Lower Cranial Nerve Palsy due to Prevertebral Tuberculosis Infection

Prevertebral tuberculosis is a rare infectious disease that often affects immunocompromised patients in developing countries. We present the case of a patient who complained of headache, dysarthria, and dysphagia. Neurological examination revealed multiple cranial nerve palsies, including the hypoglossal, glossopharyngeal, and vagus nerves. Brain magnetic resonance imaging demonstrated an infiltrative lesion in the prevertebral space, and the biopsy revealed chronic inflammation. On suspicion of immune-mediated inflammation, the patient was treated with intravenous dexamethasone and oral prednisolone, with minimal response. Eleven months after the initial diagnosis, the patient’s neurological symptoms were aggravated, and we detected newly developed pulmonary tuberculosis. After the treatment of pulmonary tuberculosis, his neurological symptoms improved, and the imaging study demonstrated improvements. Although we lacked positive laboratory or biopsy results for tuberculosis, we suspect that the lesions were distant tuberculosis infections. Tuberculosis should be considered in patients with unknown infiltrative mass-like lesions in the prevertebral spaces.

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Lower Cranial Nerve Palsies in the COVID-19 Pandemic: A 10-Case Series of Intensive Care Unit Patients

European Neurology ◽

10.1159/000519226 ◽

2021 ◽

pp. 1-4

Author(s):

Pierre Decavel ◽

Olympe Nahmias ◽

Carine Petit ◽

Laurent Tatu

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Prone Position ◽

Cranial Nerve ◽

Nerve Palsy ◽

Case Series ◽

University Hospital ◽

Cranial Neuropathy ◽

Lower Cranial Nerve ◽

Cranial Nerve Palsies

Introduction: A number of neurological complications of COVID-19 have been identified, including cranial nerve paralyses. We present a series of 10 patients with lower cranial nerve involvement after severe COVID-19 infection requiring hospitalization in an intensive care unit. Methods: We conducted a retrospective, observational study of patients admitted to the post-intensive care unit (p-ICU) of Besançon University Hospital (France) between March 16 and May 22, 2020. We included patients with confirmed COVID-19 and cranial neuropathy at admission to the p-ICU. All these patients were treated by orotracheal intubation, and all but one underwent prone-position ventilation therapy. Results: Of the 88 patients admitted to the p-ICU, 10 patients (11%) presented at least 1 cranial nerve palsy. Of these 10 patients, 9 had a hypoglossal nerve palsy and 8 of these also had a deficit in another cranial nerve. The most frequent association was between hypoglossal and vagal palsies (5 patients). None of the patients developed neurological signs related to a global neuropathy. We found no correlation between the intensity of the motor limb weakness and the occurrence of lower cranial nerve palsies. All but 2 of the patients recovered within less than a month. Conclusion: The mechanical compressive hypothesis, linked to the prone-position ventilation therapy, appears to be the major factor. The direct toxicity of SARS-CoV-2 and the context of immune dysfunction induced by the virus may be involved in a multifactorial etiology.

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Micro-neurosurgical excision of dumbbell shaped very large jugular foramen schwannoma

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v18i2.12015 ◽

2012 ◽

Vol 18 (2) ◽

pp. 183-192

Author(s):

Forhad H Chowdhury ◽

Mohammod R Haque ◽

Mahmudul Hasan

Keyword(s):

Cranial Nerve ◽

Cranial Nerves ◽

Young Male ◽

Carotid Bifurcation ◽

Short Review ◽

Jugular Foramen ◽

Lower Cranial Nerve ◽

Cranial Nerve Palsies ◽

Cervical Approach ◽

High Cervical

Introduction: Jugular foramen tumor is a rare tumor. Jugular foramen schwannoma is rarer. This type of tumor may present in combination of different cranial nerve palsies in the form of different syndromes or may also be diagnosed incidentally. Management of such tumor is not straight forward.Case reports: Two young male presented with headache, vomiting, gait instability, right sided hearing loss. Clinically they had different cranial nerves dysfunction. Imaging showed jugular foramen tumor extending from posterior fossa to almost common carotid bifurcation at neck in both cases. Near total microsurgical excisions of the tumor were done through retrosigmoid suboccipital plus transmastoid high cervical approach with facial nerve mobilization in one case and without mobilization in other case. In case 1 combination of lower cranial nerve palsies is unique with inclusion of VIII nerve and that does not belong to any of the jugular foramen syndromes (i.e. Vernet, Collet- Sicard, Villaret, Tapia, Schmidt, and Jackson). Here IX, X, XI, XII and VIII cranial palsies was present (i.e.Collet-Sicard syndrome plus VIII nerve syndrome!). In the second case there was IX & X dysfunction with VIII dysfunction. We also went through the short review of the literature here DOI: http://dx.doi.org/10.3329/bjo.v18i2.12015 Bangladesh J Otorhinolaryngol 2012; 18(2): 183-192

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Skull base infection presenting with multiple lower cranial nerve palsies

American Journal of Otolaryngology ◽

10.1016/j.amjoto.2009.04.001 ◽

2010 ◽

Vol 31 (5) ◽

pp. 376-380 ◽

Cited By ~ 25

Author(s):

Harriet Patmore ◽

Ala Jebreel ◽

Sandeep Uppal ◽

Chris H. Raine ◽

Paul McWhinney

Keyword(s):

Skull Base ◽

Cranial Nerve ◽

Lower Cranial Nerve ◽

Cranial Nerve Palsies

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Multiple lower cranial nerve palsies due to nasopharyngeal actinomycosis masquerading as a tumour – A diagnostic conundrum

Annals of Indian Academy of Neurology ◽

10.4103/aian.aian_867_20 ◽

2021 ◽

Vol 0 (0) ◽

pp. 0

Author(s):

Madhavi Karri ◽

Balakrishnan Ramasamy ◽

Santhosh Perumal

Keyword(s):

Cranial Nerve ◽

Lower Cranial Nerve ◽

Cranial Nerve Palsies

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Occipital Bone Cyst Causing Lower Cranial Nerve Palsies

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100119274 ◽

1974 ◽

Vol 1 (3) ◽

pp. 206-209 ◽

Cited By ~ 3

Author(s):

M. Banna ◽

W. G. Bradley ◽

R. M. Kalbag ◽

B. E. Tomlinson

Keyword(s):

Cranial Nerve ◽

Bone Cyst ◽

Occipital Bone ◽

Unicameral Bone Cyst ◽

Bone Cysts ◽

Lower Cranial Nerve ◽

First Report ◽

Cranial Nerve Palsies ◽

Tubular Bones

SummaryA 20-year-old girl presented with neck and occipital pain for six weeks, which was found to be due to a unicameral bone cyst of the left occipital condylar region.Although there have been very few reports of simple bone cysts in bones than the long tubular bones, it appears that the present case is probably the first report of such a lesion occurring in the skull.

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Benign occipital unicameral bone cyst causing lower cranial nerve palsies complicated by iophendylate arachnoiditis

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp.37.9.1059 ◽

1974 ◽

Vol 37 (9) ◽

pp. 1059-1068 ◽

Cited By ~ 2

Author(s):

W. G. Bradley ◽

R. M. Kalbag ◽

P. S. Ramani ◽

B. E. Tomlinson

Keyword(s):

Cranial Nerve ◽

Bone Cyst ◽

Unicameral Bone Cyst ◽

Lower Cranial Nerve ◽

Cranial Nerve Palsies

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Partial Hypoglossal to Facial Nerve Anastomosis for Reinnervation of the Paralyzed Face in Patients with Lower Cranial Nerve Palsies

Neurosurgery ◽

10.1227/00006123-199409000-00027 ◽

1994 ◽

Vol 35 (3) ◽

pp. 532-533 ◽

Cited By ~ 43

Author(s):

Michael D. Cusimano ◽

Laligam Sekhar

Keyword(s):

Facial Nerve ◽

Cranial Nerve ◽

Lower Cranial Nerve ◽

Cranial Nerve Palsies ◽

Nerve Anastomosis

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Electrophysiologic Investigation of Lower Cranial Nerve Diseases by Means of Magnetically Stimulated Neuromyography of the Larynx

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949210100801 ◽

1992 ◽

Vol 101 (8) ◽

pp. 629-634 ◽

Cited By ~ 14

Author(s):

Walter F. Thumfart ◽

Patrick Zorowka ◽

Claus Pototschnig ◽

Hans E. Eckel

Keyword(s):

Vagus Nerve ◽

Cranial Nerve ◽

Early Stage ◽

Early Investigation ◽

Healthy Population ◽

Intracranial Stimulation ◽

Recurrent Nerve ◽

Lower Cranial Nerve ◽

Laryngeal Muscles ◽

Cranial Nerve Palsies

Zoom endoscopic electromyography of the larynx, as introduced in 1979, has contributed greatly to the diagnosis of lower cranial nerve palsies, but in the early stage of a vagus nerve disorder one cannot investigate the nerve conduction from the brain stem to the laryngeal muscles with electrical stimulation. As with the early diagnosis of facial nerve palsies, up to now the intracranial part of the motoric brain nerves could not be stimulated directly. With a new magnetic coil device (Novametrix, Magstim 200) this intracranial stimulation is easily possible in the awake patient with painless magnetic stimuli that induce a muscle action potential into the laryngeal muscles. Hence, an immediate diagnosis is possible. Two coils with mean diameters of 8.5 or 3 cm were used. The stimulator delivered current pulses of peak amplitude up to 5,000 A with rise times of 140 microseconds and 65 microseconds, respectively, that generated peak fields of up to 2 T. In a healthy population, cisternal stimulation of the vagus nerve leads to a muscular response in the vocal muscle after 4 to 6.6 milliseconds (mean 5 milliseconds). Cortical stimulation leads to such a response after 9.5 to 12 milliseconds. Potentials in healthy individuals have been shown to be very uniform. Stimulation in recurrent nerve palsies may show prolongation of these latencies up to 30 milliseconds. The method is limited by the fact that complete neural blocks cannot be overcome by proximal stimulation. We have applied magnetic stimulation to 190 patients with different disorders of the vagus nerve. It allows a differential diagnosis of palsies immediately after their onset, and is thus the first method to make such an early investigation possible.

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