Combined VIth and XIIth cranial nerve palsies: A clival syndrome

In 1947, Godtfredsen1 reported nine patients in whom the spread of nasopharyngeal cancer to the cavernous sinus produced ophthalmoplegia, usually due to abducens palsy and often accompanied by trigeminal neuropathy. In addition, retropharyngeal lymph node involvement near the hypoglossal canal resulted in XIIth nerve damage.1 He concluded that “ophthalmoplegia (most often sixth nerve paresis) and paresis of the twelfth cranial nerve . . . must be regarded as pathognomonic of a malignant neoplasm in the nasopharynx.”1 Awareness of this unusual pattern of cranial neuropathy has aided the diagnosis of cryptic nasopharyngeal cancers, especially before the introduction of computed scanning. However, tumors arising from the mid and lower clivus are ideally located to interrupt these forward-exiting nerves. It is unlikely that damage to both the VIth and XIIth cranial nerves is peculiar to nasopharyngeal malignancy. To investigate the causes of combined VIth and XIIth cranial neuropathies, I reviewed my experience with an …