Multiple Cranial Neuropathies

Abstract

In considering multiple cranial neuropathies, we are examining several important conditions that can affect cranial nerves once they have exited the brainstem. Intrinsic brainstem disease can mimic these syndromes but is almost always accompanied by neighborhood signs. The most common disease location giving rise to multiple cranial neuropathies is the cavernous sinus. Any pathology therein can cause a cavernous sinus syndrome that may present as a combination of unilateral ophthalmoplegia, autonomic dysfunction, and trigeminal neuropathy. The majority of primary lesions in the cavernous sinus are meningiomas, but a cavernous sinus syndrome can result from an adjacent process such as a pituitary adenoma. Less common but much more serious causes of multiple cranial neuropathies are mucormycosis and metastatic cancer.