Multiple CN Palsy

Question 1

Possible causes of MCNP

Answer 1

• cavernous sinus syndrome
• superior orbital fissure syndrome
• orbital apex syndrome
• tumours most common

Question 2

Cavernous sinus syndrome - aetiology/signs

Answer 2

Aetiology
- neoplastic
- traumatic
- inflammatory
- granulomatous
- vascular

Aetiology
- ophthalmoplegia
- ptosis
- facial sensory loss
- proptosis
- horners syndrome due to MCNP of 3rd 4th and 6th nerve
- orbital congestion
- sympathetic disturbance - miosis

Question 3

What is superior orbital fissure syndrome - aetiology and features

Answer 3

Aetiology
- trauma
- tumours
- carotid aneurysm
- CNVI most commonly damaged
- CNIV least common

Features
- ophthalmoplegia
- ptosis
- proptosis
- fixed dilated pupil
- lacrimal hyposecretion

Question 4

What is tolosa-hunt syndrome

Answer 4

• painful ophthalmoplegia of unknown origin located in SOF and anterior CSS
• pain - granulomatous inflammation
• if pain reduces with steroid treatment within 72 hours it is diagnostic

Question 5

What is orbital apex syndrome

Answer 5

• posterior part of the pyramidal shaped orbit at the cranioacial junction
• OAS is characterised by the involvement of CNs 2,3,4,6
• vision loss in CN2