3rd, 4th, 5th, 6th, 7th Nerve Syndromes

Question 1

What are the 6 syndromes of the 6th nerve?

Answer 1

1. Brainstem syndrome
2. Subarachnoid space syndrome (pseudotumor - tethering in Dorello’s canal)
3. Petrous apex syndrome
4. Cavernous sinus syndrome
5. Orbital syndrome
6. isolated 6th nerve palsy

Question 2

What are the 3 brainstem syndromes of CN6?

Answer 2

1. Millard-Gubler syndrome (6,7,contralateral hemiparesis)
2. Raymonds syndrome (6+contralateral hemiparesis)
3. Foville’s syndrome (5-8 palsy + Ipsilateral Horner’s syndrome)

Question 3

What are the 3 Petrous Apex Syndrome?

Answer 3

1. Gradenigo’s - 6th nerve palsy + ipsilateral decreased hearing, facial pain, facial paralysis)
2. Petrous skull fracture - 5-8 CN involvement
3. Pseudo-Gradenigo - nasopharyngeal carcinoma or CPA tumor

Question 4

What innervates the SR muscle?

Answer 4

The CONTRALATERAL 3rd nerve nucleus

Question 5

What innervates the levator muscle?

Answer 5

Both levators are innervated by ONE subnuclear structure - central caudal nucleus–> there fore a nuclear 3rd requires b/l ptosis

Question 6

What are the 4 fascicle 3rd nerve syndromes?

Answer 6

1. Nothnagel - Ipsilateral 3rd nerve + cerebellar ataxia (lesion in area of the superior cerebellar peduncle)
2. Benedikt’s syndrome - lesion of the red nucleus (ipsi 3rd nerve with contralateral hemitremor)
3. Weber’s syndrome - (lesion of cerebral peduncle) - ipsi 3rd with contra hemiparesis
4. Claude - both benedikt + Nothnagel

Fascicular lesions always ischemic, infiltrative, or rarely inflm

Question 7

What are the 2 vessels that the 3rd + 4th nerve courses betwn in the midbrain?

Answer 7

1. Posterior Cerebral Artery (top)

2. Superior Cerebellar Artery (bottom)

Question 8

When does abberant regeneration of 3rd nerve occur?

Answer 8

1. Tumor
2. Trauma
   (never to ISCHEMIA)

Question 9

Whart are the 2 clinical phenomenon of abberant regeneration?

Answer 9

1. Lid-Gaze dyskinesis

2. Pupil-gaze dyskinesis

Question 10

What CN is the only one to exit the dorsal aspect of the brainstem?

Answer 10

CN 4

Question 11

Which CN has the longest intracranial nerve?

Answer 11

CN 4 (75mm)

Question 12

The left nerve fascicle innervates what muscle?

Answer 12

R SO

Question 13

What are the 5 syndromes of CN 4?

Answer 13

1. Nuclear-Fascicular syndrome
2. Subarachnoid space syndrome
3. Cavernous sinus syndrome
4. Orbital syndrome
5. Isolated CN 5 palsy

Question 14

In Brown’s syndrome what adaptations occur?

Answer 14

1. Chin up position ( affected eye usually hypotropic)

2. Face turn (AWAY from Brown’s eye)

Question 15

What causes paroxysmal, rapid, vertical, and torsional movements of one eye that are usually small, necessitating slit-lamp exam?

Answer 15

SO myokymia (tx with carbamazepine)

Question 16

In double maddox rod test which line is one top?

Answer 16

White

Question 17

Greater than how many degrees of torsion suggestive b/l 4th nerve palsy?

Answer 17

10 degrees (also large V pattern stab >25D)

Question 18

How do you differentiate 4th nerve palsy from skew deviation?

Answer 18

Skew - increased vertical strabismus on up gaze

4th nerve - increased on down gaze

Question 19

What type of inflm do you see in Tolosa-Hunt?

Answer 19

Granulomatous

Question 20

In Botulism what happens with pupils?

Answer 20

Dilated, poorly reactive pupils, ptosis

Question 21

What is the bulbar variant of Guillain-Barre syndrome?

Answer 21

Miller Fisher syndrome - pupils involved with loss of accomadation.

Question 22

What are the 2 functions of CN5?

Answer 22

1. Ipsilateral sensory

2. Ipsilateral motor - muscles of mastication (masseter, temporalis, pterygoids)

Question 23

Concentric periporal numbness has the lesion where?

Answer 23

Central (nuclear) origin - ischemic, demylination

Question 24

What is CN5 nerve distribution pain with ipsilateral Horner’s syndrome?

Answer 24

Raeder’s paratrigeminal neuralgia

- middle aged or elderly males

Question 25

A supranuclear facial nerve palsy causes what?

Answer 25

Contralateral weakness of the lower 2/3 of the face

Question 26

The incidence of Bell’s palsy higher in what 3 people?

Answer 26

1. Pregnant
2. DM
3. Fhx of Bell’s

Question 27

What muscles are affected in Bell’s palsy?

Answer 27

BOTH the upper and lower face muscles unilaterally.

Question 28

What is the name of the dz that has recurrent, alternating facial palsy with facial swelling, transverly fissured tongue in kids ?`

Answer 28

Melkersson-Rosenthal syndrome

Question 29

What 7th nerve d/o is due to dysfunction at the basal ganglia?

Answer 29

blepharspasm (b/l)

Question 30

The 7th CN affect taste where?

Answer 30

Anterior 2/3 of tongue.

Question 31

Which nerve palsy has aberrant regeneration?

Answer 31

7th (10-20%)&raquo_space;>3rd nerve

7th - blepharospasm, hemifacial spasm

Question 32

Which 7th nerve palsy causes total unilateral facial droop?

Answer 32

Lower motor neuron (upper motor neuron only causes contralateral lower face droop)

Question 33

Webers causes what?

Answer 33

3rd nerve fasicle paresis with contraleteral hemiparesis (Weber = WEAK)

Question 34

Claudes causes what?

Answer 34

3rd nerve fasicular palsy at the superior cerebellar peduncle causes ipsi 3rd with contralteral ataxia (Claude = CLUMPSY)

Question 35

An eye with a 4th nerve palsy will look like what in primary gaze?

Answer 35

Nasal upshoot - when looking nasal