Journal of Neurology

, Volume 256, Issue 3, pp 299–304

Cranial nerve palsy in Wegener’s granulomatosis – Lessons from clinical cases


DOI: 10.1007/s00415-009-0121-1

Cite this article as:
Nowack, R., Wachtler, P., Kunz, J. et al. J Neurol (2009) 256: 299. doi:10.1007/s00415-009-0121-1


The problem of diagnosing vasculitic neuropathy is discussed based on case reports of two patients with Wegener’s granulomatosis. One patient developed de novo 6th nerve palsy as an isolated relapse manifestation and the second patient a sequence of multiple cranial nerve palsies. Brain imaging with CT and MRI and the laboratory provided no clues suggesting active vasculitis. However, in both patients the neuropathies fully recovered in response to standard induction protocols of vasculitis. In the absence of organspecific proof of vasculitis, these treatment decisions were guided by the overall clinical presentations. Cranial neuropathy may be the first obvious vasculitic manifestation preceding other organ disease, and since single reliable tests for its diagnosis are lacking, a multidisciplinary approach is advocated here to detect vasculitic manifestations in other organs.

Key words

ANCAsystemic vasculitisabducens nerve palsyvagal nerve palsyWegener’s granulomatosiscranial neuropathy

Copyright information

© Steinkopff-Verlag 2009

Authors and Affiliations

  1. 1.Nephrology/Dialysis centre LindauLindauGermany
  2. 2.Neurologische GemeinschaftspraxisRavensburgGermany
  3. 3.Ear, Nose & Throat DepartmentCopenhagenDenmark