Isolated cranial nerve palsies in multiple sclerosis

Abstract

During a 10 year period 24 patients with definite multiple sclerosis with isolated cranial nerve palsies were studied (third and fourth nerve: one patient each, sixth nerve: 12 patients, seventh nerve: three patients, eighth nerve: seven patients), in whom cranial nerve palsies were the presenting sign in 14 and the only clinical sign of an exacerbation in 10 patients. MRI was carried out in 20 patients and substantiated corresponding brainstem lesions in seven patients (third nerve: one patient, sixth nerve: four patients, eighth nerve: two patients). Additional abnormal findings of electro-oculography, or masseter reflex, or blink reflex, or combinations of these were found in 20 patients and interpreted in favour of a brainstem lesion at the level of the respective cranial nerve. In 11 of 14 patients with isolated cranial nerve palsies as the presenting sign of multiple sclerosis, dissemination in space was documented by MRI, and in the remaining three by evoked potentials. In patients with multiple sclerosis with isolated cranial nerve palsies, MRI is the most sensitive method of documenting dissemination in space and electrophysiological testing the most sensitive at disclosing brainstem lesions.

Isolated cranial nerve palsies in multiple sclerosis

“…In the only study retrospectively investigating isolated cranial nerve palsy in MS, it was found in 1.6% of MS patients 3 . The authors conclude that isolated cranial nerve palsies more often occur as a presenting symptom than during disease relapse (p<0.001), which is consistent with our results.…”

“…Although brainstem involvement is common at MS onset and during the course of the disease, isolated cranial nerve involvement is rare in MS patients. However, magnetic resonance imaging (MRI) may fail to visualize every symptomatic demyelinating lesion [3][4][5] .…”

A Case of Multiple Sclerosis Presented with 5th, 6th and 7th Cranial Nerve Paralysis

“…4,5 İzole kraniyal sinir felçleri ise MS'nin oldukça nadir görülen bulgularındandır. 6 Kraniyal sinir tutulumunun patogenezi tam olarak aydınlatılmamış olsa da birçok çalışmada beyin sapı demyelinizasyonu ile ilişkili olarak saptanmıştır. 7 Beyin sapı tutulumu gerek başlangıçta gerekse ilerleyen hastalık döneminde MS hastalarında sık görülen bir tablodur.…”

Isolated Trochlear Nerve Palsy in Tolosa-Hunt Syndrome

“…Regarding various causes of unilateral SOMP, orbital myositis (13,14), thyroid ophthalmopathy (15), trauma (16), surgery (16), cysticercosis (16), peripheral ischemia (16), midbrain stroke (16), congenital (16), multiple sclerosis (17), ophthalmic migraine (18), aneurysm (7,8), cyst (19), neuroborreliosis (20), tumor (9,21), dural carotidcavernous sinus fistula (10), and herpes zoster ophthalmicus (22) have been noted. However, in the present patient, these various causes of unilateral SOMP (7-10, 13-22) could be excluded, based on her clinical course and MR examinations findings.…”