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  • Updated 06.01.2024
  • Released 08.25.1998
  • Expires For CME 06.01.2027

Multiple cranial neuropathies: overview

Introduction

Overview

There are numerous syndromes of multiple cranial nerve involvement. This article describes a segmental classification that can help organize and differentiate the various cranial polyneuropathies.

Key points

• Several diseases can cause multiple cranial nerve palsies, including cancer, benign tumors, infections, traumatic brain injury, and vascular lesions.

Historical note and terminology

Galen (131 AD to 201 AD) was the first to classify cranial nerves but counted only seven pairs of nerves (36). This classification was employed until the 17th century. Galen demonstrated the existence of 11 of the 12 cranial nerves (he regarded the olfactory nerve as an extension of the brain) but combined several and arrived at a total of seven. Although Flemish anatomist Andreas Vesalius (1514-1564) followed the classification of Galen, his excellent dissections of the brain showed nine pairs of cranial nerves (73). English physician and anatomist Thomas Willis (1621-1675) described the arteries at the base of the brain and showed 10 pairs of cranial nerves (77). This was the first reclassification of cranial nerves since the time of Galen, and it provided the correct numbering up to cranial nerve X. He described the accessory nerve but did not give it the number it has now: XI. Complete classification of all 12 cranial nerves did not take place until a century later by German physician and anatomist Samuel Thomas von Sömmerring (1755-1830) (65).

The best summary of the 19th-century understanding of cranial nerve disorders was by British neurologist Sir William Gowers (1845-1915), who devoted 150 pages to cranial nerve disorders in his 1886 Manual of Diseases of the Nervous System (19).

Several syndromes involving particular combinations of multiple cranial nerve palsies were described toward the end of the 19th century and at the beginning of the 20th century.

Terms used for multiple cranial nerve palsies include “polyneuritis cranialis,” "cranial polyneuropathy," "multiple cranial neuropathies," and "multiple cranial nerve palsies," although the latter term would strictly apply only to cranial neuropathies involving the motor cranial nerves (III, IV, VI, VII, IX, X, XI, and XII).

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