Update in Radiology
Cranial nerve disorders: Clinical manifestations and topography
Sintomatología derivada de los pares craneales: Clínica y topografía
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A) Corte axial a nivel de la protuberancia, que muestra el trayecto fascicular y cisternal del VII par (flecha blanca) y VIII par en ángulo pontocerebeloso (flecha negra). B) Posición relativa del nervio facial (F), coclear (C), vestibular superior (Vs) e inferior (Vi) en vértice del conducto auditivo interno. C y D) Los cortes axiales de secuencias potenciadas en T1 poscontraste muestran sendos neurinomas del acústico. Ambos muestran la típica morfología en cono de helado de estos tumores, con componente intracanalicular y cisternal, y componente quístico con ausencia de realce en D, también frecuente en estos tumores. En ambos casos, el tumor comprime el pedúnculo cerebeloso medio adyacente (asterisco). E) Corte axial de secuencia potenciada en T1 poscontraste que muestra una tumoración con realce homogéneo en la cisterna del ángulo pontocerebeloso y extensión al interior del conducto auditivo interno correspondiente a un meningioma. Puede apreciarse la amplia base de implantación y cola dural (flecha), hallazgos que permiten diferenciarlo del schwannoma.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Jorquera Moya, S. Merino Menéndez, J. Porta Etessam, J. Escribano Vera, M. Yus Fuertes" "autores" => array:5 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Jorquera Moya" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Merino Menéndez" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Porta Etessam" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Escribano Vera" ] 4 => array:2 [ "nombre" => "M." 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Part 2: Low-flow lesions" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "124" "paginaFinal" => "133" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Malformaciones vasculares y tumores de partes blandas. Parte 2: lesiones de bajo flujo" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0045" "etiqueta" => "Figure 9" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr9.jpeg" "Alto" => 698 "Ancho" => 1750 "Tamanyo" => 113661 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">17-Year-old female with Surge–Weber syndrome. Susceptibility weighted image (a) shows atrophy and cortical mineralization involving the sulcus of the right parietal-temporal occipital convexity (arrows), reflecting low vascular malformations in the pia mater. Marked right calvarial thickening is seen on axial T2-weighted (b) and coronal T1-weighted (c) images. Facial capillary malformation was present on clinical exam.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. Flors, K.D. Hagspiel, A.W. Park, P.T. Norton, C. Leiva-Salinas" "autores" => array:5 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Flors" ] 1 => array:2 [ "nombre" => "K.D." "apellidos" => "Hagspiel" ] 2 => array:2 [ "nombre" => "A.W." "apellidos" => "Park" ] 3 => array:2 [ "nombre" => "P.T." "apellidos" => "Norton" ] 4 => array:2 [ "nombre" => "C." "apellidos" => "Leiva-Salinas" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0033833818301486" "doi" => "10.1016/j.rx.2018.02.012" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0033833818301486?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510718300715?idApp=UINPBA00004N" "url" => "/21735107/0000006100000002/v1_201903140618/S2173510718300715/v1_201903140618/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173510719300060" "issn" => "21735107" "doi" => "10.1016/j.rxeng.2019.01.005" "estado" => "S300" "fechaPublicacion" => "2019-03-01" "aid" => "1101" "copyright" => "SERAM" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Radiologia. 2019;61:94-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 6 "formatos" => array:2 [ "HTML" => 2 "PDF" => 4 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Radiology today</span>" "titulo" => "Evaluation of a multidisciplinary training programme in magnetic resonance imaging of patients with axial spondyloarthritis: PROGRESSES Project" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "94" "paginaFinal" => "98" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evaluación de un programa de formación multidisciplinar en resonancia magnética en espondiloartritis axial: Proyecto PROGRESSES" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1626 "Ancho" => 2184 "Tamanyo" => 155324 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Percentage of responses among radiologists and rheumatologists concerning the situation in which magnetic resonance imaging contributes most to the study of patients with inflammatory spinal pain/spondyloarthritis.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Almodóvar, P. Zarco, E. Loza, Á. Bueno" "autores" => array:4 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Almodóvar" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Zarco" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Loza" ] 3 => array:2 [ "nombre" => "Á." 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Jorquera Moya, S. Merino Menéndez, J. Porta Etessam, J. Escribano Vera, M. Yus Fuertes" "autores" => array:5 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Jorquera Moya" "email" => array:1 [ 0 => "manuela.jorquera@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "S." "apellidos" => "Merino Menéndez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "Porta Etessam" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Escribano Vera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "M." "apellidos" => "Yus Fuertes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Sección de Neurorradiología, Hospital Clínico San Carlos, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Neurorradiología, Hospital Ruber Internacional, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sintomatología derivada de los pares craneales: Clínica y topografía" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0040" "etiqueta" => "Figure 8" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr8.jpeg" "Alto" => 1168 "Ancho" => 3000 "Tamanyo" => 245263 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Carotid paraganglioma. (A) Echo-Doppler showing a solid tumour that separates the carotid bifurcation. (B) The post-contrast computed tomography image shows intense heterogeneous enhancement of the mass at the carotid bifurcation. (C) In the reformatted parasagittal image we see the lesion in the bifurcation separating both carotids (lyre sign), while the vagal paraganglioma displaces them anteromedially.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Anatomy of memory</span><p id="par0005" class="elsevierStylePara elsevierViewall">There are 12 pairs of cranial nerves that connect the brain stem with structures of the head and neck and the thoracic and abdominal cavities. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarises the anatomical course of cranial nerves III to XII.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">There are three types according to their function: sensory, motor and mixed nerves. <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> lists the nomenclature, function and clinical semiology of the cranial nerves.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">In each cranial nerve, the intra-axial (nucleus and fascicle), cisternal, dural and interdural, bony or foraminal and extraforaminal segments are differentiated.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">1</span></a> The <span class="elsevierStyleItalic">nuclei</span> are distributed from the midbrain to the proximal cervical cord.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">cisternal segment</span> has two parts, a central one, myelinated by oligodendrocytes, and a peripheral one whose myelin is formed by Schwann cells. Between both segments is the transition or Steiner-Redlich zone, variable from one pair to another, more vulnerable to neurovascular compression and threshold for the location of schwannomas (distal to this).</p><p id="par0025" class="elsevierStylePara elsevierViewall">In some nerves, a <span class="elsevierStyleItalic">dural segment</span> can be identified, located in a dural evagination with cerebrospinal fluid (CSF) content such as Meckel's <span class="elsevierStyleItalic">cave</span>.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">interdural segment</span> is located between two dura mater sheets and is occupied by venous plexuses such as the cavernous sinus.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">foraminal segment</span>, also surrounded by venous plexuses, is located at the base of the skull.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">extraforaminal segment</span> corresponds to the extracranial nerve course.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Imaging techniques</span><p id="par0045" class="elsevierStylePara elsevierViewall">Magnetic resonance imaging (MRI) is the technique of choice for the evaluation of cranial nerves.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The intra-axial segment can be evaluated by means of the usual sequences for the study of the brain. The remaining segments require specific sequences, and these are the SSFP (Steady-State Free Precession), named as 3D FIESTA/CISS, Fast Imaging Employing Steady-state Acquisition/Constructive Interference Steady State sequences, which demonstrate the cranial nerves in their cisternal path, and when post-contrast has been performed, the interdural and foraminal trajectories by the enhancement of the venous plexuses.<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">2–4</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The 3D FLAIR sequence makes it possible to see the cistern segments and the detection of post-contrast enhancements in these and in the meninges.<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The 2D FSE T1, T1 post-contrast and T2 with fat suppression and post-contrast sequences 3D T1 with fat suppression make it possible to evaluate the cisternal, foraminal and extraforaminal segments, and the course in the craniofacial region of the terminal branches of the cranial nerves.</p><p id="par0065" class="elsevierStylePara elsevierViewall">In neurovascular compression syndromes, angiographic sequences are useful, mainly 3D TOF. The visualisation of the images co-registered with the FIESTA/CISS sequence facilitates the interpretation of the findings.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">7</span></a> The sequences of time-resolved imaging of contrast kinetics (TRICKS) are especially indicated when a dural fistula or AVM is suspected.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">8</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The nerves of greater section allow for their microstructural evaluation by means of diffusion tensor sequencing.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">9</span></a> Tractography can be useful in locating some of the nerves that are difficult to identify in the case of expansive processes.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">10</span></a><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> summarises the main sequences that must be performed in case of pathology of the cranial nerves.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Computed tomography (CT) complements magnetic resonance imaging (MRI), which allows us to evaluate the foramina and intraosseous trajectories of the cranial nerves at the base of the skull, especially the petrous apex (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Semiology and pathology of cranial nerves I and II</span><p id="par0080" class="elsevierStylePara elsevierViewall">Nerves I (olfactory nerve) and II (optic nerve) are considered prolongations of white matter tracts of the central nervous system. They do not follow the anatomical classification or division into the same segments as the rest of the cranial nerves; nor do they share the same pathology, so clinical semiology and pathology will be dealt with separately.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Olfactory disorders</span><p id="par0085" class="elsevierStylePara elsevierViewall">The olfactory nerve consists of a set of unmyelinated nerve fillets that arise from the olfactory portion of the pituitary mucosa in the roof of the nostril; said fillets cross the lamina cribrosa and end in the ventral region of the <span class="elsevierStyleItalic">olfactory bulb</span> where they synapse with the second neuron (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The efferent axons leave the olfactory bulb and reach the olfactory cortex through the olfactory tract.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Anosmia can occur due to injury at any location of the olfactory pathway. When it is unilateral, the location is proximal to the piriform cortex. The most common causes are sinonasal inflammatory pathology and trauma of the base of the skull.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">11</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Esthesioneuroblastoma, or olfactory neuroblastoma, is a rare tumour in older adults that derives from the basal cells of the olfactory mucosa. Patients may present with nasal congestion, epistaxis, anosmia and headache. They tend to be large tumours at diagnosis. Although there is usually microscopic dural involvement, in 30% the intracranial invasion is clear, and in these cases non-tumour cysts are common in the tumour-brain parenchyma interface (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">12</span></a></p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Other causes of anosmia in the conductive pathway are neoplasms of the nasal cavity and paranasal sinuses, toxic substances such as cocaine and tobacco and, in the central sensorineural area, Kallmann syndrome, infections, meningioma, surgery and radiation. Hyposmia is also common in the early stages of Alzheimer's and Parkinson's diseases.<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">13</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Optic neuropathy</span><p id="par0105" class="elsevierStylePara elsevierViewall">It is characterised by specific signs and symptoms shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.</p><p id="par0110" class="elsevierStylePara elsevierViewall">The optic pathway includes the optic nerves, the chiasm and the retrochiasmatic structures (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">In the optic nerve several segments are distinguished: <span class="elsevierStyleItalic">intraocular</span> (formed by the axons of ganglion cells of the retina), <span class="elsevierStyleItalic">intraorbital</span> (intraconal, surrounded by meninges), <span class="elsevierStyleItalic">intracanalicular</span> (in the optic canal) and <span class="elsevierStyleItalic">intracranial</span> (10<span class="elsevierStyleHsp" style=""></span>mm before the chiasm, coated only by pia mater). The optic nerves join to form the chiasm where the fibres of the nasal retina of each nerve decussate and join the fibres of the temporal retina not discussed to form the <span class="elsevierStyleItalic">optical strips</span>. These are directed to the lateral geniculate bodies, continuing with the optical radiation to the medial region of the occipital lobe.</p><p id="par0120" class="elsevierStylePara elsevierViewall">The sudden presentation of visual deficit points towards ischaemic, demyelinating or traumatic aetiologies, while progressive deficit is characteristic of the infiltrative or compressive processes.</p><p id="par0125" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Lesions of the intraorbital segment</span> of the optic nerve cause a central scotoma.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Non-arteritic anterior ischaemic optic neuropathy (NAION) is the most common cause of unilateral vision loss and papilloedema (papillitis) in adult individuals (older than 50 years) with cardiovascular risk factors, while in older patients NAION is caused by giant cell arteritis.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Optic neuritis is inflammation of the optic nerve secondary to demyelination. Typically, it affects adults between 20 and 50 years old (more common in women). It is rare in children.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">14</span></a> Diagnosis is clinical. MRI can show thickening of the optic nerve and signal hyperintensity in T2 and post-contrast enhancement, indistinguishable from other inflammatory processes. The presence of lesions in cerebral white matter in MRI is the most important predictor for the development of multiple sclerosis; therefore, in the face of an episode of optic neuritis, the MRI study is mainly aimed at detecting demyelinating encephalic lesions.</p><p id="par0140" class="elsevierStylePara elsevierViewall">The remaining causes that produce optic neuropathy can be seen in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">In <span class="elsevierStyleItalic">the orbital apex</span>, the defect is usually sectoral.</p><p id="par0150" class="elsevierStylePara elsevierViewall">The compression of the body of the <span class="elsevierStyleItalic">chiasm</span> produces a bitemporal hemianopsia, more commonly produced by pituitary tumours.</p><p id="par0155" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Post-chiasmatic lesions</span> lead to congruent homonymous deficits, which means identical defects in each eye, and respect the macula.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Semiology and pathology of cranial nerves III–XII</span><p id="par0160" class="elsevierStylePara elsevierViewall">The isolated involvement of the cranial nerves can be associated with specific clinical signs and symptoms (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). The complex lesions that associate paralysis of several pairs are due to meningeal pathology, of the trunk and of the base of the skull. The lesions in the trunk associate motor and sensory deficits.</p><p id="par0165" class="elsevierStylePara elsevierViewall">The pathology of the cranial nerves, according to the affected anatomical segment, can be seen in <a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>.</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">Although there are peculiarities of each cranial pair, cranial nerves III–XII share some pathological processes:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0175" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Glioma of the trunk</span> is more common in children and in the pons. It is usually a low-grade diffuse glioma. In MRI, the characteristic image is an infiltrative lesion, expansive, heterogeneous in T2 and hypointense in T1 with variable enhancement. It frequently produces paralysis of nerves VI and VII, ataxia and signs of involvement of long tracts.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0180" class="elsevierStylePara elsevierViewall">In adults, the tumours that most frequently affect the trunk are metastases, especially lung and breast metastases, and lymphoma.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0185" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Trunk syndromes</span> are usually of ischaemic origin. They combine motor and sensory deficits with cranial nerve palsy (<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>).</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0190" class="elsevierStylePara elsevierViewall">In MRI, the <span class="elsevierStyleItalic">infectious involvement of the trunk</span> is manifested by increase of volume, signal hyperintensity in T2 and enhancement (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">•</span><p id="par0195" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Meningeal involvement with involvement of the cisternal segment</span> by inflammatory and tumour processes, such as meningeal carcinomatosis and lymphoma, often results in deficits of multiple cranial nerves that are usually progressive. The MRI shows enhancement and thickening of the cisternal segments of the nerves, and meningeal enhancements, and often it is the 3D-FLAIR post-contrast sequence that is the most sensitive for its detection.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">6</span></a> They usually manifest with involvement of VII, III, VI and lower cranial nerves IX, X and XI. In the differentiation of inflammatory and tumour involvement, clinical correlation and laboratory tests, especially the CSF analysis, will be essential (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>).</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">•</span><p id="par0200" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Schwannoma or neurinoma</span> is the most common primary neoplasm of the cranial nerves. It originates in the myelin sheath of the cranial nerves, most often in the sensory nerves. When it occurs in mixed or motor nerves, type 2 neurofibromatosis or schwannomatosis is usually associated and it affects multiple nerves. The most common location is the lower division of the VIII pair, followed by the V, X, XII and VII.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">15</span></a> In the VIII pair they appear as intracanalicular and cistern masses with characteristic morphology of an ice-cream cone. Less frequently they are exclusively intracanalicular, extracanalicular or labyrinthine (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>).</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel"><span class="elsevierStyleBold">•</span></span><p id="par0205" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Neurofibromas</span> can originate from Schwann cells, from other perineurial cells or from fibroblasts. They are more common outside the skull and are associated with type 1 neurofibromatosis. In the image they are well defined, they can contain calcification and they enhance moderately. Haemorrhage and cysts are less common.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">15</span></a></p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">•</span><p id="par0210" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Paragangliomas</span> are neuroendocrine tumours that are derived from the chromaffin cells of the extrarenal paraganglionic system. They usually establish themselves in four different locations: in the carotid bifurcation, accompanying the vagal nerve, in the jugular foramen and in the middle ear. They are usually familiar and multicentric. The most common are the carotid and jugular paragangliomas. Although usually benign, paragangliomas can malignify in 3–4% of cases.<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">16</span></a></p></li></ul></p><p id="par0215" class="elsevierStylePara elsevierViewall">In the jugular foramen, they affect the lower cranial nerves and manifest as solid tumours with lobulated or oval morphology. Occasionally, they may extend to the middle ear (jugulotympanic paraganglioma) (<a class="elsevierStyleCrossRef" href="#fig0035">Fig. 7</a>). Carotid and vagal paragangliomas have the same characteristics in MRI, although they do not destroy the bone, as they are far from it. The different displacement they produce from the internal and external carotids is used to differentiate them (<a class="elsevierStyleCrossRef" href="#fig0040">Fig. 8</a>).</p><elsevierMultimedia ident="fig0035"></elsevierMultimedia><elsevierMultimedia ident="fig0040"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Ophthalmoplegia and diplopia</span><p id="par0220" class="elsevierStylePara elsevierViewall">Binocular diplopia is the main symptom caused by lesion or pathology of nerves III, IV and VI, which supply the extraocular muscles (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Involvement of the intra-axial segment</span><p id="par0225" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Ischaemia</span> occurs more frequently in the pons. At this level, infarcts do not cross the midline and follow the distribution of the perforating branches of the basilar artery. In the midbrain, however, they can cross the midline and produce a more complex oculomotor symptomatology (<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>).</p><p id="par0230" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Wernicke encephalopathy</span> is a serious clinical picture caused by thiamine deficiency. It is characterised by ophthalmoplegia, ataxia and encephalopathy. It is reversible if intravenous vitamin B<span class="elsevierStyleInf">1</span> therapy is started early.</p><p id="par0235" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Miller-Fisher syndrome</span> is the most common form of non-classical variants of Guillain–Barré syndrome; it is characterised by partial or complete ophthalmoplegia, sensory ataxia, and areflexia. While MRI may show enhancement of cranial nerves, it is not necessary to perform it for diagnosis.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">17</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Involvement of the cisternal segment</span><p id="par0240" class="elsevierStylePara elsevierViewall">The most common causes of third nerve palsy in adults are ischaemia, the mass effect due to aneurysm, uncal herniation and tumours.</p><p id="par0245" class="elsevierStylePara elsevierViewall">The microvascular involvement of the <span class="elsevierStyleItalic">III cranial nerve</span> may be responsible for its paralysis, or isolated paresis, in up to 75% of cases in individuals older than 45 years-old with cardiovascular risk factors. Less frequently, it is also a cause of isolated paresis of nerves IV and VI in adults.<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">18–20</span></a></p><p id="par0250" class="elsevierStylePara elsevierViewall">The extrinsic compression of the III cranial nerve usually produces non-reactive mydriasis. In these cases, it is necessary to rule out an aneurysm in the posterior communicating artery, and, to a lesser extent, in the tip of the basilar artery. However, in patients younger than 45 years-old, even without pupillary involvement, a compressive cause should be ruled out. The expansive processes of the cerebral hemispheres that cause transtentorial herniation can produce paralysis or paresis isolated from the III and VI nerves.</p><p id="par0255" class="elsevierStylePara elsevierViewall">The trochlear nerve, however, is the most vulnerable to head injuries.<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">19</span></a></p><p id="par0260" class="elsevierStylePara elsevierViewall">The involvement of primary tumours such as schwannoma is rare, and is more common in neurofibromatosis type 2 and in schwannomatosis. Compression is more common due to extra-axial tumours (epidermoid cysts) and secondary involvement (meningeal carcinomatosis, leukaemic or lymphomatous infiltration). Clivus tumours such as meningiomas, metastases, and bone tumours such as chordoma often affect the VI nerve (<a class="elsevierStyleCrossRefs" href="#fig0025">Figs. 5, 9 and 10</a>).<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">21</span></a></p><elsevierMultimedia ident="fig0045"></elsevierMultimedia><elsevierMultimedia ident="fig0050"></elsevierMultimedia><p id="par0265" class="elsevierStylePara elsevierViewall">In childhood, <span class="elsevierStyleItalic">ophthalmoplegic migraine</span> (considered an idiopathic inflammatory cranial mononeuropathy) presents with recurrent headaches and paresis of one or more oculomotor nerves (<a class="elsevierStyleCrossRef" href="#fig0045">Fig. 9</a>).<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">22</span></a></p><p id="par0270" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Lesions of the cavernous sinus</span> can produce ophthalmoplegia (III, IV, and VI), anisocoria or mydriasis (III), and deficits of V1 and V2, chemosis, proptosis, and Horner syndrome due to involvement of the oculosympathetic fibres around the internal carotid artery (<a class="elsevierStyleCrossRef" href="#fig0055">Fig. 11</a> and <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="fig0055"></elsevierMultimedia><p id="par0275" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Lesions in the superior orbital fissure</span> or sphenoid cleft lead to the involvement of III, IV, VI and V1 nerves and of the superior ophthalmic vein with ophthalmoplegia, V1 neuropathy, proptosis, chemosis and fixed mydriasis.</p><p id="par0280" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Tolosa-Hunt syndrome</span>, self-limiting and recurrent painful ophthalmoplegia, produced by a granulomatous inflammation of the cavernous sinus or superior orbital fissure, is a diagnosis of exclusion. In the differential diagnosis, meningioma and lymphoma must be included.</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Trigeminal neuropathy</span><p id="par0285" class="elsevierStylePara elsevierViewall">Trigeminal neuropathy produces anaesthesia, pain or burning in the regions supplied by each branch (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). MRI is essential for diagnosis.</p><p id="par0290" class="elsevierStylePara elsevierViewall">Involvement of the <span class="elsevierStyleItalic">nuclear or fascicular segment</span> may be the first presenting symptom of multiple sclerosis.</p><p id="par0295" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">involvement of the cisternal segment</span> can be manifested with paresis, sensory symptoms and decreased corneal reflex. The most common pathologies are tumours, infections and vascular compression (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>) (<a class="elsevierStyleCrossRefs" href="#fig0025">Figs. 5, 10 and 12</a>). It can also manifest with neuralgia, most frequently in the territory of V2 and V3. In individuals older than 40 years-old, it is usually idiopathic, although vascular compression is sometimes demonstrated. The most vulnerable nerve portion corresponds to the transition zone. The arteries most commonly involved are the superior cerebellar artery and the anterior inferior cerebellar artery; venous compression is less common. The presence of atrophy or distortion and displacement of the nerve will support the diagnosis of neurovascular compression.<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">23</span></a> Some authors propose performing a DTI sequence which demonstrates a decrease of the values of fractional anisotropy in the affected nerve.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">9</span></a></p><elsevierMultimedia ident="fig0060"></elsevierMultimedia><p id="par0300" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">cavernous sinus and the orbital apex</span> are common sites of perineural dissemination of some neurotropic tumours, such as adenoid cystic, mucoepidermoid and squamous cell carcinomas, melanoma and lymphoma. As in the lesions of the superior orbital fissure, the involvement is usually limited to V1. The MRI showed thickening and enhancement of the affected nerve and signs of secondary denervation.</p><p id="par0305" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Petrous apex syndrome</span> or <span class="elsevierStyleItalic">Gradenigo's syndrome</span> consists of paralysis of the VI nerve with hypesthesia and pain in the territory of V1. Divisions V2 and V3 may also be affected at times. Among the causes are suppurative otitis media or mastoiditis, neoplasms, traumatisms, inferior petrosal sinus thrombosis, etc.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Facial paralysis</span><p id="par0310" class="elsevierStylePara elsevierViewall">Involvement of the facial nerve results in peripheral facial paralysis, while involvement of the supranuclear structures produces central facial paralysis.</p><p id="par0315" class="elsevierStylePara elsevierViewall">Peripheral paralysis is idiopathic in 80% of cases (Bell's palsy). Imaging studies are indicated when there is a deficit of other cranial nerves, there is no clinical recovery after 3–6 weeks from the onset of symptoms or there are muscle spasms or contractions, which suggests a structural cause.</p><p id="par0320" class="elsevierStylePara elsevierViewall">In the <span class="elsevierStyleItalic">cisternal segment</span>, facial paralysis is commonly attributed to tumoural causes: meningeal carcinomatosis, acoustic neurinomas, or more rarely of the facial nerve or lymphoma (<a class="elsevierStyleCrossRef" href="#fig0050">Fig. 10</a>).<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">24</span></a></p><p id="par0325" class="elsevierStylePara elsevierViewall">Involvement of the nerve in the <span class="elsevierStyleItalic">facial canal</span> is, most commonly, secondary to infections of the middle ear and especially to cholesteatomas (which present restriction to diffusion in the diffusion sequences), and less commonly to tumours such as schwannomas, hemangiomas, meningiomas, jugulotympanic paragangliomas and malignant bone tumours, especially chondrosarcoma (<a class="elsevierStyleCrossRef" href="#fig0065">Fig. 13</a>).</p><elsevierMultimedia ident="fig0065"></elsevierMultimedia><p id="par0330" class="elsevierStylePara elsevierViewall">The presence of post-contrast enhancement in MRI of the intracanalicular or labyrinthine portions should always be considered anomalous, while the enhancement in the rest of the portions, including the genicular nerve, should not be interpreted as a pathological finding.</p><p id="par0335" class="elsevierStylePara elsevierViewall">Traumatisms with fracture of the petrous can cause facial paralysis, especially in longitudinal fractures (the most common), which usually involve the geniculate ganglion fossa, where the facial canal is weakest.<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">24</span></a></p><p id="par0340" class="elsevierStylePara elsevierViewall">The presence of peripheral facial paralysis secondary to a <span class="elsevierStyleItalic">parotid lesion</span> should suggest a malignant neoplasm.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Hemifacial spasm</span><p id="par0345" class="elsevierStylePara elsevierViewall">It is considered a neurovascular compression syndrome of the face, normally produced by the anterior inferior (AICA) and posterior inferior cerebellar arteries (PICA) and the vertebral arteries.<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">23</span></a></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Sensorineural hearing loss, tinnitus and/or vertigo</span><p id="par0350" class="elsevierStylePara elsevierViewall">Audiovestibular symptoms, such as asymmetric hearing loss, sudden sensorineural hearing loss, tinnitus and vertigo, should make us suspect pathology of the VIII nerve.</p><p id="par0355" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Hearing loss</span> must be sensorineural to be attributed to involvement of the VIII nerve. Imaging studies are indicated in young people, and in older people when it is clearly asymmetric or unilateral.</p><p id="par0360" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Tinnitus</span> is the perception of sound without any external sound source. The majority are primary, without an identifiable cause.</p><p id="par0365" class="elsevierStylePara elsevierViewall">Non-pulsatile tinnitus only requires imaging tests (MRI) when hearing loss, vertigo or headache is associated.<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">25,26</span></a> Pulsatile tinnitus can be secondary to an anomaly or vascular tumour.</p><p id="par0370" class="elsevierStylePara elsevierViewall">The causality of some variants of normality in the production of tinnitus, such as the high jugular gulf<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">27–29</span></a> or the vascular loops in contact with the VIII nerve is unclear. While for some authors these vascular loops (e.g. AICA) are anatomical variants with no clinical correlation,<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">30–32</span></a> others have found a higher incidence of such loops in patients with pulsatile tinnitus.<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">33,34</span></a></p><p id="par0375" class="elsevierStylePara elsevierViewall">The most common structural lesion in the internal auditory canal (IAC) or cerebellopontine angle associated with hearing loss and tinnitus is vestibular schwannoma (acoustic neurinoma) (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>).</p><p id="par0380" class="elsevierStylePara elsevierViewall">Prolonged <span class="elsevierStyleItalic">vertigo</span> of acute onset is due to a loss of vestibular function, which is usually unilateral. The clinical examination is fundamental in the distinction between central and peripheral lesion.</p><p id="par0385" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Vestibular paroxysm</span> is considered a neurovascular compression syndrome of the VIII pair, most often caused by the anterior inferior and posterior inferior cerebellar arteries and the vertebral arteries.<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">23</span></a></p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Lower cranial nerve neuropathy (IX, X, XI and XII)</span><p id="par0390" class="elsevierStylePara elsevierViewall">The anatomical relationship of the lower cranial nerves IX, X and XI favours the joint complex neuropathy of all of them. Although the hypoglossal nerve (XII nerve) presents a different path at the base of the skull, its proximity means that it is also usually affected by the same pathologies, which is why it is included in this section.</p><p id="par0395" class="elsevierStylePara elsevierViewall">In the cistern of the cerebellopontine angle, fusiform aneurysms of the vertebral artery and PICA, due to mass effect, can cause symptoms of lower nerves.</p><p id="par0400" class="elsevierStylePara elsevierViewall">The remaining causes of involvement in the trunk and in the cisternal path are common to the rest of the cranial nerves (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><p id="par0405" class="elsevierStylePara elsevierViewall">At the base of the skull, they also share with the remaining cranial nerves the same causes of involvement of this segment, such as neoplasms (especially metastasis and chordoma), infections or trauma. The pathology that establishes itself in the jugular foramen causes simultaneous injury and combined neuropathy of nerves IX, X and XI, which is known as <span class="elsevierStyleItalic">Vernet's syndrome</span> or <span class="elsevierStyleItalic">jugular foramen syndrome</span>. It is usually caused by tumours, the most common being meningioma, schwannoma and paraganglioma; the latter more specific to this region (<a class="elsevierStyleCrossRef" href="#fig0035">Fig. 7</a>).</p><p id="par0410" class="elsevierStylePara elsevierViewall">In the <span class="elsevierStyleItalic">suprahyoid neck</span>, the lower cranial nerves can be affected by carotid and vagal paragangliomas, schwannomas, malignant tumours, dissections and aneurysms of the internal carotid artery, and abscesses (<a class="elsevierStyleCrossRef" href="#fig0040">Fig. 8</a>).</p><p id="par0415" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">isolated involvement of the glossopharyngeal nerve (IX nerve pair)</span> can manifest with sensory, motor and autonomic symptoms. Glossopharyngeal neuralgia may occur as a consequence of vascular compression, and may involve a branch of the PICA, the vertebral artery or a compression of the nerve between both.<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">23</span></a> Exceptionally, in its extracranial segment, entrapment of the nerve by an elongated styloid or by ossification of the stylohyoid ligament (Eagle's syndrome) may occur.</p><p id="par0420" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">isolated involvement of the vagus nerve (X nerve pair)</span> usually occurs in the infrahyoid region of the neck, where only the vagus nerve continues to the mediastinum.</p><p id="par0425" class="elsevierStylePara elsevierViewall">Isolated peripheral vagal neuropathy (recurrent laryngeal nerve) manifests with dysphonia secondary to paralysis of the ipsilateral laryngeal muscles (except the cricothyroid muscle), including the vocal cord. While on the left side, the recurrent laryngeal nerve turns around in the aortic arch and is affected with lesions of the latter (aneurysms) and mediastinal tumours or adenopathies, on the right side, said nerve ascends before, after surrounding the subclavian artery. Both can be injured by iatrogenesis, trauma or extralaryngeal neoplasm (especially oesophageal or pulmonary).</p><p id="par0430" class="elsevierStylePara elsevierViewall">The involvement of the vagus nerve distal to the origin of the recurrent laryngeal nerve may be caused by thoracic or abdominal neoplasms, compression by aortic aneurysm, cardiomegaly or TB sequelae.</p><p id="par0435" class="elsevierStylePara elsevierViewall">In imaging, atrophy due to denervation of the proximal vagus is manifested by a decrease in the constricting muscles of the pharynx, and dilatation of the airway on the same side in the oropharynx and hypopharynx. More caudally, radiological findings are related to paralysis of the vocal cord (<a class="elsevierStyleCrossRef" href="#fig0070">Fig. 14</a>).</p><elsevierMultimedia ident="fig0070"></elsevierMultimedia><p id="par0440" class="elsevierStylePara elsevierViewall">The technique of choice in suspected proximal vagal neuropathy is MRI, including in the study of the spinal cord and neck to the hyoid. When the vagal neuropathy is distal or peripheral, prior to direct otorhinolaryngological examination, a CT scan should be performed with intravenous iodinated contrast, exploring from the hyoid to the mediastinum; and even the carina in the case of left neuropathy.<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">16</span></a></p><p id="par0445" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">isolated involvement of the spinal accessory nerve (XI nerve pair)</span> occurs more commonly in the posterior triangle of the neck, after surgical interventions, by tumour or infectious infiltration (tuberculosis) of the cervical lymph nodes or trauma with shoulder dislocation. In the image, signs of denervation of the sternocleidomastoid or trapezius muscles can be observed (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">35</span></a></p><p id="par0450" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">isolated involvement of the hypoglossal nerve (XII nerve pair)</span> produces atrophy of the tongue. In cases of chronic atrophy, the most common findings on CT scan and MRI are fatty infiltration and prolapse of the tongue towards the oropharynx. It can be injured in the base of the skull (hypoglossal canal) by primary (chordomas or meningiomas) or metastatic tumours, and fractures of the occipital condyle, and, in the neck, by nasopharyngeal or lingual carcinomas, adenopathies or dissection of the internal carotid artery.<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">36</span></a></p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Horner syndrome</span><p id="par0455" class="elsevierStylePara elsevierViewall">It is produced by interruption of the oculosympathetic pathway. It is defined by the presence of miosis, ptosis (with apparent enophthalmos) and anhidrosis.</p><p id="par0460" class="elsevierStylePara elsevierViewall">The aetiology depends on the place where the pathway formed by three neurons is affected:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">•</span><p id="par0465" class="elsevierStylePara elsevierViewall">The 1st neuron (<span class="elsevierStyleItalic">central</span>) can be injured in the hypothalamus, brain stem (infarcts, demyelinating diseases) or in the cervical cord (trauma, tumours, syringomyelia, etc.). Brain MRI should be performed in patients with cerebral or brain stem symptoms.<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">37</span></a></p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">•</span><p id="par0470" class="elsevierStylePara elsevierViewall">The 2nd neuron (<span class="elsevierStyleItalic">preganglionic</span>) originates in the cervicothoracic cord (trauma, paravertebral tumours, spondylosis, etc.), reaches the sympathetic chain from the roots C8–T2 (lesions in the lower brachial plexus by traumatic avulsion, tumours of the apex pulmonary) and ascends to the superior cervical ganglion, close to the carotid bulb (thyroid carcinomas, surgery).</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">•</span><p id="par0475" class="elsevierStylePara elsevierViewall">In the absence of brain symptoms, MRI or CT scan studies should be directed to the neck, and cover the area from the angle of the jaw (superior cervical ganglion), or C2–C3 to T2.<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">37</span></a></p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">•</span><p id="par0480" class="elsevierStylePara elsevierViewall">The 3rd neuron (<span class="elsevierStyleItalic">postganglionic</span>) begins in the superior cervical ganglion. The vasomotor fibres and those destined for the sweat glands of the face ascend with the external carotid artery (lesions distal to the superior cervical ganglion do not produce facial anhidrosis). The remaining oculosympathetic fibres ascend with the internal carotid artery to the cavernous sinus, from where they reach their target organs transmitted by V1. Horner syndrome will be caused by any injury that dilates or compresses the internal carotid artery or exerts pressure on the carotid plexus. Among the most common causes are carotid dissection, cavernous sinus lesions and cluster headache. The examination of choice is MRI and angiography using MRI or CT scan (<a class="elsevierStyleCrossRef" href="#fig0075">Fig. 15</a>).<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">37</span></a></p><elsevierMultimedia ident="fig0075"></elsevierMultimedia></li></ul></p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusions</span><p id="par0485" class="elsevierStylePara elsevierViewall">The set of 12 pairs of cranial nerves constitutes a section of the highly complex nervous system, and is a diagnostic challenge both from a clinical and radiological point of view. Knowledge of anatomy and clinical orientation are crucial for the choice of the most appropriate study protocol and detection of the pathology. The imaging technique of choice for cranial nerve pathology is MRI, as it is the only technique that allows direct visualisation of the cranial nerves, supplemented, when necessary, by other techniques such as CT scan, ultrasound or angiography.</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Authorship</span><p id="par0490" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">1.</span><p id="par0495" class="elsevierStylePara elsevierViewall">Responsible for the integrity of the study: MJM.</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">2.</span><p id="par0500" class="elsevierStylePara elsevierViewall">Study conception: MJM.</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">3.</span><p id="par0505" class="elsevierStylePara elsevierViewall">Study design: MJM.</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">4.</span><p id="par0510" class="elsevierStylePara elsevierViewall">Data collection: MJM, SMM, JPE, JEV and MYF.</p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">5.</span><p id="par0515" class="elsevierStylePara elsevierViewall">Analysis and interpretation of data: MJM, SMM, JPE, JEV and MYF.</p></li><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">6.</span><p id="par0520" class="elsevierStylePara elsevierViewall">Statistical processing: Not applicable.</p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">7.</span><p id="par0525" class="elsevierStylePara elsevierViewall">Literature search: MJM, SMM, JPE, JEV and MYF.</p></li><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">8.</span><p id="par0530" class="elsevierStylePara elsevierViewall">Drafting of the paper: MJM, SMM, JPE, JEV and MYF.</p></li><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">9.</span><p id="par0535" class="elsevierStylePara elsevierViewall">Critical review of the manuscript with intellectually relevant contributions: MJM, SMM and MYF.</p></li><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">10.</span><p id="par0540" class="elsevierStylePara elsevierViewall">Approval of the final version: MJM, SMM, JPE, JEV and MYF.</p></li></ul></p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of interest</span><p id="par0545" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:21 [ 0 => array:3 [ "identificador" => "xres1163745" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1089322" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1163746" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1089323" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Anatomy of memory" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Imaging techniques" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Semiology and pathology of cranial nerves I and II" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Olfactory disorders" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Optic neuropathy" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Semiology and pathology of cranial nerves III–XII" ] 10 => array:3 [ "identificador" => "sec0035" "titulo" => "Ophthalmoplegia and diplopia" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Involvement of the intra-axial segment" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Involvement of the cisternal segment" ] ] ] 11 => array:2 [ "identificador" => "sec0050" "titulo" => "Trigeminal neuropathy" ] 12 => array:2 [ "identificador" => "sec0055" "titulo" => "Facial paralysis" ] 13 => array:2 [ "identificador" => "sec0060" "titulo" => "Hemifacial spasm" ] 14 => array:2 [ "identificador" => "sec0065" "titulo" => "Sensorineural hearing loss, tinnitus and/or vertigo" ] 15 => array:2 [ "identificador" => "sec0070" "titulo" => "Lower cranial nerve neuropathy (IX, X, XI and XII)" ] 16 => array:2 [ "identificador" => "sec0075" "titulo" => "Horner syndrome" ] 17 => array:2 [ "identificador" => "sec0080" "titulo" => "Conclusions" ] 18 => array:2 [ "identificador" => "sec0085" "titulo" => "Authorship" ] 19 => array:2 [ "identificador" => "sec0090" "titulo" => "Conflicts of interest" ] 20 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-11-17" "fechaAceptado" => "2018-09-27" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1089322" "palabras" => array:5 [ 0 => "Cranial pairs" 1 => "Cranial nerves" 2 => "Cranial neuropathies" 3 => "Neuralgia" 4 => "Cranial nerve palsy" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1089323" "palabras" => array:5 [ 0 => "Pares craneales" 1 => "Nervios craneales" 2 => "Neuropatía de pares craneales" 3 => "Neuralgia" 4 => "Parálisis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The detection of pathological conditions related to the twelve cranial pairs represents a significant challenge for both clinicians and radiologists; imaging techniques are fundamental for the management of many patients with these conditions. In addition to knowledge about the anatomy and pathological entities that can potentially affect the cranial pairs, the imaging evaluation of patients with possible cranial pair disorders requires specific examination protocols, acquisition techniques, and image processing.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This article provides a review of the most common symptoms and syndromes related with the cranial pairs that might require imaging tests, together with a brief overview of the anatomy, the most common underlying processes, and the most appropriate imaging tests for different indications.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La detección de la patología relacionada con los doce pares craneales representa un importante desafío, tanto para los clínicos como para los radiólogos. Las técnicas de imagen son fundamentales para el manejo de muchos de los pacientes. Adicionalmente al conocimiento anatómico y de las entidades patológicas que potencialmente puedan afectarlos, la evaluación por imagen de los pares craneales requiere protocolos de exploración y técnicas de adquisición y procesado específicas.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En este artículo se efectúa un repaso de los principales síntomas y síndromes relacionados con los nervios craneales que pueden precisar la realización de pruebas de imagen y la patología subyacente, así como una breve revisión de la anatomía y de las técnicas de imagen más adecuadas a la indicación.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Jorquera Moya M, Merino Menéndez S, Porta Etessam J, Escribano Vera J, Yus Fuertes M. Sintomatología derivada de los pares craneales: Clínica y topografía. Radiología. 2019;61:99–123.</p>" ] ] "multimedia" => array:21 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1931 "Ancho" => 3000 "Tamanyo" => 409420 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Technique and anatomy. (A) 3D sagittal sequence FSE T2 showing the olfactory bulb (arrow). (B) Coronal STIR sequence where the optic nerve is seen in its intraorbital path (arrow). (C) Oblique reformatting of the 3D FLAIR sequence showing the cisternal path of the III nerve (arrow). (D) 3D FIESTA sequence axial slice 0.3<span class="elsevierStyleHsp" style=""></span>mm thick, showing part of the cisternal path of the IV nerve (arrow). (E) 3D FIESTA and 3D TOF sequence fusion, which highlights the cisternal segment of the V nerve, with a blood vessel in its proximity (arrow). (F) Fractional anisotropy map, derived from the diffusion tensor sequence, where the V nerve is visualised in its cisternal path (arrow).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1922 "Ancho" => 3000 "Tamanyo" => 375023 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Technique and anatomy. (A) Sagittal reformatting of the 3D FIESTA post-contrast sequence, where the entire VI nerve path is observed in its cisternal and intradural segments (thin and thick arrows). (B and C) Coronal section of 3D FIESTA sequence reformatting and FSE sequence enhanced in T1 post-contrast and with fat suppression, where the III and VI nerves are observed in their intracavernosal path (thick and thin arrows, respectively). (D) Axial reformatting of the 3D FLAIR sequence showing the path of the VII and VIII nerves at cerebellopontine angle and internal auditory canal (arrow). (E) Oblique reformatting of the 3D FIESTA sequence where nerve roots are observed corresponding to IX, X, XI nerves (arrow). (F) Computed tomography (axial section) showing the bone canal of the XII nerve (arrow).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1987 "Ancho" => 3000 "Tamanyo" => 387065 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Esthesioneuroblastoma. A large mass is observed centred on the posterior region of the nasal passages that infiltrates the ethmoid, sphenoid and clivus and shows extension towards the anterior cranial fossa (arrow). (A) In the sequence enhanced in T1, it presents intermediate signal intensity characteristic of this type of tumour. (B) Sagittal enhanced in T1 post-contrast that shows homogeneous enhancement with intravenous contrast. (C) In the axial sequence enhanced in T2, the tumour also presents an intermediate signal as in T1. (D) The tomographic image shows the important bone destruction of the base of the skull. (E and F) Coronal images enhanced in T1, without contrast (E) and with contrast (F), from another patient, in which esthesioneuroblastoma is observed with intracranial invasion and non-neoplastic cyst in the interface (arrow).</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 3091 "Ancho" => 3000 "Tamanyo" => 481518 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Anatomy and meningioma of the optic nerve sheath. (A–D) Trajectory of the optic nerve in the orbit and optic canal (thick white arrow), with its sheath (thin arrow) in T2-weighted sequences; bone walls of the optic canal in tomographic examination (black arrow). Images (E) and (F) show the optic chiasm in axial and coronal planes, respectively. Visualisation of the optical strips (hollow arrows) in two successive coronal sections (G and H). Sagittal (I) and axial (J) slices of T1-weighted sequences with post-contrast fat suppression, showing the characteristic magnetic resonance image of the optic nerve meningioma in “tram tracks” referring to the concentric thickening and enhancement of the optic nerve sheath. There is a slight narrowing of the optic nerve in its proximal portion (arrows).</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 2820 "Ancho" => 2834 "Tamanyo" => 505304 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Meningeal carcinomatosis. A 62-year-old woman with a history of breast carcinoma with multiple cranial nerve palsies. Axial slices of FSE sequence enhanced in T1 post-contrast. (A) Leptomeningeal enhancement in the basal cisterns (arrowheads) and in the cerebellar folia (red arrows), as well as the III nerve on both sides (white arrows). (B) Of the trigeminal nerves (arrows). (C) Of the VI nerve pair bilaterally (short arrows) and of the VII and VIII cranial nerves in both inner auditory canals (long arrows). (D) of the lower nerves IX, X and XI (arrows).</p>" ] ] 5 => array:7 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 2858 "Ancho" => 3000 "Tamanyo" => 386786 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Anatomy and injuries of the VIII nerve. (A) Axial section at the level of the pons, showing the fascicular and cisternal path of the VII nerve (white arrow) and VIII nerve at the cerebellopontine angle (black arrow). (B) Relative position of the facial (F), cochlear (C), superior vestibular (Sv) and inferior vestibular (Iv) nerves at the vertex of the internal auditory canal. (C and D) Axial slices of post-contrast T1-weighted sequences show the corresponding acoustic neurinomas. Both show the typical ice-cream cone morphology of these tumours, with intracanalicular and cisternal component, and cystic component with absence of enhancement in D, also common in these tumours. In both cases, the tumour compresses the adjacent middle cerebellar peduncle (asterisk). (E) Axial section of T1-weighted post-contrast sequence showing a tumour with homogenous enhancement in the cerebellopontine angle cistern and extension to the interior of the internal auditory canal corresponding to a meningioma. The broad base of implantation and dural tail (arrow) can be observed, findings that make it possible to differentiate it from schwannoma.</p>" ] ] 6 => array:7 [ "identificador" => "fig0035" "etiqueta" => "Figure 7" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr7.jpeg" "Alto" => 2874 "Ancho" => 2833 "Tamanyo" => 421204 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Jugular paraganglioma. (A) FSE axial sequence enhanced in T2, showing a heterogeneous signal intensity tumour, irregular contour in the jugular foramen, compatible with jugular paraganglioma. In the case of large lesions, there may be the characteristic “salt and pepper” appearance, with hyperintense foci in T1 that represent areas of subacute haemorrhage, and hypointense foci in T2 that reflect signal emptiness in high-flow vessels. (B) The lesion intensely enhances post-contrast. (C) Computed tomography shows bone destruction in the jugular foramen, unlike what occurs in schwannomas or meningiomas, in which bone remodelling and sclerosis occur, respectively. (D) The digital angiography performed for preoperative embolisation confirms the hypervascular nature of the lesion, with marked repletion in the early arterial phase from occipitocervical perforating branches of segment V3 of the right vertebral artery.</p>" ] ] 7 => array:7 [ "identificador" => "fig0040" "etiqueta" => "Figure 8" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr8.jpeg" "Alto" => 1168 "Ancho" => 3000 "Tamanyo" => 245263 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Carotid paraganglioma. (A) Echo-Doppler showing a solid tumour that separates the carotid bifurcation. (B) The post-contrast computed tomography image shows intense heterogeneous enhancement of the mass at the carotid bifurcation. (C) In the reformatted parasagittal image we see the lesion in the bifurcation separating both carotids (lyre sign), while the vagal paraganglioma displaces them anteromedially.</p>" ] ] 8 => array:7 [ "identificador" => "fig0045" "etiqueta" => "Figure 9" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr9.jpeg" "Alto" => 1479 "Ancho" => 3000 "Tamanyo" => 327119 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Anatomy and isolated paralysis of oculomotor nerves. (A) Mesencephalic location of oculomotor (red) and Edinger–Westphal (blue) nuclei of the III cranial nerve, showing its fascicular and cisternal path (red) in oblique axial plane. (B) Cisternal path of the III cranial nerve. (C) Nucleus and path of the cisternal portion of the IV nerve (yellow), with emergence from the dorsal contralateral portion of the midbrain. (D) Nucleus and cisternal path of the VI nerve (green) in oblique section at the level of the pons until its entrance into the Dorello canal. (E) Sagittal reconstruction of the 3D FIESTA sequence, showing the path of the three previously mentioned nerves, and the situation of the intracavernous segment (CS, blue box). (F) GR sequence enhanced in T1 showing thickening of the right III nerve at its origin (arrow) in a case of ophthalmoplegic migraine. The III nerve is the one that is affected most frequently. There also tends to be a post-contrast enhancement. (G) A small hyperintense lesion (arrow) is seen in the FLAIR sequence enhanced in T2 (upper) with diffusion restriction (lower) corresponding to an acute lacunar infarct in the nucleus of the IV nerve. (H) 3D FIESTA sequence in which a discontinuity (arrowhead) can be seen in the middle third of the VI nerve (white and black arrows) secondary to rupture due to traumatic brain injury. (I) Sagittal T2 showing a tumour infiltrating the clivus, corresponding to a chordoma with a large extraosseous component (arrow) that compresses the pons and the cisternal path of the VI nerve.</p>" ] ] 9 => array:7 [ "identificador" => "fig0050" "etiqueta" => "Figure 10" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr10.jpeg" "Alto" => 987 "Ancho" => 2833 "Tamanyo" => 195331 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Secondary leptomeningeal dissemination of lymphoma. A 54-year-old male with a history of non-Hodgkin's lymphoma who consulted due to left facial paralysis, central vertigo and right hearing loss. (A) Axial section of FSE sequence enhanced in T1 in which nodular enhancements are observed in both internal auditory canals simulating acoustic neurinomas (arrows). Images reformatted in axial (B) and sagittal (C) 3D GR sequence enhanced in T1. Image B shows the enhancement of both trigeminal nerves (arrows) and image C shows nodular enhancement in the apparent origin of the left third pair (arrow).</p>" ] ] 10 => array:7 [ "identificador" => "fig0055" "etiqueta" => "Figure 11" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr11.jpeg" "Alto" => 3277 "Ancho" => 2833 "Tamanyo" => 496349 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Carotid-cavernous fistula. A 59-year-old woman with a progressive picture of 3-month history of loss of visual acuity, conjunctival injection, palpebral oedema and right VI nerve palsy. (A) The PD-enhanced axial sequence shows an abnormal signal vacuum image inside the right cavernous sinus (arrow). (B) The 3D TOF sequence of the Willis polygon reveals arterialised flow signal in said location (arrow). (C) The sagittal reconstruction of the TRICKS sequence confirms the presence of contrast filling in the arterial phase of the cavernous sinus (arrows). (D) Angiography is performed for therapeutic purposes and reveals the same finding (arrows).</p>" ] ] 11 => array:7 [ "identificador" => "fig0060" "etiqueta" => "Figure 12" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr12.jpeg" "Alto" => 3883 "Ancho" => 3000 "Tamanyo" => 705886 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Anatomy of the V nerve. Epidermoid cyst. (A) Location of the mesencephalic (M), main somatic (MS) and spinal (S) nuclei of the V nerve, together with its motor nucleus (yellow), in an oblique coronal plane reconstruction of the 3D FIESTA sequence. (B) Sagittal reconstruction of the same sequence, showing the cisternal path of the V nerve up to its entrance to the Meckel's <span class="elsevierStyleItalic">cave</span>, location of the Gasser ganglion, and its three main branches V1, V2 and V3, together with the relative position of the first two in the interior of the cavernous sinus (CS, blue box). (C–G) Magnetic resonance images of a 36-year-old woman with left trigeminal neuralgia. The coronal image enhanced in T2 (C) shows a lesion in the cistern of the left cerebellopontine angle of signal intensity similar to cerebrospinal fluid (CSF), with slight mass effect on the pons (white arrows). (D) Sagittal T1 where the lesion presents a signal slightly higher than that of the CSF, as in (E) axial FLAIR enhanced in T2 (black arrows) showing hypointense signal of the lesion. (F) The FIESTA sequence confirms the signal difference of the lesion with respect to the CSF. It can be observed that the tumour externally displaces the cisternal segment of the V nerve (arrow) and enters the interior of the Meckel's <span class="elsevierStyleItalic">cave</span> (arrowheads). (G) The axial sequence enhanced in diffusion confirms the diagnosis of epidermoid cyst by revealing the restriction of diffusion.</p>" ] ] 12 => array:7 [ "identificador" => "fig0065" "etiqueta" => "Figure 13" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr13.jpeg" "Alto" => 2068 "Ancho" => 3000 "Tamanyo" => 492189 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Anatomy and paralysis of the VII nerve. (A) Axial computed tomography (CT) section showing the labyrinthine segment. (B) Axial CT section showing the tympanic segment. (C) Coronal CT reconstruction showing the mastoid segment and the path of the facial nerve in the temporal bone until its exit through the stylomastoid foramen (arrow). (D) Coronal CT reconstruction showing the tympanic facial canal (red arrow), second knee (blue arrow), mastoid canal (yellow arrow) and stylomastoid foramen (green arrow). Four cases of patients with tumours in the intrapetrosal portion of the VII nerve are shown (Images E–H). (E) Schwannoma located in the region of the geniculate ganglion (arrows). (F) Schwannoma in the intramastoid vertical segment (arrow). Both lesions are presented on CT (upper images) as expansive lesions with well-defined borders, centred on the path of the facial nerve, and show intense homogenous enhancement after IV administration of gadolinium in T1 sequences (lower images). (G) The CT scan (upper image) shows a lytic lesion, although with a calcified honeycomb-shaped matrix characteristic of the haemangioma, that in T1 with post-contrast fat suppression (lower image) shows irregular enhancement. (H) The upper CT image shows a lesion occupying the eardrum, with partial ossicular destruction (black arrow) and in intimate contact with the tympanic portion of the facial nerve. The lower image shows diffusion restriction (arrow). Radiological findings characteristic of cholesteatoma.</p>" ] ] 13 => array:7 [ "identificador" => "fig0070" "etiqueta" => "Figure 14" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr14.jpeg" "Alto" => 2237 "Ancho" => 2833 "Tamanyo" => 398642 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Cord paralysis. Left vocal cord paralysis. (A) Axial computed tomography image demonstrates medialization of the affected cord and anterior displacement of the ipsilateral arytenoid (arrowhead). (B) There is dilatation of the laryngeal ventricle and the pyriform sinus of the same side (arrow). When the paralysed cord is the left one, as in the cases shown, the study should extend to the aortopulmonary window. In the case of image A, the left cord paralysis is caused by a saccular aneurysm of the aortic arch (black arrow), whereas in the case of image B it is produced by a tumour mass in the aortopulmonary window (asterisk).</p>" ] ] 14 => array:7 [ "identificador" => "fig0075" "etiqueta" => "Figure 15" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr15.jpeg" "Alto" => 2773 "Ancho" => 2833 "Tamanyo" => 438849 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Carotid dissection. A 31-year-old male consulted for cervical pain and anisocoria. He refers to a history of physical effort a few days before. On examination, right Horner syndrome is found. Urgent CT angiography (A and B) shows a decrease in calibre of the right internal carotid artery in its distal cervical segment (black arrowheads) with suspicion of a haematoma on its wall (arrow). (C) The T1 axial image with fat suppression reveals a hyperintense crescent in the wall of the internal carotid artery (arrow) that corresponds to a subintimal haematoma characteristic of the carotid dissection. (D) The post-contrast 3D TOF angiography image is superimposable to the coronal reconstruction of the tomography with decreased calibre of the internal carotid artery (white arrowheads).</p>" ] ] 15 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">IAC: internal auditory canal; MLF: medial longitudinal fasciculus.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cranial nerve \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Nucleus \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Apparent source \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cisternal segment \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dural/interdural segment \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Foraminal segment \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Extracranial segment \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">III nerve<br>Common ocular motor nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Midbrain anterior to aqueduct, at the level of the superior quadrigeminal tubercle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Interpeduncular fossa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Interpeduncular and prepontine cistern<br>Between posterior cerebral arteries (upper) and superior cerebellar arteries (lower) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cavernous sinus: upper region of the lateral wall \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Superior orbital fissure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Orbital apex: annulus of Zinn<br>It is divided into upper and lower branches \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IV nerve<br>Trochlear nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Midbrain: dorsal to MLF and ventral to periaqueductal grey matter at the level of the inferior quadrigeminal tubercle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Dorsal surface inferior to contralateral quadrigeminal tubercle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ambient and quadrigeminal cistern up to the margin of the tentorium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cavernous sinus: inferior lateral wall to III nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Superior orbital fissure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Orbital apex: annulus of Zinn \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">V nerve<br>Trigeminal nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 motor N: lateral pontine tegmentum<br>3 sensory N: from midbrain to C3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lateral region of the pons \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prepontine cistern \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Meckel's <span class="elsevierStyleItalic">Cave</span><br>Division into three sensitive branches:<br>• V1 ophthalmic – lateral wall of the cavernous sinus<br>• V2 maxillary – lateral wall of the cavernous sinus<br>• V3 mandibular joins the motor root \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">V1: superior orbital fissure<br>V2: greater foramen rotundum<br>V3: foramen ovale \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">V1: orbit<br>Branches: lacrimal, frontal and nasociliary n.<br>V2: pterygopalatine fossa-orbit through inferior orbital fissure<br>V3<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>motor branch: chewing space \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VI nerve<br>External ocular motor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pons near the midline at the level of the tubercle of the facial nerve that protrudes the floor of IV ventricle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bulboprotuberancial groove \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Superior course in prepontine cistern \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Dorello's canal on the back of the clivus<br>Then inside of medial cavernous sinus to V1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Superior orbital fissure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Orbit: external rectus muscle \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VII nerve<br>Facial nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ventrolateral pontine tegmentum<br>Sensory n.: n. of the solitary tract<br>Parasympathetic n.: superior salivary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bulboprotuberancial groove<br>2 nerves: facial (motor) and intermediate (sensory and parasympathetic) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cerebellopontine angle cistern \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Intratemporal<br>• IAC<br>• Labyrinthine s.<br>• Tympanic s.<br>• Mastoid s. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Stylomastoid foramen \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Parotid lateral to the retromandibular vein \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VIII nerve<br>Auditory nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lower region of the pons at the level of the IV ventricle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bulboprotuberancial groove<br>Posterior to the VII nerve<br>Three components:<br>superior vestibular, inferior vestibular and cochlear \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cerebellopontine angle cistern parallel and posterior to the VII nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Spiral and vestibular ganglion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">IAC:<br>• Cochlear: anterior inferior<br>• Superior vestibular: posterior superior<br>• Inferior vestibular: posterior inferior \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IX nerve<br>Glossopharyngeal nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Upper and middle region of the medulla oblongata<br>Motor f.: Ambiguous n.<br>Parasympathetic f.: Inferior salivary n.<br>Sensory f.: Solitary and spinal n. of the trigeminal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Top third of the postolivary groove \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lateral bulbo-cerebellar cistern \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Jugular foramen (<span class="elsevierStyleItalic">pars nervosa</span>) through the glossopharyngeal meatus<br>Form the upper and lower ganglia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Nasopharyngeal carotid space<br>Bottom of tongue \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">X nerve<br>Vagus nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Upper and middle region of the medulla oblongata<br>Ambiguous and dorsal vagus nuclei in IV ventricle floor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Upper third of the postolivary groove flow to the IX nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lateral bulbo-cerebellar cistern \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Jugular foramen (<span class="elsevierStyleItalic">pars vascularis</span>) through the vagal meatus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Nasopharyngeal carotid space. Retro-styloid space<br>Superior mediastinum \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">XI nerve<br>Spinal accessory nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ambiguous nucleus, origin of the cranial root, and anterior horns of the first five cervical segments origin of the spinal root \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lateral groove of the bulb and anterior horns of the spinal cord \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Basal cistern \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Jugular foramen (<span class="elsevierStyleItalic">pars vascularis</span>) through the vagal meatus. It joins to the X nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Nasopharyngeal carotid space<br>Subparotid space<br>Sternocleidomastoid and trapezius muscles \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">XII nerve<br>Hypoglossal nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Posterior region of the medulla oblongata in the triangle of the hypoglossal nerve at the level of the floor of the IV ventricle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Preolivary groove \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prebulb cistern \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hypoglossal canal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Carotid space<br>It joins X and XI below the jugular foramen \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1986331.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Anatomy of the cranial nerves.</p>" ] ] 16 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cranial nerve \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Name \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Function/innervation \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Clinical semiology \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">I nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Olfactory nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Sensory \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Smell \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Anosmia<br>Hyposmia<br>Hyperosmia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">II nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Optic nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Sensory \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Vision \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased visual acuity<br>Changes in perception of colours<br>Mononuclear campimetric defects<br>Afferent pupillary defect<br>Abnormalities in the optic disc (oedema, pallor, etc.) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">III nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Oculomotor nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Motor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Eye movements: upper, inner and lower rectus muscles and the upper eyelid lift<br>Parasympathetic fibres in the periphery of the nerve: muscle of the sphincter of the pupil and ciliary muscle (constriction of the pupil and accommodation of the lens) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Diplopia<br>Ptosis<br>Mydriasis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IV nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Trochlear nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Motor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Superior oblique muscle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Difficulty for downward movement of the eyeball<br>Vertical diplopia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">V nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Trigeminal nerve<br><br>V1 ophthalmic<br><br>V2 maxillary<br><br>V3 mandibular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><br><br>Sensory<br><br>Sensory<br><br>Mixed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">It carries sensory information from:<br>• Scalp and forehead, upper eyelid, cornea, nose, nasal mucosa, frontal sinuses and parts of the meninges<br>• Lower eyelid and cheek, back and tip of the nose, upper lip, upper teeth, nasal mucosa, palate and pharyngeal roof, maxillary, ethmoidal and sphenoid sinuses<br>• Lower lip, lower teeth, wings of the nose, chin, pain and temperature of the mouth. The sensitivity of the anterior two thirds of the tongue accompanies a branch of this nerve, the lingual, although these types of nerve fibres then deviate to be part of the VII nerve.<br>Motor function:<br>• Muscles of chewing, mylohyoid, anterior belly of the digastric, tensor of the soft palate and tensor of the eardrum \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Anaesthesia, pain or burning in the regions supplied by each branch<br>Absence of corneal reflex (nasociliary nerve)<br>Weakness of the chewing muscles and can lead to serous otitis media due to dysfunction of the eustachian tube (eardrum tensor) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VI nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">External ocular motor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Motor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">External rectus muscle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Horizontal diplopia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VII nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Facial nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mixed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Parasympathetic I. (secretory and vasodilator fibres): submandibular, sublingual, and lacrimal glands, sweat of the face of the auditory artery and its branches, and the vessels of the nasopharyngeal palate mucous membranes and nostrils<br>Sensory I.: taste perception of the back two thirds of the tongue, sensitivity of the skin of the back of the ear and external auditory canal<br>Motor I.: muscles of facial expression, the stirrup, stylohyoid and posterior belly of the digastric muscle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Facial paralysis: falling facial muscles on the same side of the affected nerve with difficulty in facial expression<br>Pain around the jaw or behind the ear, increased sensitivity to sound, decreased taste<br>Headache and changes in salivation and production of tears<br>Hemifacial spasm: unilateral, involuntary, paroxysmal and repeated contraction (tonic or clonic) of the muscles innervated by the facial nerve \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VIII nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Auditory or vestibulocochlear \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Sensory \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cochlear nerve: hearing<br>Vestibular nerve: balance \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hearing loss, vertigo, tinnitus<br>Vestibular paroxysmia: transient episodes of paroxysmal vertigo, impaired gait and sensation of pressure around the ear, tinnitus or unilateral hearing loss \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IX nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Glossopharyngeal nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mixed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">General sensory of the mucosa of the pharynx, the palatine tonsils, the back third of the tongue, the auditory tube and the middle ear<br>Sensitive for blood pressure and chemistry of the breast and carotid body<br>Motor and proprioceptive for the stylopharyngeus<br>Parasympathetic (secretomotor) for the parotid gland \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Neuralgia<br>Paroxysmal pain in the back of the tongue, tonsillar fossa, pharynx, angle of the jaw and/or ear \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">X nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Vagus nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mixed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Sensory I.: tonsillar region, back of the nose and throat, larynx, ear, stomach<br>Parasympathetic I.: heart, bronchi, stomach, oesophagus, intestine, pancreas or liver<br>Motor I.: larynx (recurrent laryngeal nerve and superior laryngeal nerve) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Dysphonia and dysphagia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">XI nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Spinal accessory nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Motor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Sternocleidomastoid and trapezius muscles \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Drop of the affected shoulder and weakness of head support<br>Less than 6 months of progression: atrophy of the ipsilateral muscles<br>More than 6 months: compensatory hypertrophy of the levator scapulae muscle on the same side \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">XII nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hypoglossal nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Motor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Intrinsic and extrinsic muscles of the tongue (styloglossus, hyoglossus, genioglossus) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Loss of volume of the tongue, reduced number of papillae, deviation of this to the pathological side \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1986328.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Function of the cranial nerves and clinical semiology.</p>" ] ] 17 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sequence \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Plane \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Comments \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diffusion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Detection of ischaemic pathology \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T2*/SWI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2D/3D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Detection of parenchymal haemorrhage or superficial siderosis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FLAIR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axial (sagittal) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2D (3D) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3D acquisition preferred if available \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T2 FSE/TSE \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Coronal (sagittal) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2D (3D) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fat saturation. 3D acquisition preferred if available \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T1 FSE/TSE \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axial and coronal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fat saturation if there is a suspicion of carotid dissection \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FIESTA/CISS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Positioning according to the clinically affected nerve \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TOF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Optional in case of suspicion of vascular compression syndrome \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TRICKS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Optional in case of suspicion of skull base fistula \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">STIR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Coronal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Optional in case of suspicion of pathology of the optic nerve \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T1 FSE/TSE (+GD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axial and coronal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fat saturation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FIESTA/CISS (+GD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Important in evaluation of lower nerves and with intracavernosal path \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">T1 GR/FSE (+GD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fat saturation. High-resolution volumetric acquisition \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FLAIR (+GD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axial (sagittal) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2D (3D) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3D acquisition preferred if available \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1986333.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Magnetic resonance sequences useful in cranial nerve pathology.</p>" ] ] 18 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pathology \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Prechiasmal \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Chiasmal \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Retrochiasmal \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Congenital \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Coloboma<br>Leber's hereditary optic neuropathy<br>Septo-optic dysplasia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Traumatic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Section or compression of the optic nerve by bone fragment or foreign body<br>Avulsion<br>Indirect injury: oedema, ischaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Brain contusion<br>Brain haemorrhage \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vascular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Carotid-cavernous fistula<br>Ischaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ischaemia<br>Haemorrhage<br>Vascular malformation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Degenerative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Drusen \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Inflammatory \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Optic neuritis<br>Neuromyelitis optica<br>Sarcoidosis<br>Systemic lupus erythematosus<br>Inflammatory pseudotumour<br>Infections<br>Graves’ disease<br>Optic perineuritis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Sarcoidosis<br>Tuberculosis<br>Optic neuritis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Sarcoidosis<br>Tuberculosis<br>Optic neuritis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Primary neoplasms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Optic nerve glioma<br>Perioptic meningioma<br>Lymphoproliferative disorders \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Optic nerve glioma<br>Perioptic meningioma<br>Lymphoproliferative disorders \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Brain glioma<br>Brain lymphoma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Extrinsic neoplasms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lymphangioma<br>Epidermoid cyst<br>Dermoid cyst<br>Meningioma<br>Myeloma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Macroadenoma<br>Craniopharyngioma<br>Meningioma<br>Hemangiopericytoma<br>Chondrosarcoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Meningioma<br>Metastasis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Secondary neoplasms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Metastasis (extrinsic compression) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Metastasis (extrinsic compression) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Metastasis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other causes of extrinsic compression \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fibrous dysplasia<br>Nasosinusal pathology (mucocele, subperiosteal abscesses, neoplasia) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Arachnoid cyst<br>Rathke's cyst \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Idiopathic intracranial hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1986332.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">Pathology of the visual pathway.</p>" ] ] 19 => array:8 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at5" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">PML:</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pathology \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Intra-axial segment \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cisternal segment \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dural and interdural segments<br>Meckel's <span class="elsevierStyleItalic">Cave</span> and cavernous sinus<br>(III, IV, VI, V1, V2) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Foraminal segment and base of skull \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Congenital \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aplasia or hypoplasia of the nerve and nuclei \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aplasia or hypoplasia<br>Arachnoid cyst \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Traumatic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Haemorrhage \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Section \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Compression or section due to bone fracture of the base of the skull, orbit and face \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vascular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Infarction<br>Haemorrhage<br>Cavernoma<br>Arteriovenous malformation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ischaemia<br>Vascular compression by arterial or venous loop<br>Compression by vascular malformation<br>Subarachnoid haemorrhage \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Carotid aneurysm Carotid-cavernous fistula<br>Thrombosis of the cavernous sinus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Arteriovenous malformation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Inflammatory and infectious \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Demyelinating disease<br>Bickerstaff's encephalitis<br>Miller-Fisher syndrome<br>Systemic lupus erythematosus<br>Acute disseminated encephalomyelitis<br>PML<br>Herpes zoster<br>HIV encephalitis<br>Behçet's disease<br>Lyme disease<br>Whipple's disease<br>Listeria encephalitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Multiple sclerosis<br>Chronic inflammatory demyelinating polyneuropathy<br>Sarcoidosis<br>Tuberculosis<br>Disease related to IgG<span class="elsevierStyleInf">4</span><br>Fungal infection<br>Meningitis<br>Herpes simplex and varicella zoster<br>Idiopathic neuropathy<br>Fisher's syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aggressive bacterial and fungal sinusitis<br>Sarcoidosis<br>Wegener's granulomatosis<br>Tolosa-Hunt syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aggressive bacterial or fungal infection<br>Petrositis: Gradenigo's syndrome (V, VI, VII, VIII)<br>Wegener's granulomatosis<br>Osteomyelitis due to infection of the paranasal sinuses<br>Cholesteatoma (VII) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neoplasms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Glioma lymphoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Schwannoma<br>Neurofibroma<br>Lipoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Schwannoma<br>Meningioma<br>Malignant<br>Schwannoma<br>Hemangiopericytoma<br>Pituitary adenoma<br>Chordoma and chondrosarcoma of the base of the skull<br>Lymphoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Schwannoma<br>Paraganglioma (jugular foramen)<br>Meningioma<br>Plexiform neurofibroma<br>Clival chordoma<br>Myeloma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Secondary neoplasms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Metastasis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Perineural dissemination<br>Meningeal carcinomatosis<br>Secondary lymphoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Metastasis<br>Perineural dissemination \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Perineural dissemination<br>Haematogenous metastases (lung, prostate, breast)<br>Tumour invasion (squamous cell nasopharyngeal carcinoma) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other causes of extrinsic compression \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fibrous dysplasia<br>Nasosinusal pathology (mucocele, subperiosteal abscesses, neoplasia) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Meningioma<br>Schwannoma<br>Epidermoid cyst<br>Lipoma<br>Tumours of the base of the skull (chordoma, sarcomas, metastasis, etc.)<br>Large tumours of the cerebellopontine angle<br>Tumours of the nasopharynx, paranasal sinuses, etc. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pituitary apoplexy<br>Extension of orbital pathology \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Non-neoplastic bone lesions:<br>• Paget's disease<br>• Histiocytosis<br>• Fibrous dysplasia \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1986330.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">Pathology of cranial nerves III–XII.</p>" ] ] 20 => array:8 [ "identificador" => "tbl0030" "etiqueta" => "Table 6" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at6" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Syndrome \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Location of the lesion \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cranial nerve involved \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Other deficits \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weber's syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ventral midbrain region due to involvement of the corticospinal and corticobulbar pathways of the cerebral peduncle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fascicle of the III nerve<br>Ipsilateral III nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Contralateral hemiplegia or hemiparesis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Benedikt syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Midbrain<br>Red nucleus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Nucleus of the III nerve<br>Ipsilateral III nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hemiataxia and contralateral choreoathetosis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Claude syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Dorsomedial region of the midbrain with involvement of the medial region of the red nucleus, the rubrodentate fibres and the superior cerebellar peduncle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Nucleus of the III nerve<br>Ipsilateral paralysis of the III nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Contralateral arm and leg ataxia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nothnagel syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Quadrigeminal plate and superior cerebellar peduncle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Nucleus of the III nerve<br>Ipsilateral paralysis of the III nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Leg ataxia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lateral pontine syndrome or Marie–Foix or Marie–Foix–Alajouanine syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lateral infarction of the pons<br>Involvement of the corticospinal tract<br>Cerebellar tracts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Nuclei of nerves VII and VIII<br>Facial paralysis<br>Sensorineural hearing loss, ipsilateral vertigo and nystagmus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Contralateral hemiplegia or hemiparesis<br>Ataxia of ipsilateral extremities \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Inferior medial pontine or Foville syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Involvement of the corticospinal tract, the medial lemniscus and the middle cerebellar peduncle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Nuclei of nerves VI and VII<br>Facial paralysis, diplopia and ipsilateral horizontal gaze paralysis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Contralateral hemiplegia or hemiparesis<br>Loss of proprioception and contralateral vibration \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Captivity syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Involvement of the pyramidal pathway. The midbrain preserved with III nerve intact. Preserved consciousness and cognition with paralysis of all voluntary muscles \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Paralysis of nerves VI and VII \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tetraparesis<br>Respiratory failure \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Raymond syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lesion of the ventral pons<br>Corticospinal fibres<br>Corticofacial fibres \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ipsilateral fascicle of the VI nerve<br>Horizontal conjugate gaze palsy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Contralateral hemiparesis<br>Facial paresis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Millard-Gubler syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lesion of the ventral pons<br>Pyramidal tract \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Nuclei of VI and VII<br>Ipsilateral facial paralysis, absence of corneal reflex and diplopia and exotropia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Contralateral hemiplegia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Facial tubercle syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Medial longitudinal fasciculus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Nucleus of the VI nerve and knee of the VII nerve<br>Decreased taste in front two thirds of the tongue, hyperacusis, diplopia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Horizontal conjugate gaze palsy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Wallenberg syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lateral bulbar syndrome<br>Inferior cerebellar peduncle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Nucleus of the VIII vestibular symptoms<br>Spinal nucleus of V nerve with acute pain in the face ipsilateral<br>Ambiguous nucleus: dysphonia, dysphagia, dysarthria and decreased gag reflex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ipsilateral ataxia<br>Hypoalgesia and temperature in the contralateral hemibody \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dejerine syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Medial bulbar syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ipsilateral paralysis of the XII nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Contralateral hemiplegia or hemiparesis and hemianesthesia<br>Nausea, vertigo and contralateral ataxia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Babinski–Nageotte syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hemibulbar syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Contralateral hemiplegia \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1986329.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">Trunk syndromes.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:37 [ 0 => array:3 [ "identificador" => "bib0190" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anatomic considerations, nomenclature, and advanced cross-sectional imaging techniques for visualization of the cranial nerve segments by MR imaging" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 12 | 0 | 12 |
| 2024 October | 55 | 12 | 67 |
| 2024 September | 112 | 12 | 124 |
| 2024 August | 103 | 4 | 107 |
| 2024 July | 82 | 12 | 94 |
| 2024 June | 108 | 22 | 130 |
| 2024 May | 68 | 6 | 74 |
| 2024 April | 103 | 6 | 109 |
| 2024 March | 110 | 24 | 134 |
| 2024 February | 171 | 17 | 188 |
| 2024 January | 147 | 14 | 161 |
| 2023 December | 73 | 21 | 94 |
| 2023 November | 171 | 17 | 188 |
| 2023 October | 136 | 19 | 155 |
| 2023 September | 58 | 14 | 72 |
| 2023 August | 36 | 6 | 42 |
| 2023 July | 16 | 6 | 22 |
| 2023 June | 7 | 5 | 12 |
| 2023 May | 8 | 3 | 11 |
| 2023 April | 7 | 12 | 19 |
| 2023 March | 22 | 4 | 26 |
| 2023 February | 3 | 0 | 3 |
| 2023 January | 9 | 8 | 17 |
| 2022 December | 12 | 5 | 17 |
| 2021 January | 1 | 0 | 1 |
| 2020 June | 1 | 2 | 3 |
| 2020 May | 1 | 2 | 3 |
| 2019 November | 1 | 0 | 1 |
| 2019 July | 1 | 0 | 1 |
| 2019 June | 1 | 2 | 3 |
| 2019 March | 1 | 2 | 3 |
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