Combined 6th and 12th Cranial Nerve Palsies (Godtfredsen Syndrome) due to Clival Lesions

Background: Godtfredsen syndrome (GS), originally described by Dr. Erik Godtfredsen in 1946, is the combination of cranial nerve (CN) 6th and 12th palsies. The most common etiology of GS is a lesion of the clivus. Methods: A retrospective case series of GS is described. Results: Three patients were included: 1) a 38-year-old woman with a clival breast cancer metastasis; 2) a 35-year-old woman with a clival chordoma; and 3) a 72-year-old woman with a partially embolized dural arteriovenous fistula involving the hypoglossal canal. Conclusions: GS is a combination of CN 6th and 12th palsies and most commonly is due to a lesion in the clivus. Clinicians should be aware of this uncommon combination of cranial nerve findings, the localizing significance, and the differential diagnosis of clival lesions.