Case of Nasopharyngeal Carcinoma Presenting With Rare Combination of Multiple Cranial Nerve Palsies

Abstract

Cranial nerve palsies are commonly known comorbidities associated with nasopharyngeal carcinoma, occurring in nearly 20% of cases. These palsies occur in isolation or in common groupings, depending on the anterior or posterior cranial vault extension of the lesion. Cranial nerve VII palsy is relatively rare, with an incidence of less than 1%. As a poor marker of prognosis, cranial nerve involvement may lead to significant morbidity amongst patients with nasopharyngeal carcinoma. We report a case of a 73-year-old male diagnosed with nasopharyngeal carcinoma with extension into the skull base who presented with both anterior and posterior cranial nerve involvement throughout the course of his disease. With lesions in cranial nerves III, V, VI, VII, IX, and XII, this patient experienced a sequence of right-sided facial paralysis, facial pain, inability to abduct his right eye, rightward tongue deviation, tinnitus, hearing loss, decreased extraocular eye movement superiorly, and dysphagia which subsequently worsened with chemotherapy and radiation. Most notably, he presented with a right-sided cranial nerve VII palsy, not commonly reported in the literature.