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Neurology > Anatomy 4 > Flashcards

Anatomy 4 Flashcards

1
Q

which cranial nerves have parasympathetic function?

A

oculomotor
facial
glossopharyngeal
vagus

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2
Q

cranial nerve passes through which 3 areas during its course and what can go wrong at each level?

A 
CNS
- brainstem stroke
intracranial
- intracranial tumour
extracranial
- extracranial trauma (e.g orbital injury)
can also have a base of skull fracture
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3
Q

what 2 nerves come off the midbrain?

A

3 and 4

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4
Q

what nerves come off pons?

A

trigeminal

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5
Q

what nerves come off medulla?

A

glossopharyngeal
vagus
hypoglossal

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6
Q

what runs through optic canal>

A

optic nerve

optic artery

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7
Q

function of olfactory nerve?

A

only modality is smell (special sensory)

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8
Q

describe the course of the olfactory nerve

A

olfactory nerves sit in the olfactory mucosa in the nasal cavity, exposed to the air
nerves go up through the cribiform plate of the ethmoid bone and enter the anterior cranial fossa
olfactory nerves then synapse in olfactory bulb
nerves then pass down olfactory tract to cortical areas in the brain

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9
Q

only function of optic nerve?

A

vision (special sensory)

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10
Q

course of optic nerve?

A

neurons leave retina and travel posteriorly via the optic nerve from the posterior hemisphere of eye through the orbit
enters the middle cranial fossa via the optic canal
travels around pituitary stalk to optic chiasm to form the optic tract
connect with CNS via thalamus then diencephalon

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11
Q

how can damage occur to optic nerve?

A 
optic nerve can be compressed in the optic canal
retinal artery (supply to optic nerve) can be disrupted or compressed in optic canal
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12
Q

how can olfactory nerve be tested?

A

ask patient to smell a familiar smell while covering the contralateral nostril

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13
Q

how can optic nerve be tested?

A 
acuity
colour
fields
reflexes
fundoscopy
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14
Q

function of oculomotor nerve?

A 
eye movement (motor)
pupil constriction (parasympathetic)
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15
Q

course of oculomotor?

A

leaves CNS at midbrain (mesencephalon)
travels towards the orbit in the lateral wall of the cavernous sinus
exits the cranium in the superior orbital fissure
passes through SOF into the orbit and supplies all extraocular eye muscles apart from 2
parasympathetic fibres synapse in ciliary ganglion (constricts)

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16
Q

function of trochlear nerve?

A

eye movement (motor)

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17
Q

course of trochlear nerve?

A

leaves CNS at back of the midbrain
travel towards the orbit in the lateral wall of cavernous sinus
leaves cranium through superior orbital fissure
passes through SOF into the orbit and supplies superior oblique

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18
Q

function of abducent nerve?

A

eye movement (motor)

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19
Q

course of abducent nerve?

A

leaves CNS at pontomedullary junction
travels towards the orbit within the cavernous sinus
leaves cranium via SOF
passes through SOF into orbit and supplies lateral rectus

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20
Q

describe the H test?

A

tests nerves of eye movement

  • down and in = SO
  • up and in - IO
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21
Q

function of vestibulocochlear nerve?

A

hearing and balance (special sensory)

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22
Q

course of vestibulocochlear?

A

axons from cochlear and vestibular apparatus enter cranium via internal acoustic meatus into the posterior cranial fossa
axons travel posteromedially from the internal acoustic meatus to the pontomedullary junction
connect with CNS at pontomedullary junction

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23
Q

how is vestibulocochlear nerve tested?

A

rinne and weber test

24
Q

function of spinal accessory nerve?

A

motor to sternocleidomastoid and trapezius

25
Q

course of spinal accessory nerve?

A

leaves CNS at cervical spinal cord
ascends through foramen magnum then travels towards jugular foramen in posterior cranial fossa
then leaves cranium via jugular foramen in posterior cranial fossa
axons then go to supply SCM on deep surface then continue across posterior triangle to supply trapezius and SCM

26
Q

how can spinal accessory be tested?

A

shrug shoulders - trapezius
flex neck and turn to opposite side - SCM
also check for wasting etc

27
Q

function of hypoglossal nerve?

A

motor (muscles of tongue)

28
Q

course of hypoglossal nerve?

A

leaves CNS via many rootlets between the pyramids and olives of the medulla
passes anteriorly to hypoglossal canal
leaves cranium via hypoglossal canal in posterior cranial fossa
then descends lateral to the carotid sheath
at the level of the hyoid, it turns anteriorly towards lateral aspect of the tongue
supplies most muscles of the tongue apart from palatoglossus (vagus)

29
Q

how is hypoglossal nerve tested?

A

ask patient to stick tongue straight out

  • if both CN XIIs are working it will go straight
  • if there is unilateral CN XII pathology then tongue will point to affected side
30
Q

divisions of trigeminal nerve?

A 
ophthalmic = sensory
maxillary = sensory
mandibular = sensory and motor
31
Q

course of trigeminal nerve?

A

leaves CNS at pons (between midbrain and medulla)
travels inferior to the edge of the tentorium cerebelli between posterior and middle cranial fossae
V1 leaves cranium via superior orbital fissure
V2 leaves via formane rotundum
V3 leaves via foramen ovale
sensory axons from all 3 divisions course from superficial and deep structures of the face posteriorly towards their respective cranial foramen
motor axons from V3 course from foramen ovale towards the skeletal muscle they supply

32
Q

what does V1 supply?

A 
upper eyelid
cornea (corneal reflex)
conjunctiva
skin over roof/bridge/tip of nose
bones and soft tissue of orbit
upper anterior nasal cavity
paranasal sinuses
anterior and posterior cranial fossae
33
Q

what does V2 supply?

A 
skin over lower eyelid
skin over maxilla
skin over ala of nose
skin/mucosa of upper limb
lower posterior nasal cavity
maxilla and maxillary sinus
floor os nasal cavity/palate
maxillary teeth and associated soft tissue
34
Q

what does V3 supply sensation to?

A 
skin over mandible and TMJ
middle cranial fossa
mandible
anterior 2/3 tongue (sensation)
floor of mouth
buccal mucosa
mandibular teeth
35
Q

function of tensor veli palatine?

A

tenses palate

opens eustachian tube?

36
Q

motor function of V3?

A 
3 pairs of jaw closing muscles
- masseter
- temporalis
- medial pterygoid
1 pair of jaw closing muscles
- lateral pterygoid
tensor veli palatine
tensor tympani
37
Q

trigeminal sensory testing?

A

close eyes and gently brush skin in each dermatome

38
Q

trigeminal motor testing?

A

palpate strength of contraction of the masseter and temporalis by asking patient to clench teeth
ask patient to open jaw against resistance

39
Q

function of facial nerve?

A

special sensory (teste)
motor
parasympathetic

40
Q

course of facial nerve?

A

leaves CNS at anterolateral pontomedullary junction
travels directly into internal acoustic meatus in the posterior cranial fossa
leaves cranium via stylomastoid foramen in temporal bone
most somatic motor axons pass into parotid gland, then into 6 branches that supply muscles of facial expression
(fibres of chorda tympani enter cranial fossa via internal acoustic meatus in temporal bone)

41
Q

course/function of chorda tympani?

A

posterior wall of tympanic cavity, past incus and malleus and tensor tympani then out of tympanic cavity

carries special sensory of taste back to brain
carries parasympathetic fibres form brainstem to glands

42
Q

site of lesion on facial nerve?

A

symptoms can determine whether the lesion is before or after the chroda tympani branches off the facial nerve

43
Q

how is the facial nerve tested?

A

raise eyebrows (frontalis)
close eyes tightly (orbicularis oculi)
smile (elevators of lips)
puff out cheeks and hold air (orbicularis oris)

44
Q

functions of glossopharyngeal nerve?

A 
special sensory (taste)
sensory
motor
visceral afferent
parasympathetic
45
Q

course of glossopharyngeal?

A

leaves CNS from lateral superior medulla
travels towards jugular foramen in posterior cranial fossa
leaves cranium via jugular foramen
descends to pharynx and larynx
- stylopharyngeus, parotid, pharyngeal mucosa, carotid body/sinus, posterior 1/3 tongue

46
Q

general sensory function of glossopharyngeal?

A 
posterior 1/3 tongue
mucosa of pharynx
palatine tonsils
eustachian tube
middle ear cavity
47
Q

special sensory function of glossopharyngeal?

A

vallate papillae (with taste buds)

48
Q

visceral afferent function of glossopharyngeal?

A

visceral afferents to carotid sinus baroreceptors and carotid body chemoreceptors

49
Q

somatic motor function of glossopharyngeal?

A

stylopharyngeus

50
Q

parasympathetic function of glossopharyngeal nerve?

A

parotid gland

51
Q

clinical relevance of glossopharyngeal?

A

can be used in carotic massage
massage increases pressure sending signal via glossopharyngeal causing vagus to calm down heart
involved in gag reflex
associated with referred pain between ear and throat

52
Q

modalities of vagus?

A

sensory
motor
visceral afferent
parasympathetic

53
Q

course of vagus?

A

leaves CNS via lateral medulla (inferior to CN IX)
travels towards jugular foramen in posterior cranial fossa
leaves cranium via jugular foramen
axons supply lots of structures between palate and midgut

54
Q

vagus nerve in the neck?

A

runs within carotid sheath posterior to and between the common carotid artery and internal jugular vein
runs inferiorly into the thorax then gives off recurrent laryngeal nerve to turn back superiorly to supply muscles of larynx
- left curves under aortic arch
- right curves under right subclavian artery

55
Q

vagus nerve in chest?

A

right
- on lateral aspect of trachea
left
- on lateral aspect of aortic arch
both pass posterior to long root and onto oesophagus
both pass through diaphragm with oesophagus

56
Q

vagus nerve in abdomen?

A 
passes onto surface of stomach
branches to
- spleen
- pancreas
- celiac and superior mesenteric ganglia
- kidneys
- midgut
- parasympathetic axons to splenic flexures of colon
57
Q

how is vagus nerve tested?

A 
say "ahh" (muscles of palate)
- uvula will point towards normal side in unilateral pathology
swallow water (pharyngeal muscles)
- splutter = abnormal swallow
listen to speech (laryngeal muscles)

Neurology (53 decks)

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