title: Cranial nerve palsy secondary to cerebrospinal fluid diversion.
abstract: OBJECTIVE
  Cranial nerve palsy (CNP) secondary to cerebrospinal fluid (CSF) diversion is less familiar to us as a result of its rarity in incidence and insidiousness in presentation. This study aims to further expound the pathophysiological mechanism, clinical presentation, diagnosis, management and prognosis of CNP.
  
  
  METHODS
  From June 2012 to February 2015, 5 of 347 consecutive patients with CNPs secondary to different CSF diversion procedures were treated at our institution. A systematic PubMed search of published studies written in English for patients developing CNPs after CSF diversion procedures from January 1950 to June 2015 was conducted.
  
  
  RESULTS
  Overall, 29 studies and 5 patients of the current series totaling 53 CNPs met the inclusion criteria. CN II, III, IV, V, VI, VII and VIII were got involved in 2 (3.8%), 2 (3.8%), 5 (9.4%), 1 (1.9%), 44 (83.0%), 4 (7.5%) and 1 (1.9%) patients respectively. Thirty-eight patients (71.7%) developed CNPs following inadvertent lumbar puncture, 8 (15.1%) following lumbar drainage, and 7 (13.2%) following ventriculoperitoneal shunt. Forty-eight (90.6%) patients got resolved completely.
  
  
  CONCLUSIONS
  The proposed mechanism of CNP after CSF diversion procedure is CSF hypovolemia and subsequent downward displacement of the brain and traction and distortion of the vascular and peripheral neural structures. As a result of its distinct anatomic characteristics rather than long intracranial course, CN VI is most commonly affected. With early recognition and timely conservative management, most patients could get favorable recovery.
authors.affiliation: Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China.
authors.forename: Guichen
authors.initials: G
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, China.
authors.forename: Xiaobo
authors.initials: X
authors.lastname: Zhu
authors.affiliation: Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, China.
authors.forename: Jinchuan
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Department of Surgery, Changchun Orthopaedics Hospital, Changchun, Jilin, China.
authors.forename: Zhiguo
authors.initials: Z
authors.lastname: Han
authors.affiliation: Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, China. Electronic address: hkyyayz@yeah.net.
authors.forename: Kun
authors.initials: K
authors.lastname: Hou
mesh_terms: D000368:Aged; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects*; D003389:Cranial Nerve Diseases / Q000000981:diagnostic imaging* / Q000209:etiology*; D004322:Drainage / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology*; D013129:Spinal Puncture / Q000009:adverse effects; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects
keywords: Cerebrospinal fluid diversion; Cerebrospinal fluid hypovolemia; Cranial nerve palsy; External lumbar drainage; Lumbar puncture; Ventriculoperitoneal shunt