Ocular, speech, and swallowing problems in a 9-year-old boy: A rare case of polyneuritis cranialis

Multiple cranial neuropathy is defined as the dysfunction of two or more cranial nerves which can be caused by traumatic, toxic, vascular, neoplastic, infectious, and inflammatory reasons.1 A common cause of polyneuropathy in pediatrics is neuropathies such as Guillain-Barre syndrome (GBS). GBS is an autoimmune neuropathy triggered by infectious causes such as viral respiratory or gastrointestinal diseases. The incidence of GBS is estimated to be 1-2 in 100000 of the general population. The manifestation of GBS is the progressive ascending weakness of the limbs and the absence of the deep tendon reflexes. During the course of GBS, facial nerve palsy, pain, autonomic dysfunction, paresthesia, numbness, and respiratory failure may occur. The diagnosis is based on the clinical characteristics, elevated levels of protein in cerebrospinal fluid (CSF) without pleocytosis, and electrophysiologic findings.2 Miller-Fisher syndrome (MFS) is a variant of GBS that involves the cranial nerves and is presented by the triad of areflexia, ophthalmoplegia, and ataxia.3 Cranial nerve involvement is a common finding in GBS but multiple cranial nerve palsy is rare. This type has been mentioned in the literature as polyneuritis cranialis (PNC) and accounts for 3%-5% of the variants. Acute multiple cranial neuropathies without limb involvement are very rare.4