A CT-clinical approach to patients with symptoms related to the V, VII, IX-XII cranial nerves and cervical sympathetics.

Forty-three patients who had signs and symptoms possibly related to the extracranial course of cranial nerves V, VII, IX, X-XII, and the cervical sympathetics were examined prospectively using high resolution CT to obtain images of thin sections during rapid drip infusion of contrast material. Anatomic areas in the scan protocols included the posterior fossa, cavernous and paranasal sinuses, skull base, temporal bone, nasopharynx, parotid gland, tongue base, and neck. Nine of the 23 patients with possible fifth nerve deficits had extracranial structural lesions that explained the symptoms; none of these nine, however, had typical trigeminal neuralgia. Of eight patients with peripheral seventh nerve abnormalities, two had positive findings on scans. No patient with classic Bell palsy had a positive finding on CT. Two of five patients presenting with the Horner syndrome had positive findings on CT. Of five patients presenting with referred ear pain, three had carcinoma of the upper aerodigestive tract. Our experience suggests that patients at high risk for structural lesions responsible for cranial nerve deficits can be selected by clinical criteria. Moreover, it is essential to extend the CT examination of such patients beyond the skull base when clinically indicated. Protocols for each clinical setting are presented.