Disorders Of Cranial Nerves With Clinical Examination

I.     Olfactory nerve

The nerves arise from olfactory receptors in the nasal mucosa and pass through the cribriform plate to anterior cranial fossa and terminate in olfactory area in the frontal lobe.

(a) Anosmia
Loss of sense of smell is usually caused by tumours of frontal lobe or head injuries causing damage to cribriform plate; also due to meningitis, hydrocephalus and in cases of hysteria.

Aetiology
-Head injuries.
-Tumours of the frontal lobe.

II.  Optic nerve

Aetiology (damage): Trauma, vascular accidents, tumours, aneurysm, basal meningitis.

(a) Papilledema
Oedema of the optic disc or papilla from any cause; maybe inflammatory (Papillitis) or due to passive venous congestion.

Aetiology

• Increased intracranial pressure. Tumours, abscess, meningitis, outflow block of 4th ventricle.
• Optic neuritis.
• Diseases of the retinal artery. Malignant hypertension.
• Obstruction to venous drainage.
• Chronic nephritis.
• Cerebral tumours.
• Pulmonary encephalopathy.
• In some cases of hematemesis and melena.
• Cerebral oedema after head injury; cerebral anoxia.
• Vitamin A intoxication.

On examination of disc

• Congestion of retinal veins.
• Increased pinkness of the disc.
• Blurring of the disc margin starting on the nasal side.
• Filling of the physiological cup.
• Haemorrhage in and around the disc.
• Elevation of the optic disc.
• Visual changes: Peripheral constriction and enlargement of ‘Blindspot’.
• Pallor of the disc due to optic atrophy in later stages. Papillitis is distinguished from Papilledema due to increased intracranial pressure by the acute and often marked reduction of visual acuity that accompanies the former.

(b) Retrobulbar neuritis / optic neuritis

Inflammation of optic nerve which causes loss of vision.

Aetiology

• Disseminated sclerosis.
• Vitamin deficiency especially B12.
• Infections.
  • Local: Retinitis.
  • General: Syphilis, typhoid, smallpox.
• Toxins: Methyl alcohol, quinine and its derivatives lead.
• Excessive smoking, the contraceptive pill.

Symptoms

• Irritability: Pain in eye worse by movement.
  • Tenderness over the eye.
  • Papillitis: If the lesion is anteriorly present.
  • (Retrobulbar neuritis): Normal disc: If the lesion is posterior.
  • Severe loss of visual acuity. Loss is typical of central vision.

(c) Optic atrophy (Optic neuropathy)

Loss of fibres in the optic nerve is followed by reactive gliosis and reduced vascularization.

Types
-Primary
-Secondary

Etiology

• Pressure on the nerve by glaucoma, tumour, aneurysms etc.
• Optic neuritis due to any cause listed above.
• Long-standing papilledema.
• Thrombosis of the central retinal artery.
• Trauma.
• Genetically determined: Leber’s optic atrophy.
• Diabetes mellitus.
• Poisons: Alcohol, quinine, etc.

On examination
Pallor of the disc.

Differential diagnosis

• Anterior ischemic optic neuropathy is a condition caused by interruption of blood supply to the optic nerve secondary to the atherosclerotic or inflammatory disease of the ophthalmic artery or its branches.
  It presents clinically as an acute, painless, visual loss in one eye usually accompanied by an altitudinal visual field defect. In severe cases, visual field defect and visual loss is complete and permanent. The fundus shows a pale swollen optic disc surrounded by splinter shaped peri-papillary haemorrhages.
  
• Syndrome of bitemporal hemianopia: This type of visual disorder is usually related to the suprasellar extension of a pituitary adenoma, but may also be due to a craniopharyngioma, saccular aneurysm of the Circle of Wills, meningioma of the tuberculum sella and rarely sarcoidosis, metastatic carcinoma, and Hand- Schuller Christian disease.

III.   Oculomotor nerve

Muscles supplied

• External ocular muscles except lateral rectus and superior oblique.
• Levator palpebrae superiors.
• Ciliary muscles.
• Sphincter papillae.

Aetiology (damage)

• Disseminated sclerosis.
• Meningovascular syphilis.
• Diabetes mellitus: Pupil will be spared.
• Cerebral aneurysms.
• Granulomatous disorder: Tolosa Hunt Syndrome.

Symptoms / signs

• Ptosis.
• Diplopia.
• External deviation of the eye (Divergent strabismus).
• Pupil dilated and not reacting to light or accommodation, (complete paralysis).

IV. Trochlear nerve

Muscles supplied
Superior oblique muscle.

Damage causes

• Strabismus (Squint/Exophoria)
• Paralytic squint: Due to the weakness of one or more extraocular muscles.
• Concomitant squint (Lazy eye): Cause refractive error during childhood.
• Nystagmus: Series of involuntary, rhythmic oscillations of one or both eyes. It may manifest in horizontal or vertical planes or as a series of rotation about the central axis.

Types

• Gaze nystagmus.
• Fixation nystagmus.
• Vestibular nystagmus.
• Cerebellar mechanisms.
  

V.     Trigeminal nerve (Prosopalgia)

• Sensory to face, cornea, sinuses, nasal mucosa, teeth and anterior two-third of the tongue.
• Motor to muscles of mastication.

Aetiology (damage)

• Cerebrovascular accidents.
• Space occupying lesion.
• Fracture base of the skull.
• Tabes dorsalis.

(a) Trigeminal neuralgia: Unknown Etiology.

Precipitating factors

• Cold wind blowing on the face.
• Washing the face with very cold water.
• Chewing or even talking.

Symptoms / signs

• Commonly affects elderly people.
• Pain comes in paroxysms.
• Lancinating and confined to the distribution of the nerve.
• Each paroxysm lasts for few seconds but may be followed by a dull ache.
• There may be spasm of facial muscle.
• The pain may recur.
• Flushing of face, dilatation of the pupil, excessive lachrymation, secretion of nasal mucus and saliva on the side of pain.

Differential diagnosis

• Disseminated sclerosis, young persons affected.
• Basillar aneurysm.
• Pain due to aural infection, toothache, temporo-mandibular arthralgia.
• Herpes zoster, post herpetic neuralagia.
• Cerebral tumours.
  

VI.   Abducent nerve

Muscles supplied: Lateral rectus muscle of the eye.

Aetiology (damage): Pressure by aneurysm over cavernous sinus.

Damage caused
Downward displacement of the brain stem due to raised intra cranial pressure.
Diplopia.
Convergent strabismus.

VII.   Facial nerve

• Motor to scalp, facial muscles.
• Sensory taste in anterior 2/3 of tongue (via Chorda tympani).
• Nerve to stapedius muscle.

Cranial nerve syndrome
Site	Cranial nerves involved	Eponymic syndrome	Usual cause
Sphenoid fissure (Superior orbital)	III, IV, first division of V, VI	FOIX	Invasive tumor of spheniod bone, aneurysm.
Lateral wall of cavernous sinus	III, IV, first division of V, VI often with Proptosis	FOIX TOLOSA HUNT	Aneurysms or thrombosis of cavernous sinus, invasive tumors from sinuses and sella.
Retrosphenoid space	II, III, IV, V, VI	Jacob	Large tumors of middle cranial fossa.
Apex of petrous bone meatus	V, VI	Gradenigo	Petrositis, tumors of petrous bone.
Internal auditory	VII, VIII (dermoids etc.)	—	Tumors of petrous bone, infectious processes.
Pontocerebellar angle	V, VII, VIII and sometimes IX	—	Acoustic neuromas, Meningiomas

Site	Cranial nerves involved	Eponymic syndrome	Usual cause
Jugular foramen	IX, X, XI	Vemet	Tumors, Aneurysms
Posterior latero- condylar space	IX, X, XI, XII	Collect-Sicard	Tumor of parotid gland, carotid body and metastatic tumor.
Posterior retro parotid space and metastatic syndrome	IX, X, XI, XII	Villaret Homer	Tumors of parotid gland, Mackenzie carotid body tumor, lymph node tumors, tuberculous adenitis

(a) Bell’s palsy

Etiology

• Idiopathic.
• Exposure to cold air.
• Any injury.
• C.V.A.
• Brain tumours.
• Meningitis and encephalitis.
• May be associated with diabetes, severe hypertension, dental anaesthesia, 3rd trimester of pregnancy.
• The paralysis is caused by compression of nerve fibres by oedema in the stylomastoid canal.

Symptoms

• Aching pain behind the ear for one or two days.
• Unilateral facial paralysis develops rapidly.
• Eye on the affected side cannot be closed, water from the eyes.
• Mouth is drawn over the opposite side. Saliva and fluids may run from the angle of the mouth, loss of sense of taste.
• Affected side feels numb.
• Sweating is less on affected side.
• If the lesion is in the middle ear portion,  taste on the same side is affected. If the nerve to stapedius is interrupted there is hyperacusis (Painful sensitivity to loud sounds).

Signs

• Paralysis of affected side — both upper as well as the lower part.
• Lines of expression are flattened on the affected side; the patient is unable to wrinkle his brow.
• He cannot close his eye; on closing the eyes eyeball rolls upwards and outwards which is called Bell’s phenomenon.
• Tongue deviates to healthy side.
• On attempting to show teeth lips do not separate on affected side.
• Whistling is not possible.
• Cheeks puff out with expiration; food collects between teeth and cheek on the affected side.
• EMG: Evidence of denervation after 10 days indicates that there has been axonal degeneration and there will be long delay before regeneration occurs and it may be incomplete.
  

VIII.   Auditory nerve

The nerve has two components, auditory (cochlear) and vestibular components in which the former is responsible for hearing and later one is for maintenance of equilibrium.

Aetiology (damage)

• Acoustic neuroma (C. P. angle tumour).
• Meningitis.
• Toxins
• Kanamycin.
• Streptomycin.

Symptoms / signs

• Tinnitus.
• Deafness.
• Vertigo: Sensation of turning of the environment or of the patient himself.

Aetiology

• Ocular lesions: Diplopia
• Cerebellar lesions.
• Brain stem lesions:
• Syringobulbia.
• Medullary infarction.
• Insufficiency of basilar artery.
• Lesion of vestibular nerve: Acoustic neuroma.
• Aural lesion
• Otitis media.
• Meniere’s syndrome.
• Labyrinthal injury.
• Toxins
• Streptomycin
• Quinine.
• Salicylates, diuretics, caffeine.
• Anxiety neurosis.

(a) Meniere’s syndrome

It is characterised by vertigo, tinnitus and progressive nerve deafness.

Aetiology

• Unknown.
• Often associated with dilatation of endolymphatic system due to increase in endolymph.
• Migraine may be present with it.
• Local infection in teeth and tonsils; allergy to either ingestant or inhalant.
• Vitamin C deficiency.

Symptoms

• Progressive deafness.
• Tinnitus.
• Vertigo: Severe with sudden onset; patient may fall.
• Nausea and vomiting.
• Other automatic motions.

Signs

• Rotatory nystagmus.
• Ataxia.

Treatment

• During attack patient must lie perfectly still.
• Destruction of the labyrinth, by surgery or ultrasonic, or division of the eighth nerve may be required.
  
  

IX.   Glossopharyngeal nerve

• Sensory for posterior 1/3 of tongue.
• Motor fibres to pharynx.

Damage causes
Difficulty in swallowing, loss of taste in post l/3rd of the tongue and extending to posterior wall of pharynx; the constrictor muscle do not constrict.

X.  Vagus nerve

• Motor to soft palate, larynx and pharynx.
• Sensory to heart, respiratory passage, for lungs and abdominal visceras (Para sympathetic).

Aetiology

• Nuclei: CVA, encephalitis, diphtheria, rabies etc.
• Other sites: Space occupying lesions, syphilis, trauma, mediastinal lymphadenopathy etc.

Damage causes

• Nasal intonation of voice.
• Nasal regurgitation of food.
• Absence of certain movement of palate.
• Difficulty in deglutition.
• Aphonia.
  
  

XI.   Spinal accessory nerve

• Motor to sterno-mastoid and trapezius muscles.
• Sensory fibres to vagus.

Aetiology (damage)

• Syringobulbia.
• Basal meningitis.
• Thrombophlebitis etc.

Damage causes

• Inability to rotate the head due to paralysis of sterno-mastoid muscle.
• Weakness on elevation of shoulder due to paralysis of fibres of trapezius muscle.
  
  

XII.   Hypoglossal nerve

This is the motor cranial nerve and it supplies to muscles of tongue.

Aetiology

• Head injury.
• Chronic bulbar palsy.
• Syringo bulbia.
• Space occupying lesion.
• Operation in the neck.
• Neurosyphilis.

Effects of paralysis

• Unilateral paralysis will produce unilateral wasting of tongue, deviation of tongue towards the paralysed side and sickle-shaped appearance.
• Bilateral paralysis will give rise to complete wasting of the tongue, difficulty in articulations.
• Fasciculation may be present when the lesion is due to Chronic Bulbar Palsy.

Homoeopathic treatment of cranial nerve disorders

Ist Anosmia

Alumina: A very general condition corresponding to this drug is dryness of mucous membranes and skin, and tendency to paretic muscular states. Pain at root of nose. Sense of smell diminished. Fluent coryza. Point of nose cracked, nostrils sore, red; worse touch. Scabs with thick yellow mucus. Tettery redness. Ozœna atrophica sicca. Membranes distended and boggy.
Anac: Frequent sneezing. Sense of smell perverted. Coryza with palpitation, especially in the aged. The Anacardium patient is found mostly among the neurasthenics; such have a type of nervous dyspepsia, relieved by food; impaired memory, depression, and irritability; diminution of senses (smell, sight, hearing).
Cyclamen: Diminished smell. Strong odors do not affect the smell.
Other remedies: Hep., Kali bi., Mag. m., Nat. mur., Puls.

IInd Optic neuritis

Apis: Lids swollen, red, oedematous, everted, inflamed; burn and sting. Conjunctiva bright red, puffy. Lachrymation hot. Photophobia. Sudden piercing pains. Pain around orbits. Serous exudation, œdema, and sharp pains. Suppurative inflammation of eyes. Keratitis with intense chemosis of occular conjunctiva. Staphyloma of cornea following suppurative inflammation. Styes, also prevents their recurrence.
Merc.: Lids red, thick, swollen. Profuse, burning, acrid discharge. Floating black spots. After exposure to glare of fire; foundrymen. Parenchymatous keratitis of syphilitic origin with burning pain. Iritis, with hypopyon.

Optic atrophy (Optic neuropathy)

Phos: Sensation as if everything were covered with a mist or veil, or dust, or something pulled tightly over eyes. Black points seem to float before the eyes. Patient sees better by shading eyes with hand. Fatigue of eyes and head even without much use of eyes. Green halo about the candle light (Osmium). Letters appear red. Atrophy of optic nerve. Partial loss of vision from abuse of tobacco (Nux). Paresis of extrinsic muscles. Diplopia, due to deviation of the visual axis. Amaurosis from sexual excess. Glaucoma. Thrombosis of retinal vessels and degenerative changes in retinal cells. Degenerative changes where soreness and curved lines are seen in old people. Retinal trouble with lights and hallucination of vision.
Strych nit: Dimness of vision. Sense of sight became much impaired (soon). Confused misty vision. Persistent amaurosis. Numerous sparks before the eyes, sometimes blackish, sometimes white, sometimes red.
Increased peripheric sensibility for blue. Temporary increase of visual power. More distinct perception of peripheric points. Lasting enlargement of the field of vision.

IIIrd Ptosis

Gels: Ptosis; eyelids heavy; patient can hardly open them. Double vision. Disturbed muscular apparatus. Corrects blurring and discomfort in eyes even after accurately adjusted glasses. Vision blurred, smoky (Cycl; Phos). Dim-sighted; pupils dilated and insensible to light. Orbital neuralgia, with contraction and twitching of muscles. Bruised pain back of the orbits. One pupil dilated, the other contracted. Deep inflammations, with haziness of vitreous. Serous inflammations. Albuminuric retinitis.
Morph: Bluish, drooping lids. Itching of eyes. Delusion of vision on closing eyes. Starting, injected; diverging strabismus. Pupils unequally contracted. Look unsteady. Ptosis. Paresis of recti interni.
Sep: Muscular asthenopia; black spots in the field of vision; asthenic inflammations, and in connection with uterine trouble. Aggravation of eye troubles morning and evening. Tarsal tumors. Ptosis, ciliary irritation. Venous congestion of the fundus.
Zinc met.: Pterygium; smarting, lachrymation, itching. Pressure as if pressed into head. Itching and soreness of lids and inner angles. Ptosis. Rolling of eyes. Blurring of one-half of vision; worse, stimulants. Squinting. Amaurosis, with severe headache. Red and inflamed conjunctiva; worse, inner canthus.
Other remedies: Caust., Con.

Diplopia

Bell: Throbbing deep in eyes on lying down. Pupils dilated (Agnus). Eyes feel swollen and protruding, starring, brilliant; conjunctiva red; dry, burn; photophobia; shooting in eyes. Exophthalmus. Occular illusions; fiery appearance. Diplopia, squinting, spasms of lids. Sensation as if eyes were half closed. Eyelids swollen. Fundus congested.
Cycl.: Dim vision, worse on waking, with spots before eyes. Flickering of various colors. Convergent strabismus. Sees countless stars. Diplopia. Disturbance of vision, associated with gastric disturbances.
Other remedies: Gels., Hyos., Nit ac.

Divergent strabismus (Squint/Exophoria)

Morph: (Refer Ptosis)
Other remedies: Nat mur., Agar, Jabo., Nat sul.

IVth Strabismus

Bell: Diplopia, squinting, spasms of lids. Sensation as if eyes were half closed. Eyelids swollen. Fundus congested.
Santon: Strabismus due to worms. Sudden dimness of sight. Color blindness; Xanthopsia. Dark rings about eyes.
Stram: Seem prominent, staring wide open; pupils dilated. Loss of vision; complains that it is dark, and calls for light. Small objects look large. Parts of the body seem enormously swollen. Strabismus. All objects look black. Other remedies: Cic., Gels., Hyos., Zinc.

Vth Trigeminal neuralgia (Prosopalgia)
Acon., Agar., Ars., Bell., Caps., Ced., Cham., Cinch., Colo., Gels., Mag. ph., Mez., Plat., Rhus. tox., Spig., Verbascum.

Location

• Eyes: Cinnab., Spig.
• Jaw lower: Amphis., Rhod.
• Jaw upper: Amphis., Calc., Caust., Euphorbia, Kali, cy., Verbascum.
• Teeth, temples, ears, eyes, malar bones: Act sp., Cham., Coff., Colo., Kali cy., Spig., Verbascum.
• Unilateral left: Acon., Colo., Lach., Spig., Verbascum.
• Unilateral right: Cactus, Kal., Mag. ph., Mer., Puls, Sang c. Aconite: On rising the red face becomes deathly pale, or he becomes dizzy. Tingling in cheeks and numbness. Neuralgia, especially of left side, with restlessness, tingling, and numbness. Pain in jaws.

Kali iod: Facial neuralgia. Lancinating pain in upper jaw.
Mag phos: Severe neuralgic pain; worse behind right ear; worse,   by going into cold air, and washing face and neck with cold water. Toothache; better by heat and hot liquids.
Platinum: Prosopalgia, with numb feeling in malar bones, as if the parts were between screws. Pain at root of nose, as if squeezed in a vise. Coldness, creeping, and numbness, in whole right side of face. Pains increase and decrease gradually.
Rhodo: Prosopalgia; violent jerking pain involving dental nerves, from temple to lower jaw and chin; better, warmth and eating. Toothache in damp weather and before a storm. Swollen gums. Stumps of teeth are loosened.

Type of pain

• Cramp like: Cact., Mez., Plat., Verbascum.
• Cutting, tearing: Ars., Cham., Colo., Puls., Spig.
• Lightening like radiating: Bell., Colo., Kali carb., Nux v., Rhod., Spig., Strych.
• Periodical intermittent: Cinch., Colo., Spig.

Modalities

• Aggravation
  • from chewing: Mez.
  • from cold exposure: Acon., Coff., Mag. c., Mag p., Dul., Sil., Spig.
  • from touch: Bell., Cinch., Cupr. m., Hep., Mez., Spig.
  • from eating: Mez.
  • from movement: Bell., Spig.
  • from warmth: Cham., Glon., Puls.
  • in night: Ars., Puls.
• Amelioration.
  • from cold application: Clem., Puls.
  • from eating: Rhod.
  • from pressure: Colo., Rhod.
  • from rubbing: Plat.
  • from warmth: Colo., Mag. phos., Naja.

VIth Convergent strabismus:
Cycl. (Refer Diplopia)

Jabo: Eye strain from whatever cause. Irritability of the ciliary muscle. Eyes easily tire from slightest use. Heat and burning in eyes on use.
Headache; smarting and pain in globe on use. Everything at a distance appears hazy; vision becomes indistinct every few moments. Retinal images retained long after using eyes. Irritation from electric or other artificial light. Pupils contracted; do not react to light. Staring eyes. Near- sighted. Vertigo and nausea after using eyes. White spots before eyes. Smarting pain in eyes. Lids twitch. Atrophic choroiditis. Spasm of the accommodation while reading.

VIIth Facial palsy (Bell’s palsy)

• Acon., Ars., Phos., Caust., Dulc, Gels., Graph., Kali chlor., Kali iod., Rhus tox., Senega.
• facial palsy left side: Caust., Senega.
• facial palsy right side: Bell., Caust.
• facial palsy single side: Caust.

Caust: Paralysis of one side of face from the forehead to the chin. Mouth drawn to one side. Occasional spasmodic twitching of muscles on left side of face. Paleness of face.
Senega: Paralysis of left side of face. Heat in face. Sensation as if muscles of (l. half) of face were paralysed.


VIIIth Vertigo

Absinth: Vertigo, with tendency to fall backward. Dizzy on rising. General confusion. Wants head low. Pupils dilated unequally. Face blue. Spasmodic facial twitching. Dull occipital headache (Gelsem, Picric ac).
Acon: Fullness; heavy, pulsating, hot, bursting, burning undulating sensation. Intercranial pressure (Hedera Helix). Burning headache, as if brain were moved by boiling water (Indigo). Vertigo; worse on rising (Nux., Opium) and shaking head. Sensation on vertex as if hair were pulled or stood on end. Nocturnal furious delirium.
Agr: Vertigo from sunlight, and on walking. Head in constant motion. Falling backward, as if a weight in occiput. Lateral headache, as if from a nail (Coff; Ignat).
Con: Vertigo, when lying down, and when turning over in bed, when turning head sidewise, or turning eyes; worse, shaking head, slight noise or conversation of others, especially towards the left.
Opium: Vertigo; lightness of head in old people. Dull, heavy, stupid. Delirium. Vertigo after fright. Pain in back of head; great weight there (Gels). Bursting feeling. Complete insensibility; no mental grasp for anything. Paralysis of brain.
Tabacum: Vertigo on opening eyes; sick headache, with deathly nausea; periodical. Tight feeling as from a band.
Theridion: Vertigo, with nausea and vomiting on least motion, particularly when closing eyes.
Other remedies: Apis., Arg nit., Bell., Bry., Calc., Carbo veg., Chin sulp., Cinch., Coca, Con., Gels., Glon., Morph., Nux vom., Opium, Phos., Puls., Silicea, Tab., Ther.

Meniere’s Disease

Chenop: Sudden vertigo. Meniere’s disease. Affections of auditory nerves (Nat salicyl). Torpor of auditory nerve. Hearing better for high-pitched sounds. Comparative deafness to sound of voice, but great sensitiveness to sound, as of passing vehicles and also a shrinking from low tones. Buzzing in ears. Enlargement of tonsils. Aural vertigo.
Chin s: Violent ringing, buzzing, and roaring in ears, with deafness. Pain in forehead and temples, increasing gradually at noon, of malarial origin, with vertigo and pulsation. Worse left side.
Nat s: Sticking pain, earache, lightning-like stitches in damp weather.  Piercing stitches in ears. Vertigo; relieved by sweat on head.
Sali ac: Vertigo; tendency to fall to left side. Roaring and ringing in ears. Deafness, with vertigo.
Ther: Least noise <; every shrill sound and reverberation penetrates whole body, esp. teeth, < vertigo. Loud noises make too strong an impression (> Acon.). Pressure above ears; fulness behind ears. Violent itching behind ears. Roaring in ears. Rushing in ears like a waterfall, with impaired hearing.

IXth Dysphagia

Cajup: Feels closed up. Oesophagus: paralysed; swollen sensation; constricted, < attempting to swallow solid food. Burning in pharynx and œsophagus. Persistent sensation of choking.
Caps: Sore throat with painful deglutition and pulling sensation in the pharynx. Inflammation, with dark redness and burning of the throat. Canth: Difficult deglutition, with strangulation in the throat, and nocturnal regurgitation of food. Impeded deglutition, esp. in the case of liquids. Burning in the throat, on swallowing.
Other remedies: Bapt., Bell., Hyos., Ign., Lach., Merc c., Merc s., Mer. v., Acid mur., Phyt., Stram.

Taste loss

Amyg. pcr: Loss of smell and taste. Gastric and intestinal irritation when the tongue is elongated and pointed, tip and edges red. Constant nausea and vomiting.
Mag. m.: Loss of smell and taste, following catarrh.
Nat nit: Taste altered, almost sour. Sour taste and sour eructations, for a short time, almost like heartburn. Peculiar, almost coppery taste on the lips and tongue, all the forenoon.
Cant: Loss of taste. Taste of pitch (rough) in the mouth and in the throat. Thirst, from dryness of the lips, with repugnance to all drinks. Want of appetite, with disgust and repugnance to all sorts of food.
Stram: Loss of taste. Food tastes only of sand, or straw (or has no taste at all). Violent thirst (for large quantities, drinking with avidity). Violent thirst, esp. for acid drinks. Constant bitterness in mouth, with bitter taste of food. Burning thirst, generally with dread of water and all liquids.
Other remedies: Ant. c., Nat. m., Puls.

Xth Aphonia

Caust: The leading feature of the Causticum effects is Paralysis, showing itself both in voluntary and involuntary muscles. Paralytic weakness. Paralysis of single nerves or single parts. Ptosis; facial paralysis; paralysis of tongue; muscles of deglutition, of extremities; of vocal cords; of bladder; of rectum; lead paralysis. Allied to paralysis are convulsions, chorea, cramps, starting, restlessness, twitching.
Gels: Voice weak. Paralysis of the glottis with difficult deglutition. Spasm of the glottis, in evening, threatening suffocation. Roughness of the throat, raw, as if ulcerated in the larynx. Slow pulse, tired feeling, mental apathy.
Paralysis of various groups of muscles about the eyes, throat, chest, larynx, sphincter, extremities, etc.
Ox. acid: Nervous aphonia with cardiac derangement (Coca; Hydrocy ac). Burning sensation from throat down. Breathing spasmodic, with constriction of larynx and chest. Hoarseness. Aphonia. Paralysis of the tensors of vocal cord.

XIth Inability in moving the neck to opposite side

Acon: Weakness and pain, as from a bruise in the nape of the neck. Painful stiffness in the nape of the neck, the loins, and the hip joints.
Bell: Painful swelling and stiffness in the neck and in the nape of the neck. Painful swelling in the glands of the neck and in those of the nape of the neck.
Bry: Painful stiffness of the neck. Rheumatic stiffness and tension in the nape of the neck, and in the neck.
Lach: Drawn over to one side in sore throat. Rheumatism of the neck. Stiffness of neck. Pain in nape, as if dislocated. A remedy for torticollis, rheumatic symptoms about neck.

XIIth Tongue atrophy

Mur acid.: Tongue, pale, swollen, dry, leathery, paralyzed. Deep ulcers on tongue. Hard lumps in tongue. Epithelioma; edges bluish-red (Carbol ac). Aphthous mouth. Gums and glands swollen. Fetid breath. Sordes on teeth.

Tongue paralysis

Bell: Sensation of cold, of torpor, and of numbness in the tongue. Tongue red, hot, dry, and cracked, or loaded with whitish mucus, or yellowish, or brownish; redness of the edges of the tongue.Inflammatory swelling and redness of the papillæ of the tongue. Phlegmonous inflammation of the tongue. Soreness of the tongue, esp. on touching it, with a sensation as if it were covered with vesicles. Heaviness, trembling, and paralytic weakness of the tongue, with difficult and stuttering speech. Dumbness. Voice weak, whistling, and nasal.
Both: Paralysis of tongue. Inability to articulate without any affection of the tongue.
Caust: Bites inside of cheek from chewing. Paralysis of tongue, with indistinct speech.
Con: Tongue red, mottled. Felt as if her tongue stuck to the roof of the mouth, and she could not move it. Tongue covered over its upper surface, as well as over a large portion of the lower surface, with dirty mucus, and dry. Tongue stiff, swollen, painful. Burning as from pepper on the tip of the tongue. Boring pain in the tongue at night. Sticking and burning in the left side of the tip of the tongue. Sticking and biting on the tip of the tongue.
Cur: Curare produces muscular paralysis, probably through its action   on the nerve endings in the muscles, without affecting either the muscle substance or the nerve substance, and without impairing sensation and consciousness. Tongue and mouth drawn to right. Tongue coated. On waking tongue yellowish at base, papillæ raised, light pink anteriorly, bitter or bloody taste, yellow-white. Mouth dry.
Other remedies: Dulc., Gels., Mur acid., Plumb met.

Reference: Textbook of Practice of Medicine with Homoeopathic Therapeutics by Kamal Kansal & Rakesh Kaushal