Multiple cranial nerve palsies due to a hyperextension injury to the cervical spine

Abstract

The case of a patient with multiple bilateral cranial nerve palsies and spinal cord sparing secondary to a stable hyperextension injury to C-1 is presented.

Third, Fourth, and Sixth Cranial Nerve Palsies Following Closed Head Injury

“…He hypothesized that the injury was secondary to upward and posterior displacement of the brainstem causing stretch injury to the sixth cranial nerve as it passes through Dorello's canal under the rigid petrosphenoidal ligament. Neither of these studies (23,36) provides information as to the location of the blow. In two other reports, the mechanism is less clear.…”

“…Lindenberg (23) described a patient with a traumatic neck hyperextension who had pathologic evidence of injury to the pontine segment of the sixth cranial nerve. Schneider (36) reported two cranial nerve 6-injured patients following traumatic neck hyperextension in a motor vehicle accident who had suffered cervical vertebral but no craniofacial fractures. He hypothesized that the injury was secondary to upward and posterior displacement of the brainstem causing stretch injury to the sixth cranial nerve as it passes through Dorello's canal under the rigid petrosphenoidal ligament.…”

Trauma to the cranial nerves

“…The long intradural course, its passage over the petrous ridge with its relative fixity under the petroclinoid ligament and to the cavernous sinus makes it vulnerable to stretch or tear 39 . Hyperextension trauma to cervical spine can also cause abducens nerve palsy, accompanied with lower cranial palsies 40 .…”

“…Mild cases show recovery, while in severe and complete injuries, prognosis for recovery is poor. Paralysis of lower four cranial nerves together with that of abducens nerve has been reported after hyperextension injury to cervical spine 40,71 .…”