Cranial Neuropathies

Blunt trauma can result in a stretching injury of cranial nerves, which, when severe, can result in nerves being torn loose from the brain stem. Stretching injuries often occur at points of attachment or at points of angulation. Skull fractures and penetrating trauma such as gunshot wounds can cause nerve lacerations.

Blunt trauma most often damages cranial nerves I, VII, and VIII; less often II, III, IV, and VI; and least often V, IX, X, XI, and XII. The incidence of cranial neuropathies increases with more severe head injury. For example, the overall incidence of anosmia is about 7 percent but increases to 30 percent in patients with anterior fossa fractures or severe head injury. Even trivial head injury can result in anosmia. Injury to the optic nerves and chiasm has been reported in up to 5 percent of patients with head injuries. Ocular motility disorders occur in up to one third of patients sustaining closed head injury; the abducens nerve is the most commonly injured. Trigeminal nerve and branch injuries often occur as a result of facial trauma. Facial nerve injuries frequently occur with temporal bone fractures.

The site of likely trauma, clinical features, evaluation, management, and prognosis are summarized in T§ble.,..51-5.i


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