​Symptoms and Signs – Differential Diagnosis of Cranial nerve lesions
Ill
Vascular:
Aneurysm: posterior communicating artery, basilar (in the brainstem), in the
cavernous sinus
Infarction in the brainstem
Infarction in the nerve trunk ('medical' causes) diabetes, hypertension, SLE,
polyarteritis nodosa, giant cell arteritis
Thrombosis: in the cavernous sinus
Inflammation/infiltration of the basal meninges: TB, sarcoid, lymphoma,
carcinoma, syphilis
Tumour: brainstem, cavernous sinus, superior orbital fissure/orbit tumour/
granuloma
Tentorial herniation ('coning')
Brainstem CVA/demyelination/tumour
Cavernous sinus lesions (aneurysm, tumour, thrombosis)
lnfective/carcinomatous meningitis
Orbital tumour
Nerve trunk infarction

IV
Head trauma

V
Sensory: trigeminal neuralgia, herpes zoster, nasopharyngeal carcinoma
Cerebellopontine angle tumour (acoustic neuroma, meningioma)
Brainstem CVA/tumour/demyelination
Cavernous sinus lesions (aneurysm, tumour, thrombosis)
Neoplastic infiltration of skull base
Petrositis (Gradenigo's syndrome)

VI
Damage to the nerve's blood supply (vasa nervosum): diabetes mellitus,
hypertension
False localizing sign of increased intracranial pressure
Brainstem CVA/demyelination/tumour, Wernicke-Korsakoff syndrome
Cavernous sinus lesions
Cerebellopontine angle tumour
lnfective/carcinomatous meningitis
Petrositis (Gradenigo's syndrome)
Orbital tumour

Multiple palsies
Trauma
Basal meningeal infiltration: carcinoma, TB, sarcoid, lymphoma,
leukaemia
Brainstem lesions (CVA, tumour)
Guillain-Barre syndrome
Mononeuritis multiplex
Arnold-Chiari malformation
Paget's disease
CSF