case of multiple cranial nerve injuries

ABSTRACT

A female patient 30 years old, mother with one child, housewife with no special habits of medical importance complained of deviation of the angle of the mouth to the right side of two days' duration. Lacrimation of the left eye and difficulty in closing the left eye were present for two days, for which she had consulted aneurologist. She had a past history of chronic left ear discharge, tinnitus, and decrease in hearing acuity of left ear. General examination revealed no detectable abnormalities. Neurological examination revealed left trigeminal nerve palsy, sensory along three divisions. Corneal reflex was absent. There was decrease hearing acuity of left ear especially sensory neural affection. Left facial and hypoglossal nerves were affected. Long tract was not affected. High resolution power CT for left ear, and MRI brain with contrast were normal.ESR, CBC, C-RP were Normal. Sarcoidosis battery revealed elevated serum calcium, and Angiotensin converted enzyme [ACE] with elevated CSF ACE. The patient was treated with Methyl predinsolone l00mg/day in divided doses, Calcium supplement OD and Pantazole FBI 40 mg/day, and given physiotherapy. Recovery was seen within two weeks