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**Table 1: Anosmia**
Differential list for anosmia
Neoplastic	Esthesioneuroepithelioma Olfactory groove meningioma Suprasellar meningioma Frontal lobe glioma
Vascular	Subarachnoid hemorrhage ACA aneurysm Sheehan’s syndrome Scleroderma
Infectious	Upper respiratory infection (e.g. Influenza which damages neuroepithelium) Intracranial abscess Meningitis Herpes encephalitis Osteomyelitis (frontal, ethmoid) Syphilis (impact membranes)
Endocrine	Diabetes mellitus
Metabolic	Hypothyroidism Vitamin deficiency
Toxic	Aminoglycosides Amphetamines Cocaine Lead Cadmium Hypercalcemia Heavy smoking
Inflammatory	Chronic rhinitis Chronic sinusitis Nasal polyposis
Miscellaneous	Traumatic neuropathy (2nd most common cause) Alzheimer’s disease Kallmann syndrome Paget’s disease Chronic atrophic rhinitis Albinism

**Table 2: Oculomotor Nerve Palsy**
Differential for oculomotor nerve palsy
Neoplastic	Meningioma (extra-/intra-orbital) Glioma Pituitary adenoma Orbital hemangioma Carcinomatous meningitis Orbital epidermoid Neurofibroma Orbital lipoma Nasopharyngeal extension Melanoma metastasis to the orbit Other metastasis
Vascular	Aneurysm (P-comm, SCA, PCA, ICA, basilar tip) Midbrain infarction (paramedian PCA branches or basilar bifurcation perforators) Nerve trunk infarction (Diabetes mellitus) Cavernous sinus thrombosis Caroticocavernous fistula Hemorrhage (SAH, epidural, subdural) Dural AVM Arteritis Pituitary apoplexy
Infectious	Meningitis (bacterial, fungal) Mucormycosis Mononucleosis Meningovascular syphilis Herpes zoster encephalitis
Endocrine	Thyrotoxicosis (mimic)
Inflammatory	Multiple sclerosis INO (mimic) Sarcoidosis MG (mimic) GBS (including Miller-Fisher variant)
Miscellaneous	Traumatic neuropathy (blowout fracture of the orbit) Latent strabismus (mimic) Orbital fibrous dysplasia Tolosa-Hunt syndrome

**Table 3: Trochlear Nerve Palsy**
Differential list for trochlear nerve palsy
Neoplastic	Pituitary adenoma Glioma Trochlear schwannoma Tentorial/parasellar/tuberculum sella/diaphragma sella meningioma Choriocarcinoma Teratoma Germinoma Dysgerminoma Carcinomatous meningitis Metastasis
Vascular	Hemorrhage (SAH, epidural, subdural) Aneurysm (intracavernous ICA) Cavernous sinus thrombosis Caroticocavernous fistula Infarction
Infectious	Meningitis Mastoiditis Herpes zoster encephalitis
Endocrine	Diabetes mellitus (related infarction, most common cause) Thyrotoxicosis (mimic)
Inflammatory	Multiple sclerosis MG (mimic)
Miscellaneous	Traumatic neuropathy Latent strabismus (mimic) Tolosa-Hunt syndrome Brown’s syndrome

**Table 4: Trigeminal Neuropathy**
Differential for trigeminal neuropathy
Neoplastic	Glioma (pontine, orbital) Vestibular schwannoma (CPA) Trigeminal schwannoma Meningioma (orbital and non-orbital) Orbital hemangioma Neurofibroma Dermoid cyst (CPA) Epidermoid cyst (CPA) Lipoma Metastatic melanoma Metastasis
Vascular	Infarction (cerebral or brainstem) Aneurysm (intracavernous ICA) Cavernous sinus thrombosis Vasculitis (SLE, PSS, Scleroderma, Sjogren’s syndrome, Amyloidosis)
Infectious	Petrositis (Gradenigo’s syndrome)
Endocrine	Diabetic neuropathy
Inflammatory	Multiple sclerosis Orbital pseudotumor
Miscellaneous	Traumatic neuropathy Fibrous dysplasia Trigeminal neuralgia Tolosa-Hunt syndrome Chiari malformation

**Table 5: Abducens Nerve Palsy**
Differential for abducens nerve palsy
Neoplastic	Glioma (pontine) Pituitary adenoma Vestibular schwannoma (CPA) Meningioma (CPA, diaphragm sella, tuberculum sella, parasellar) Chordoma (clival) Chondroma (clival) Epidermoid tumor (CPA) CNS lymphoma Carcinomatous meningitis Metastasis
Vascular	Infarction Aneurysm (CPA, intracavernous ICA) Cavernous sinus thrombosis Caroticocavernous fistula Hemorrhage (SAH)
Infectious	Meningitis (bacterial, fungal) Meningovascular syphilis Herpes zoster encephalitis Petrositis (Gradenigo’s syndrome)
Endocrine	Diabetes mellitus (related infarction) Thyrotoxicosis (mimic)
Toxic	Wernicke’s encephalopathy
Congenital	Mobius syndrome
Inflammatory	Multiple sclerosis INO MG (mimic) Sarcoidosis
Miscellaneous	Traumatic neuropathy Arachnoid cyst Migraine (mimic) Paget’s disease Tolosa-Hunt syndrome

**Table 6: Facial Nerve Palsy**
Differential diagnosis for facial nerve palsy
Neoplastic	Glioma (pontine) Meningioma Vestibular schwannoma (CPA) Trigeminal schwannoma Facial schwannoma Cholesteatoma Glomus tumor Dermoid cyst Epidermoid cyst Metastasis Post-parotid surgery (lesion mandibular branch)
Vascular	Infarction (pontine tegmentum) Aneurysm Post-carotid endarterectomy (mandibular branch) Basilar dolichoectasia
Infectious	Poliomyelitis Herpes zoster (Ramsey-Hunt syndrome) Lyme disease Epstein-Barr virus Mumps Rubella HIV Meningovascular syphilis
Metabolic	Porphyria
Inflammatory	Multiple sclerosis Sarcoidosis
Miscellaneous	Traumatic neuropathy Melkersson-Rosenthal syndrome Progressive supranuclear palsy Bell’s palsy Benign recurrent cranial nerve paralyses

**Table 7: Glossopharyngeal, Vagus, and Accessory Nerve Pathology**
Differential diagnosis for glossopharyngeal, vagus, or accessory nerve pathology
Neoplastic	Glioma Schwannoma Neurofibroma Meningioma Paraganglioma (Glomus jugulare) Cholesteatoma Non-Hodgkin’s lymphoma Rhabdomyosarcoma Nasopharyngeal carcinoma Metastasis
Vascular	Infarction (medulla) Hemorrhage (AVM, HTN) Aneurysm (vertebral) Vertebral artery ectasia
Infectious	Meningitis Malignant otitis externa
Metabolic	Central pontine myelinolysis
Inflammatory	Multiple sclerosis
Miscellaneous	Traumatic neuropathy Glossopharyngeal neuralgia Iatrogenic injury post-radical neck dissection Benign recurrent cranial nerve paralyses Extracranial causes for vagus neuropathy (jugular vein thrombosis, aortic aneurysm, malignancy, infection)

**Table 8: Hypoglossal Nerve Palsy**
Differential diagnosis for hypoglossal nerve palsy
Neoplastic	Glioma Meningioma Schwannoma Neurofibroma Osteoma Chordoma Paraganglioma (Glomus jugulare) Sarcoma Metastasis
Vascular	Infarction (basal/paramedian medulla) Hemorrhage (brainstem, SAH) Aneurysm Vertebrobasilar dolichoectasia Basilar invagination Post-carotid endarterectomy
Infectious	Malignant otitis externa Abscess Mucormycosis Aspergillosis Poliomyelitis Diphtheria Botulism
Inflammatory	Multiple sclerosis Shy-Drager syndrome
Miscellaneous	Traumatic neuropathy Chiari malformation Multiple systems atrophy Post-radical neck dissection Benign recurrent cranial nerve paralyses

**Table 9: Multiple Cranial Neuropathies**
Differential list for cranial neuropathies
Neoplastic	Pituitary macroadenoma Meningioma (sphenoid ridge) Glioma Paraganglioma Orbital tumors Chordoma Osteoma Sarcoma Schwannoma Teratoma Glomus tumor Epidermoid/dermoid cyst Dysgerminoma Nasopharyngeal carcinoma Neurofibroma Lymphomatous meningitis Multiple myeloma Metastasis
Vascular	Aneurysm (intracavernous internal carotid, P-Comm, PCA, basilar tip, SCA, vertebral) Dural AVM Carotid-cavernous fistula Cavernous sinus syndrome (CN III, IV, V1, V2, VI) Infarction (nucleus or tract involvement) Basilar dolichoectasia Basilar invagination Hemorrhage (SAH, epidural, subdural) Pituitary apoplexy Vertebral artery ectasia PAN Granulomatosis with polyangiitis (CN VIII)
Infectious	Acute or Chronic Meningitis (bacterial, viral, fungal) Herpes zoster Diphtheria Botulism intoxication Aspergillosis Mucormycosis Cryptococcal meningitis Mastoiditis Neurocysticercosis Neurosyphilis Lyme disease (CN VII)
Inflammatory	GBS Miller-Fisher syndrome Sarcoidosis Multiple sclerosis Myasthenia gravis Lambert-Eaton syndrome Shy-Drager syndrome (CN XII) Multiple system atrophy (CN XII) Petrositis Cholesteatoma
Metabolic	Wernicke’s encephalopathy (CN VI) Porphyria (CN VII, X) Leigh’s disease Central pontine myelinolysis (CN VI, VII)
Genetic or Congenital	Mobius syndrome (CN VI, VII) Progressive supranuclear palsy Chiari malformation Osteopetrosis
Miscellaneous	Traumatic neuropathy (including surgical) Status post-lumbar puncture Amyloid Fibrous dysplasia Paget’s disease (VIII > II, III) Hyperostosis cranialis interna Polyneuritis cranialis Idiopathic cranial polyneuropathy (III, IV, V)

DOI: https://doi.org/10.18791/nsatlas.v2.02.1.3

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