Last reviewed: 6 Nov 2021
Last updated: 12 Oct 2021

Summary

Differentials

Common

  • Ischemic optic neuropathy (II)
  • Multiple sclerosis (II)
  • Viral infection (II)
  • Subarachnoid hemorrhage (III, IV, VI)
  • Meningitis (III, IV, VI)
  • Ischemic neuropathy (III, IV, VI)
  • Vascular malformations (V)
  • Herpes zoster (V)
  • Multiple sclerosis (V)
  • Bell palsy (VII)
  • Ramsay Hunt syndrome (VII)
  • Ischemic stroke (VII)
  • Vestibular neuritis (VIII)
  • Neural presbycusis (VIII)
  • Drugs (VIII)
  • Iatrogenic (X)
  • Apical lung tumor (IX, X)
  • Iatrogenic (XI)
  • Ischemic stroke (XII)

Uncommon

  • Trauma (I)
  • Neurodegenerative disorders (I)
  • Congenital (I)
  • CNS tumors (I)
  • Optic canal trauma (II)
  • CNS tumors (II)
  • Idiopathic intracranial hypertension (II)
  • Autoimmune disease: (e.g., systemic lupus erythematosus (SLE), Sjogren, granulomatosis with polyangiitis, Behcet disease [II])
  • Leber hereditary optic neuropathy (II)
  • Optical toxins or nutritional deficiency (II)
  • Neuromyelitis optica (II)
  • Uncal herniation (III, IV, VI)
  • Migraine (III, IV, VI)
  • Trauma (III, IV, VI)
  • Cerebral aneurysms (III, IV, VI)
  • Cavernous-carotid fistula (III, IV, VI)
  • Cavernous sinus thrombus (III, IV, VI)
  • CNS tumors (III, IV, VI)
  • Drugs (III, IV, VI)
  • Idiopathic intracranial hypertension (III, IV, VI)
  • Congenital (III, IV, VI)
  • Post-lumbar puncture (VI)
  • Meningitis (V)
  • CNS tumors (V)
  • Autoimmune disorders (V)
  • Skull-base osteomyelitis (V)
  • Trauma (V)
  • Dental abscess (V)
  • Spinal cord lesion (V)
  • Iatrogenic (V)
  • Mandibular tumors (V)
  • Congenital (V)
  • Tolosa-Hunt syndrome (V)
  • Wallenberg syndrome (V)
  • Neurosarcoidosis (VII)
  • CNS tumors (VII)
  • Trauma (VII)
  • Meningitis (VII)
  • Iatrogenic (VII)
  • Middle ear or mastoid infection (VII)
  • Parotid tumor (VII)
  • HIV associated (VII)
  • Lyme disease (VII)
  • CNS tumors (VIII)
  • CNS tumors (IX, X)
  • Parapharyngeal tumor (IX, X)
  • Meningitis (IX, X)
  • Skull-base osteomyelitis (IX, X)
  • Trauma (IX, X)
  • Parapharyngeal space infection (IX, X)
  • Eagle syndrome (IX)
  • Cardiovocal syndrome (X)
  • Trauma (XI)
  • CNS tumors (XI)
  • CNS tumors (XII)
  • Progressive bulbar palsy (XII)
  • Chiari I and II malformations (XII)
  • Extracranial (tongue or neck) or skull-base tumors (XII)
  • Meningitis (XII)
  • Skull-base osteomyelitis (XII)
  • Parapharyngeal space infection (XII)
  • Trauma (XII)
  • Dural arteriovenous fistula (XII)
  • Internal carotid artery aneurysm or dissection (XII)
  • Iatrogenic (XII)

Contributors

Authors

Ann Johnston, MB BS, MRCP

Consultant Neurologist

Department of Neurology

University Hospital of Wales

Cardiff

UK

Disclosures

AJ has received speaker fees from UCB and Eisai for lectures given.

Emma Tallantyre, BMBS, PhD

Neurology Specialist Registrar

University Hospital of Wales

Cardiff

UK

Disclosures

ET has received honoraria for consulting work from Novartis, Merck, Biogen, and Roche. She has received travel grants to attend or speak at educational meetings from Merck, Roche, Takeda, and Novartis.

Acknowledgements

Dr Johnston and Dr Tallantyre would like to gratefully acknowledge Dr Zachary L. Hickman, Dr Brad E. Zacharia, Dr Christopher J. Winfree, and Dr Adrian J. Wills, the previous contributors to this topic.

Disclosures

ZLH, BEZ, CJW, and AJW declare that they have no competing interests.

Peer reviewers

Robert L. Ruff, MD, PhD

Professor of Neurology

Department of Neurology

Cleveland VA Medical Center

Cleveland

OH

Disclosures

RLR declares that he has no competing interests.

Sabrina Ravaglia, MD, PhD

Staff Physician

Department of Neurological Sciences

Institute of Neurology C. Mondino

Pavia

Italy

Disclosures

SR declares that she has no competing interests.

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