Differential Diagnosis in Neurology

5.13. Multiple Cranial Neuropathy

• Neuromuscular Junction Disease:
  • Myasthenia gravis
  • Lambert-Eaton syndrome
  • Tetanus
  • Botulism (toxin)
  • Neurotoxic snake envenomation
• Autoimmune cranial neuropathies:
  • AIDP
  • CIDP
  • Bell's palsy (putative)
  • CM Fisher variant (Gd1b; GQ1b epitopes)
  • Descending AIDP (Munsat's variant; cervical-pharyngeal variant)
  • Acute oropharyngeal GBS (GT1a epitope)
• Tumor:
  • Carcinomatosis of the meninges
  • Leukemia
  • Lymphoma (Hodgkin/non-Hodgkin)
  • Garcin's syndrome (base of the skull metastatic)
  • Nasopharyngeal cancer
  • Adenocystic carcinoma of the salivary gland
  • Cylindroma of the parotid gland
  • Chromophobe adenoma (pituitary apoplexy)
  • Glomus jugulare or tympanicum
  • Melanoma (metastatic to cranial nerves)
  • Pinealoma (CSF pathways to cranial nerves)
  • Cerebellopontine angle mass or tumor (compression)
  • Retroparotid or retropharyngeal tumors (IX, X, XI, XII)
  • Mucoepidermoid cancers
• Vascular disease (peripheral supply):
  • Intraparenchymal (syndrome)
  • Inferolateral branch of the external carotid (III, IV, VI)
  • Ascending pharyngeal artery – IX, X, XI (arch of the aorta)
  • Internal maxillary artery – V, VII (branches)
  • Carotid dissection in the neck – IX, X, XII
  • Isolateral angiitis of the external carotid
• Chemotherapy:
  • Internal carotid artery cis platinum (III–VI)
  • External carotid artery cis platinum (VII, XII)
  • Gracin's syndrome (with diabetes, cancer in conjunction with chemotherapy; all cranial nerves are one side)
  • Vincristine/vinblastine-sympathetic and parasympathetic supply of the cranial nerves
• Infectious Disease:
  • Myobacterium pneumonia
  • Rochalimaea henselae (cat scratch fever)
  • Tuberculosis
  • Deep fungi (histoplasmosis, cryptococcus, microcytosis, Coccidiomycosis)
  • Cysticercosis
  • Chagas disease (trypanosoma cruzi)
  • Syphilis
  • Lyme's disease (Borrelia burgdorferi)
  • Pseudomonas aerogenesis (malignant extend otitis)
• Bone disease (foraminal exit compression):
  • Paget's
  • Osteogenesis imperfecta
  • Hyperostosis osteosclerosis of the calvarium
  • South African sclerostenosis
  • Congenitally small posterior fossa and internal auditory canal
  • Fibrous dysplasia
• Systemic disease:
  • Familial primary amyloidosis
  • Tolosa Hunt syndrome (cavernous sinus); III, IV, VI
  • Diabetes mellitus