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5 - Cranial nerves Flashcards

1
Q

What are the cranial nerves?

A 
Olfactory - I
Optic - II
Oculomotor - III
Trochlear - IV
Trigeminal - Opthalmic V1, maxillary V2, mandibular V3
Abducens - VI
Facial - VII
Vestibulocochlear - VIII 
Glossopharyngeal - IX
Vagus - X 
Accessory - XI
Hypoglossal - XII
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2
Q

Which cranial nerve travels through the cribiform plate?

A

Olfactory (I)

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3
Q

Which cranial nerve travels through the optic canal?

A

Optic (II)

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4
Q

Which cranial nerve travels through the superior orbital fissure?

A

Occulomotor (III)
Trochlear (IV)
Opthalmic (V1)
Abducens (VI)

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5
Q

Which cranial nerve travels through foramen rotundum?

A

Maxillary (V2)

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6
Q

Which cranial nerve travels through foramen ovale?

A

Mandibular (V3)

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7
Q

Which cranial nerve travels through internal acoustic meatus?

A 
Facial nerve (VII)
Vestibulocochlear (VIII)
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8
Q

Which cranial nerve travels through jugular foramen?

A

Glossopharyngeal (IX)
Vagus (X)
Spinal accessory (XI)

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9
Q

Which cranial nerve travels through hypoglossal canal?

A

Hypoglossal (XII)

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10
Q

What is the function and modality of olfactory (I) nerve?

A

Special sensory

Smell

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11
Q

What is the function and modality of optic (II) nerve?

A

Special sensory

Vision

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12
Q

What is the function and modality of oculomotor (III) nerve?

A

Motor
Extrinsic eye muscles
Levator palpebrae superioris

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13
Q

What is the function and modality of trochlear (IV) nerve?

A

Motor

Superior oblique - eye movement

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14
Q

What is the function and modality of opthalmic (V1) nerve?

A

Sensory

Scalp, forehead and nose

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15
Q

What is the function and modality of maxillary (V2) nerve?

A 
Sensory 
Cheeks 
Lower eyelid
Nasal mucosa 
Upper lip, teeth and palate
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16
Q

What is the function and modality of mandibular (V3) nerve?

A

Motor and sensory
Sensory: Anterior 2/3 tongue, mandible and lower teeth
Motor: Muscles of mastication

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17
Q

What is the function and modality of abducens (VI) nerve?

A

Motor

Lateral rectus - eye movement

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18
Q

What is the function and modality of facial (VII) nerve?

A

Motor and sensory
Motor: Muscles of facial expression, lacrimal, submandibular, sublingual and mucosal glands of nose and mouth
Special sensory: Taste for anterior 2/3 of tongue
Sensory: External ear

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19
Q

What is the function and modality of vestibulocochlear (VIII) nerve?

A

Special sensory

Hearing and balance

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20
Q

What is the modality and function of glossopharygneal (IX) nerve?

A

Motor and sensory
Motor: Autonomic - Parotid gland
Sensory: Posterior 1/3 tongue taste and sense, carotid body and sinus, soft palate, tonsils and pharynx -shared innervation with-middle ear and tympanic membrane

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21
Q

What is the modality and function of vagus (X) nerve?

A

Motor and sensory
Motor: Muscles of soft palate, pharynx, larynx (vocal cords)
Sensory: lower pharynx and larynx
Parasympathetic innervation to thoracic and abdominal viscera

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22
Q

What is the modality and function of spinal accessory (XI) nerve?

A

Motor

Trapezius and SCM

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23
Q

What is the modality and function of hypoglossal (XII) nerve?

A

Motor

Intrinsic and extrinsic tongue muscles

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24
Q

Which cranial nerves originate in the (fore)brain?

A

Olfactory (I)

Optic (II)

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25
Which cranial nerves originate in the midbrain?
Oculomotor (III) | Trochlear (IV)
26
Which cranial nerves originate from the pons?
Trigeminal (V) Abducens (VI) Facial (VII) Vestibulocochlear (VIII)
27
Which cranial nerves originate from the medulla?
Glossopharyngeal (IX) Vagus (X) Accessory (XI) Hypoglossal (XII)
28
What route does the olfactory (I) nerve take through the brain?
Cribiform foramina - olfactory bulb - olfactory tract - temporal lobe - primary olfactory cortex
29
What is anosmia and what causes it?
Loss of smell Colds - congestion in epithelium where olfactory fibres travel Head injury - shearing of fibres Intracranial tumour at base of frontal lobe
30
How is the olfactory (I) nerve tested?
Identification of smells | One nostril at a time
31
What route does the optic (II) nerve take through the brain?
Retina - optic canal - middle cranial fossa: - optic chiasm - optic tract (of opposite side) - occipital lobe
32
Describe the effect a pituitary adenoma has on vision
Pituitary gland close to optic chiasm, compressing it and affecting lateral visual field in both eyes - bitemporal hemianopia
33
How is optic (II) nerve function tested?
Opthalmoscope - optic disc visible
34
What abnormalities can be seen on a fundoscopy?
Papillodema - swollen optic disc as it carries extension of meninges, so swells with raised intracranial pressure Lesion on one eye only
35
What route does the oculomotor (III) nerve take through the brain?
Midbrain - cavernous sinus - superipr orbital fissure - orbit
36
How is the oculomotor (III) nerve tested?
Inspection of eyelid and pupils Eye movements Pupillary light reflexes
37
What effect does pathology have on the oculomotor (III) nerve?
Pupillary dilation - unopposed action of dilator pupillae Diplopia - double vision Down and out eye position- paralysis of superior, inferior and medial rectus Ptosis - paralysis of levator palpabrae superioris
38
What can cause oculomotor (III) pathology?
Raised intracranial pressure - tumour/ haemorrhage Aneurysm Cavernous sinus thrombosis Vascular - diabetes/hypertension
39
What is the route the trochlear (IV) nerve takes through the brain?
Midbrain - cavernous sinus - superior orbital fissure - orbit Only nerve to emerge from dorsal midbrain
40
How is the trochlear (IV) nerve tested?
Eye movement test
41
What causes pathology affecting the trochlear (IV) nerve?
Congenital palsy | Head injury
42
What symptom results from damage to the trochlear (IV) nerve?
Diplopia - double vision
43
What route does the trigeminal (V) nerve take through the brain?
Level of pons, form root in middle cranial fossa Opthalmic (V1): Superior orbital fissure Maxillary (V2): Foramen rotundum Mandibular (V3): Foramen ovale
44
How is the trigeminal nerve (V) tested?
Dermatomes of face Muscles of mastication action Corneal reflex- blink
45
What pathologies affect the trigeminal nerve (V)?
Trigeminal neuralgia - compression of nerve causing sudden facial pain Opthalmic shingles - herpes zoster affects opthalmic nerve Corneal ulcer - pain conveyed by trigeminal (V)
46
What fractures affect the trigeminal (V) nerve?
Blow out fracture of orbit - branch of maxillary (V2) - infraorbital Eye forced backwards, orbital floor fractures damaging nerve Reduced sensation under eye Mandible fracture - damage to mental nerve, branch of mandibular (V3)
47
Why is the lips and sides of tongue numbed in dental injections?
Injected at mandibular foramen, path for lingual nerve that innervates gums but also inferior alveolar, branch of mandibular (V3)
48
Describe the route of the abducens (VI) through the brain
Pons - cavernous sinus- superior orbital fissure - lateral rectus
49
How is the function of the abducens (VI) tested?
Eye movements
50
Why is the abducens (VI) easily affected by raised intracranial pressure and what does this cause?
Emerges anteriorly before running under pons so easily compressed Can't move laterally so unopposed medial movement of eye resulting in diplopia
51
Describe the route the facial nerve (VII) takes through the brain
Bottom of pons - internal auditory meatus in temporal bone - divides into chorda tympani and greater petrosal
52
How is the function of the facial nerve (VII) tested?
Muscles of facial expression Corneal reflex Taste function of anterior 2/3 tongue
53
What structures is the facial nerve closely related to?
Vestibulocochlear (VIII) as both travel through internal auditory meatus Middle ear - travels through petrous temporal bone Parotid gland
54
What is Bell's palsy?
Idiopathic paralysis of the facial nerve - loss of function of facial nerve: taste on anterior 2/3 of tongue on affected side, lacrimation, salivation, smiling, frowning
55
Describe the route the vestibulocochlear (VIII) nerve takes through the brain
Pons - internal acoustic meatus - petrous bone - splits, vestibular branch innervates vestibular system of inner ear and cochlear branch travels to cochlear, forming spiral ganglia
56
How is the function of vestibulocochlear (VIII) nerve tested?
Whispering | Rinne - Weber tests
57
What is the Rinne test and what is it examining?
Tuning fork on mastoid then next to ear canal If conductive hearing loss, bone conduction heard longer than air because air uses pinna, eardrum and ossicles to amplify sounds, bone allows sound to be transmitted directly to inner ear If sensorineural hearing loss, air heard longer than bone which is normal result but sound will stop much sooner
58
What is the Weber test and what is it examining?
Tuning fork in the middle of the head, testing which ear it is heard better Conductive hearing loss - sound heard best in abnormal ear as is only receiving input from bone not air, middle ear picking up ambient room noise not functioning so sound louder in affected ear Sensorineural hearing loss - sound heard best in normal ear as not receiving input from bone conduction
59
What is an acoustic neuroma and what are the symptoms?
``` Benign tumours of Schwann cells, compressing vestibulocochlear (VIII) nerve and potentially facial (VII) and trigeminal (V) nerves due to close proximity Unilateral sensorineural hearing loss Tinnitus Vertigo Muscle weakness - facial (VII) Numbness (V) ```
60
Describe the route the glossopharyngeal (IX) nerve takes through the brain
Medulla oblongata - posterior cranial fossa - jugular foramen - branch off to tympanic which exits via foramen ovale to the ear rest of branches go to jaw and pharynx
61
How is the function of glossopharyngeal (IX) nerve tested?
Gag reflex - sensory limb, motor from vagus X
62
Describe the route of the vagus (X) nerve through the brain
Medulla - jugular foramen - carotid sheath
63
How is the function of the vagus (X) nerve tested?
Observing uvula when saying AH, deviation when soft palate is elevated suggests lesion Gag reflex - motor from vagus (X), sensory from glossopharyngeal (IX) Hoarseness/dysphonia if recurrent laryngeal nerve compressed
64
Describe the route of the spinal accessory (XI) nerve through the brain
Medulla - jugular foramen - posterior triangle
65
What is the function of the spinal accessory (XI) nerve?
Innervation of SCM - lateral flexion of neck Innervation of trapezius - elevates scapula and rotates it during abduction of arm, retraction and inferior pull of scapula
66
How is the function of the spinal accessory (XI) nerve tested?
Shrug shoulders or turn head against resistance
67
Describe the route of the hypoglossal (XII) nerve through the brain
Medulla oblongata - posterior cranial fossa - hypoglossal canal - cervical plexus (crossing internal and external carotid arteries) - mandible
68
How is the function of the hypoglossal (XII) nerve tested?
Movement of the tongue as damage to it causes weakness and atrophy of tongue muscles on ipsilateral side
69
How does a carotid sinus massage slow the heart rate?
Glossopharyngeal (IX) receives signals from carotid sinus in internal carotid artery, baroreceptors sensitive to increased pressure, IX relays this to medulla oblongata. Response via vagus nerve (X) to slow heart rate

Head and neck (14 decks)

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