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Clinical Anatomy Course > 1. Cranial Nerves > Flashcards

1. Cranial Nerves Flashcards

1
Q

What do you need to know for each cranial nerve?

A
  • You should be familiar with each cranial nerve: name, components (motor, sensory, autonomic), exit from skull, and function. (Details of course and relations are not required, unless otherwise indicated).
  • For each cranial nerve, you should be familiar with common signs of lesions and routine clinical tests of functions.
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2
Q

For CN 1, describe:

  • Name
  • Components
  • Exit from skull
  • Function
  • Signs of lesion + Tests
A
  • Name -> Olfactory nerve
  • Components -> Sensory
  • Exit from skull -> Through cribriform plate of ethmoid
  • Function -> Sense of smell
  • Signs of lesion + Tests -> Loss of sense of smell
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3
Q

For CN 2, describe:

  • Name
  • Components
  • Exit from skull
  • Function
  • Signs of lesion + Tests
A
  • Name -> Optic nerve
  • Components -> Sensory
  • Exit from skull -> Optic canal
  • Function -> Vision
  • Signs of lesion + Tests -> Visual field defects diagnosed via visual field testing
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4
Q

What can commonly lead to damage of the optic nerve?

A

Raised intracranial pressure, since the optic nerve is encased in all three meningeal layers.

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5
Q

What structure is the optic nerve closely related to and why?

A
  • Pituitary gland
  • This is because the pituitary gland is just posterior to the optic chiasm, so pituitary tumours can compress the optic nerve
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6
Q

For CN 3, describe:

  • Name
  • Components
  • Exit from skull
  • Function
  • Signs of lesion + Tests
A
  • Name -> Oculomotor nerve
  • Components -> Motor
  • Exit from skull -> Superior orbital fissure
  • Function -> Ciliary muscles, Sphincter pupillae (parasympathetic), All extrinsic muscles of the eye except SO and LR, Levator palpebrae
  • Signs of lesion -> Eye deviates downwards and laterally. Pupils dilate and eyelid droops (ptosis, due to loss of levator palpebrae).
  • Tests -> Ocular movements are tested through asking the patient to follow an object with their eyes, without moving their head. Accomodation reflex is tested. Pupillary light reflex is tested.. Extraocular movements are tested for through looking for ptosis and eye positioning.
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7
Q

For CN 4, describe:

  • Name
  • Components
  • Exit from skull
  • Function
  • Signs of lesion + Tests
A
  • Name -> Trochlear nerve
  • Components -> Motor
  • Exit from skull -> Superior orbital fissure
  • Function -> Superior oblique muscle
  • Signs of lesion -> Difficulty looking down
  • Tests -> Patient is asked to look downwards and inwards, as this is the movement the muscle contributes towards most. Can use Bielschowsky’s head tilt test (isolates superior oblique muscle).
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8
Q

For CN 6, describe:

  • Name
  • Components
  • Exit from skull
  • Function
  • Signs of lesion + Tests
A
  • Name -> Abducens nerve
  • Components -> Motor
  • Exit from skull -> Superior orbital fissure
  • Function -> Lateral rectus muscle
  • Signs of lesion -> Difficulty looking down
  • Tests -> Patient is asked to look downwards and inwards, as this is the movement the muscle contributes towards most. Can use Bielschowsky’s head tilt test (isolates superior oblique muscle).
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9
Q

What are some important relations of the abducens nerve?

A

It lies lateral to the internal carotid artery in the cavernous sinus.

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10
Q

What are the 3 branches of the trigeminal nerve?

A
  • Ophthalmic
  • Maxillary
  • Mandibular
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11
Q

For the ophthalmic branch of CN 5, describe:

  • Name
  • Components
  • Exit from skull
  • Function
  • Signs of lesion + Tests
A
  • Name -> Trigeminal nerve (ophthalmic branch)
  • Components -> Sensory
  • Exit from skull -> Superior orbital fissure
  • Function -> Sensation to cornea, forehead, conjunctiva (blink reflex), upper eyelid, scalp, nose, mucosa of nasal cavity and para-nasal sinuses
  • Tests -> Blink reflex
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12
Q

For the maxillary branch of CN 5, describe:

  • Name
  • Components
  • Exit from skull
  • Function
  • Signs of lesion + Tests
A
  • Name -> Trigeminal nerve (maxillary branch)
  • Components -> Sensory
  • Exit from skull -> Foramen rotundum
  • Function -> Sensation to lower eyelid, cheek, upper teeth, hard palate, and skin overlying maxilla, including upper lip, maxillary teeth, mucosa of nose, maxillary sinuses, palate.
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13
Q

For the mandibular branch of CN 5, describe:

  • Name
  • Components
  • Exit from skull
  • Function
  • Signs of lesion + Tests
A
  • Name -> Trigeminal nerve (mandibular branch)
  • Components -> Sensory and motor
  • Exit from skull -> Foramen ovale
  • Function -> Sensation to skin overlying jaw and temple including lower lip, lower teeth, TMJ, mucosa of mouth, anterior 2/3rds of tongue. Motor to muscles of mastication.
  • Tests -> Jaw jerk reflex
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14
Q

For the CN 7, describe:

  • Name
  • Components
  • Exit from skull
  • Function
  • Signs of lesion + Tests
A
  • Name -> Facial nerve
  • Components -> Sensory and motor (and parasympathetic)
  • Exit from skull -> Internal auditory meatus
  • Function -> Taste to anterior 2/3rds of tongue.Motor tomuscles of facial expression,stapediusandbuccinator. Parasympathetic tosubmandibularandsublingual salivary glandsandlacrimal gland.
  • Signs of lesion -> Bell’s palsy, characterised by loss of expression, dry eyes, altered taste, ptosis and uncontrolled salivation/dribbling
  • Tests -> Taste tests and face movement tests
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15
Q

Describe the course of the facial nerve that you need to know.

A

Internal acoustic meatus -> Middle ear -> Through parotid gland

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16
Q

For the CN 8, describe:

  • Name
  • Components
  • Exit from skull
  • Function
  • Signs of lesion + Tests
A
  • Name -> Vestibulocochlear nerve
  • Components -> Sensory
  • Exit from skull -> Internal auditory meatus
  • Function -> Hearing and vestibular sensation
  • Signs of lesion -> Deafness and problems with balance
  • Tests -> Rinne (mastoid bone) and Weber (midline)
17
Q

What two nerves travel through the internal acoustic meatus?

A
  • Facial nerve (7)
  • Vestibulocochlear nerve (8)
18
Q

For the CN 9, describe:

  • Name
  • Components
  • Exit from skull
  • Function
  • Signs of lesion + Tests
A
  • Name -> Glossopharyngeal nerve
  • Components -> Sensory and motor
  • Exit from skull -> Jugular foramen
  • Function -> Sensation and taste to posterior 1/3rd of tongue. Sensory innervation of carotid body and sinus, middle ear and oropharynx​ (gag reflex). Motor to stylopharyngeus (swallowing). Parasympathetic innervation of parotid gland.
  • Tests -> Gag reflex, Articulation
19
Q

For the CN 10, describe:

  • Name
  • Components
  • Exit from skull
  • Function
  • Signs of lesion + Tests
A
  • Name -> Vagus nerve
  • Components -> Sensory and motor
  • Exit from skull -> Jugular foramen
  • Function -> Sensation to external auditory meatus, larynx, respiratory and fore- and midgut GI tract below airway. Parasympathetic innervation of foregut and midgut thoracic and most abdominal viscera. Motor to muscles of pharynx, larynx and palate, striated muscle of upper 2/3rds of oesophagus.
  • Tests -> Same as for CN IX
20
Q

For the CN 11, describe:

  • Name
  • Components
  • Exit from skull
  • Function
  • Signs of lesion + Tests
A
  • Name -> Spinal accessory nerve
  • Components -> Motor
  • Exit from skull -> Jugular foramen
  • Function -> Motor to sternomastoid and trapezius
  • Tests -> Shrug shoulders and rotate head
21
Q

For the CN 12, describe:

  • Name
  • Components
  • Exit from skull
  • Function
  • Signs of lesion + Tests
A
  • Name -> Hypoglossal nerve
  • Components -> Motor
  • Exit from skull -> Hypoglossal canal
  • Function -> Motor to intrinsic and extrinsic muscles of tongue
  • Tests -> Tongue function inspection
22
Q

Summarise the cranial foramina that each of the cranial nerves pass through.

A
  • Cribriform plate -> 1
  • Optic canal -> 2
  • Superior orbit fissure -> 3, 4, 5 (ophthalmic), 6
  • Foramen rotundum -> 5(maxillary)
  • Foramen ovale -> 5(mandibular)
  • Internal auditory meatus -> 7, 8
  • Jugular foramen -> 9, 10, 11
  • Hypoglossal canal -> 12
23
Q

Label this diagram, including all of the structures passing through each structure.

A
  1. Cribriform plate
    • Olfactory nerve
  2. Optic canal
    • Optic nerve
    • Ophthalmic artery
  3. Superior orbital fissure
    • Oculomotor (III), trochlear (IV), ophthalmic trigemic (V) nerves and abducens (VI) nerve
    • Superior ophthalmic vein
  4. Foramen rotundum
    • Maxillary trigeminal (V) nerve
  5. Foramen ovale
    • Mandibular trigeminal (V) nerve
  6. Foramen spinosum
    • Middle meningeal artery
  7. Foramen lacerum (don’t need to know)
  8. Carotid canal
    • Internal carotid artery and internal carotid nerve sympathetic plexus
  9. Internal acoustic meatus
    • Facial (VII) and vestibulocochlear (VIII) nerves
    • Labyrinthine artery
  10. Jugular foramen
    • Glossopharyngeal (IX), vagus (X) and hypoglossal (XI) nerves
    • Internal jugular vein
  11. Hypoglossal canal
    • Hypoglossal (XII) nerve
  12. Foramen magnum
    • Spinal cord
    • Vertebral arteries
    • Spinal accessory (XI) nerve

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