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Head and neck > 5 - Cranial nerves > Flashcards

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
Q

Which cranial nerves originate in the midbrain?

A

Oculomotor (III)

Trochlear (IV)

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26
Q

Which cranial nerves originate from the pons?

A

Trigeminal (V)
Abducens (VI)
Facial (VII)
Vestibulocochlear (VIII)

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27
Q

Which cranial nerves originate from the medulla?

A

Glossopharyngeal (IX)
Vagus (X)
Accessory (XI)
Hypoglossal (XII)

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28
Q

What route does the olfactory (I) nerve take through the brain?

A

Cribiform foramina - olfactory bulb - olfactory tract - temporal lobe - primary olfactory cortex

29
Q

What is anosmia and what causes it?

A

Loss of smell
Colds - congestion in epithelium where olfactory fibres travel
Head injury - shearing of fibres
Intracranial tumour at base of frontal lobe

30
Q

How is the olfactory (I) nerve tested?

A

Identification of smells

One nostril at a time

31
Q

What route does the optic (II) nerve take through the brain?

A

Retina - optic canal - middle cranial fossa: - optic chiasm - optic tract (of opposite side) - occipital lobe

32
Q

Describe the effect a pituitary adenoma has on vision

A

Pituitary gland close to optic chiasm, compressing it and affecting lateral visual field in both eyes - bitemporal hemianopia

33
Q

How is optic (II) nerve function tested?

A

Opthalmoscope - optic disc visible

34
Q

What abnormalities can be seen on a fundoscopy?

A

Papillodema - swollen optic disc as it carries extension of meninges, so swells with raised intracranial pressure
Lesion on one eye only

35
Q

What route does the oculomotor (III) nerve take through the brain?

A

Midbrain - cavernous sinus - superipr orbital fissure - orbit

36
Q

How is the oculomotor (III) nerve tested?

A

Inspection of eyelid and pupils
Eye movements
Pupillary light reflexes

37
Q

What effect does pathology have on the oculomotor (III) nerve?

A

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
Q

What can cause oculomotor (III) pathology?

A

Raised intracranial pressure - tumour/ haemorrhage
Aneurysm
Cavernous sinus thrombosis
Vascular - diabetes/hypertension

39
Q

What is the route the trochlear (IV) nerve takes through the brain?

A

Midbrain - cavernous sinus - superior orbital fissure - orbit
Only nerve to emerge from dorsal midbrain

40
Q

How is the trochlear (IV) nerve tested?

A

Eye movement test

41
Q

What causes pathology affecting the trochlear (IV) nerve?

A

Congenital palsy

Head injury

42
Q

What symptom results from damage to the trochlear (IV) nerve?

A

Diplopia - double vision

43
Q

What route does the trigeminal (V) nerve take through the brain?

A

Level of pons, form root in middle cranial fossa
Opthalmic (V1): Superior orbital fissure
Maxillary (V2): Foramen rotundum
Mandibular (V3): Foramen ovale

44
Q

How is the trigeminal nerve (V) tested?

A

Dermatomes of face
Muscles of mastication action
Corneal reflex- blink

45
Q

What pathologies affect the trigeminal nerve (V)?

A

Trigeminal neuralgia - compression of nerve causing sudden facial pain
Opthalmic shingles - herpes zoster affects opthalmic nerve
Corneal ulcer - pain conveyed by trigeminal (V)

46
Q

What fractures affect the trigeminal (V) nerve?

A

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
Q

Why is the lips and sides of tongue numbed in dental injections?

A

Injected at mandibular foramen, path for lingual nerve that innervates gums but also inferior alveolar, branch of mandibular (V3)

48
Q

Describe the route of the abducens (VI) through the brain

A

Pons - cavernous sinus- superior orbital fissure - lateral rectus

49
Q

How is the function of the abducens (VI) tested?

A

Eye movements

50
Q

Why is the abducens (VI) easily affected by raised intracranial pressure and what does this cause?

A

Emerges anteriorly before running under pons so easily compressed
Can’t move laterally so unopposed medial movement of eye resulting in diplopia

51
Q

Describe the route the facial nerve (VII) takes through the brain

A

Bottom of pons - internal auditory meatus in temporal bone - divides into chorda tympani and greater petrosal

52
Q

How is the function of the facial nerve (VII) tested?

A

Muscles of facial expression
Corneal reflex
Taste function of anterior 2/3 tongue

53
Q

What structures is the facial nerve closely related to?

A

Vestibulocochlear (VIII) as both travel through internal auditory meatus
Middle ear - travels through petrous temporal bone
Parotid gland

54
Q

What is Bell’s palsy?

A

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
Q

Describe the route the vestibulocochlear (VIII) nerve takes through the brain

A

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
Q

How is the function of vestibulocochlear (VIII) nerve tested?

A

Whispering

Rinne - Weber tests

57
Q

What is the Rinne test and what is it examining?

A

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
Q

What is the Weber test and what is it examining?

A

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
Q

What is an acoustic neuroma and what are the symptoms?

A 
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
Q

Describe the route the glossopharyngeal (IX) nerve takes through the brain

A

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
Q

How is the function of glossopharyngeal (IX) nerve tested?

A

Gag reflex - sensory limb, motor from vagus X

62
Q

Describe the route of the vagus (X) nerve through the brain

A

Medulla - jugular foramen - carotid sheath

63
Q

How is the function of the vagus (X) nerve tested?

A

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
Q

Describe the route of the spinal accessory (XI) nerve through the brain

A

Medulla - jugular foramen - posterior triangle

65
Q

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

A

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
Q

How is the function of the spinal accessory (XI) nerve tested?

A

Shrug shoulders or turn head against resistance

67
Q

Describe the route of the hypoglossal (XII) nerve through the brain

A

Medulla oblongata - posterior cranial fossa - hypoglossal canal - cervical plexus (crossing internal and external carotid arteries) - mandible

68
Q

How is the function of the hypoglossal (XII) nerve tested?

A

Movement of the tongue as damage to it causes weakness and atrophy of tongue muscles on ipsilateral side

69
Q

How does a carotid sinus massage slow the heart rate?

A

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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