206 11 Diseases of the Cranial Nerves

a

b

c

Fig. 11.25 Lesion of the right accessory n. in the lateral triangle of the neck. a At rest, the right shoulder is somewhat lower, and the right scapula is somewhat farther from the midline. b When the arms are raised horizontally, the contour of the levator scapulae m. is easily seen below the atrophic edge of the trapezius m. c When

d

the arms are raised vertically, the scapula tilts and the shoulder is low. d The atrophic upper edge of the trapezius m. is clearly seen in this frontal view. (From: Mumenthaler M.: Didaktischer Atlas der klinischen Neurologie. 2nd edn, Springer, Heidelberg 1986.)

Multiple Cranial Nerve Deficits

Lesions affecting more than one cranial nerve at a time are seen in various typical combinations:

Progressive involvement of multiple lower cranial nerves (Garcin syndrome) is usually due to a tumor at the base of the skull. Chronic basilar meningitis, e. g., in tuberculosis, causes multiple cranial nerve palsies in varying combinations.

Cranial polyradiculitis affects the cranial nerves symmetrically; the most prominent manifestation is bilateral facial nerve palsy.

Further causes of multiple, and possibly recurrent, cranial nerve palsies include sarcoidosis, paraproteinemia, Wegener granulomatosis, malignant otitis, and others.

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