

Abstract

Cranial nerve injury is often an overlooked aspect of neurotrauma, which is diagnosed later in the course of recovery. Most of these injuries do not require active intervention in the acute stage. Cranial nerve injuries are important cause of morbidity, which requires long-term management, repeated surgical procedures or reconstructive measures. Management of optic nerve injury remains controversial, and injury to lower cranial nerves may influence the ultimate outcome due to paralysis of aerodigestive passage. Cranial nerve injury in the setting of head injury should be diagnosed early, so that appropriate treatment can be planned early.

Shrapnel Injury of Isolated Third Cranial Nerve

“…Along this course, fascicules are labeled as the subarachnoid segment, cavernous segment, orbital apex segment, and intraorbital segment, located in the neighborhood of the internal carotid artery (ICA), basilar artery and its branches, and the brainstem. 2,4 (►Fig. 4).…”

“…Multiple cranial nerve injuries involving the third nerve may occur in skull base fractures involving the cavernous sinus and in maxillofacial or superior orbital fissure injuries; isolated third nerve injury due to trauma is reported to be 21%. 2,7,8 Elston reported 20 cases with traumatic third nerve palsy, but no penetrating injury was present in their etiology. 9 In 1400 case presentations, Keane reported traumatic oculomotor injuries in 26%.…”

“…1 These injuries can develop as a result of a direct traumatic impact, tissue reaction and an increase in intracranial pressure, or meningitis. 2,3 Cranial nerve injuries are a major cause of morbidity because they require long-term follow-up, repeated surgeries, and reconstructive interventions. Along with major arteries and veins, cranial nerves support the brain that float in cerebrospinal fluid, and they also follow a route close to important vascular-neuronal structures.…”

Multiple cranial nerve palsies after head injury. A case report

“…Third nerve involvement in CHI is more likely to be due to an expanding mass lesion. 9,10 Bilateral 3rd nerve palsy following CHI has also been well documented. 9 The mechanism of these injuries is complex.…”

Olfaction and traumatic head injury - Is it possible to discriminate between malingering and patients with smell disorders based on nowadays knowledge?

“…Olfaction dysfunction could appear in oedema, ischemia or haematoma. Closed head trauma in orbitofrontal and temporal lobes can generate dysfunction of olfactory recognition in spite of preserved olfactory identification 66 .…”