Cranial nerve palsy is a diagnostic guiding symptom, but often goes unrecognized. The differential diagnosis includes a variety of diseases, including malignant tumours of the head and neck. Here we describe three cases of cranial nerve palsy. In two of the cases the palsy was recognized following physical examination; this altered the differential diagnosis and work-up plan. In the third case the patient initially presented with cranial nerve palsy, and this case indicates the importance of the addition of diagnostic imaging. When a patient presents with cranial nerve pathology, physical examination has to be performed, searching for an underlying cause. And vice versa: if a patient presents with vague symptoms or a lump in the head and neck area, examination of the cranial nerves should be kept in mind. If oncology is suspected, the patient should be referred to an otolaryngologist at a head and neck oncology centre.
Conflict of interest: none declared. Financial support: none declared.