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CFB > Anatomy of CNIX to CNXII > Flashcards

Anatomy of CNIX to CNXII Flashcards

1
Q

Where do the bulbar nerves arise from?

A

The medulla oblongata

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2
Q

What is Bulbar palsy and what causes it?

A

Arises from a lesion of the medulla or lesion of cranial nerve nuclei medulla
Signs are usually progressive e.g., difficulties swallowing, loss of speech, weakening of the tongue. Considered a variant of motoneuron disease.

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3
Q

What is jugular foramen syndrome?

A

Refers specifically to paralysis to the cranial nerves passing through the jugular foramen, CNIX, CNX, CNXI

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4
Q

What does glossopharyngeal nerve mean?

A

Nerve for the tongue and pharynx

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5
Q

What are the 2 swellings in the glossopharyngeal nerve?

A

One is the superior (jugular) ganglion - just before it’s emergence from the foramen
Other is the inferior (petrous) ganglion - much larger and more constant

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6
Q

What do the swellings of the glossopharyngeal nerve contain?

A

Ganglia so they contain cell bodies of afferents of the nerve

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7
Q

What is the motor component of the glossopharyngeal nerve?

A

Banchiomotor fibres supply stylopharyngeus
Visceromotor (parasympathetic) fibres supply the parotid gland (via the optic ganglion)

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8
Q

What is the sensory component of the glossopharyngeal nerve?

A

Viscerosensory fibres supply carotid body and carotid sinus (VSA)
Pharynx (around tonsillar part) and middle ear (GSA)
Special sensory (and general sensory) fibres supplied to posterior1/3G of the tongue (SSA)

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9
Q

What fibre types does the glossopharyngeal nerve carry?

A

SVE, GVE, GVA, SVA, GSA

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10
Q

What are the nuclei for glossopharyngeal?

A

Inferior salivatory nucleus, nucleus ambiguus, nucleus tractus solitarius

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11
Q

What fibres come from or to the inferior salivatory nucleus?

A

Origin of pre-ganglionic parasympathetic efferent fibres for distribution to the optic ganglion. Will supply the parotid gland via the lesser superficial petrosal nerve.

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12
Q

What fibres come from or to the nucleus ambiguus?

A

Efferent nerve fibres to the stylopharyngeus

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13
Q

What fibres come from or to the nucleus tractus solitarius?

A

Visceral sensory fibres including taste fibres

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14
Q

How does CNIX exit the cranial compartment?

A

Formed by 5/6 rootless which emerge from the side of the medulla in line with those which form the vagus nerve. Passes through the jugular foramen. Leaves the intracranial space in a separate sheath of dura mater (to X and XI), and occupies a groomer on the lower border of the petrous temporal bone.

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15
Q

What does the inferior ganglion of CNIX communicate with?

A

The superior cervical ganglion, auricular branch of vagus nerve, superior ganglion of vagus nerve

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16
Q

How do the somatic sensory fibres of CNIX distribute?

A

It is through the communication with the auricular branch of the vagus nerve that the somatic sensory fibres of glossopharyngeal nerve distribute.

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17
Q

What are the branches of the glossopharyngeal nerve?

A

Sinus nerve, nerve to stylopharyngeus, tympanic branch, pharyngeal branches, lingual branch

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18
Q

What does the sinus nerve supply?

A

Carotid sinus and carotid body

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19
Q

What does nerve to stylopharyngeus supply?

A

Stylopharyngeus, tonsillar bud, pharynx, parts of the tongue

20
Q

What does the tympanic branch supply?

A

Tympanic plexus
Branch of this carries on to constitute the lesser superficial petrosal nerve

21
Q

What do the pharyngeal branches supply?

A

3/4 twigs which join with the the pharyngeal branches of the vagus and of the cervical sympathetic trunk on the middle constrictor muscle to form the pharyngeal plexus

22
Q

What does the lingual branch supply?

A

Provides afferent fibres for taste to the circumvallate papillae (SVA) and general afferent neurones to the mucous membrane of posterior 1/3 of the tongue.

23
Q

Test for CNIX

A

Test for CNIX function is the gag reflex - pharyngeal reflex. Consists of reflex pharyngeal constriction when the back wall of the oropharynx is touched by non-food substances. CNIX is the sensory limb of this reflex (CNX is the motor limb of this reflex). Swallowing has a voluntary element to it.

24
Q

What are the 2 motor nuclei of the vagus nerve?

A

Dorsal nucleus of vagus nerve - parasympathetic output to viscera
Nucleus ambiguus - branchial efferent motor fibres and preganglionic parasympathetic neurones that innervate the heart

25
Q

What are the sensory nuclei of CNX?

A

Nucleus solitarius - receives afferent taste information and primary afferents from visceral organs
Spinal trigeminal nucleus - receives information about deep/crude touch, pain and temperature of the outer ear, the dura of the posterior cranial fossa and the mucosa of the larynx

26
Q

How does CNX leave the jugular foramen?

A

Contained in the same dural sheath as CNXI. Separated by a fibrous septum.

27
Q

How does CNX arise intracrnially?

A

By convergence of 8-10 rootlets which merge from the medulla in the groover dorsal to the inferior olive.

28
Q

Describe the superior sensory ganglion/jugular ganglion

A

Spherical swelling on vagus in the jugular foramen. Cell bodies are general somatic afferent component of the nerve.

29
Q

Describe the inferior sensory ganglion (nodose ganglion)

A

After exit from the foramen. Cell bodies are concerned with the visceral afferent component.

30
Q

What are the branches of the vagus nerve?

A

Meningeal branches, auricular branches whilst in jugular fossa
In the neck: pharyngeal branches, laryngeal branches, cardiac branches

31
Q

What would damage to the right recurrent laryngeal nerve cause?

A

The vocal cord on that side (ipsilateral) is slightly adducted; symptoms are hoarse voices weak cough, risk of aspiration of fluids

32
Q

What would damage to the left recurrent laryngeal nerve cause (lower than right)?

A

May be affected in a bronchial or oesophageal carcinoma or enlarged mediastinal lymph nodes or become stretched over an aneurysm of the aortic arch.

33
Q

What do the motor modalities of CNX supply?

A

Intrinsic muscles of larynx and pharynx
Muscles of the palate
Smooth muscle - bronchi, digestive tract
Secretomotor - thoracic and abdominal viscera

34
Q

What do the sensory fibres of CNX supply?

A

External ear, auditory canal, eardrum
Pharynx and larynx
Visceral sensation - thorax and abdomen

35
Q

What is the cranial division of accessory nerve CNXI.

A

Smaller root. Originates in the medulla from nuclei just below those of the vagus nerve.

36
Q

What is the spinal division of CNXI?

A

Larger root. Originates from the spinal cord, as 12 rootlets from upper cervical neural segments. Enters cranium via foramen magnum.

37
Q

Where do the 2 roots of CNXI split?

A

The 2 divisions combine near the jugular foramen. As they exit the jugular foramen, they split again. Cranial division joins the inferior ganglion of CNX to be distributed via pharyngeal and recurrent laryngeal nerves. Spinal division descends and leaves the cranium as CNXI via jugular foramen.

38
Q

What does CNXI supply?

A

Motor nerve supplying SCM a and trapezius.

39
Q

How to test for CNXI?

A

Inspect wasting of SCM and trapezius. Test for weakness.
SCM - ask patient to rotate head against resistance
Trapezius - shrug shoulder against resistance

40
Q

What is the nucleus of the hypoglossal nerve?

A

It’s somata constitute the hypoglossal motor nucleus.

41
Q

What does CNXII communicate with?

A

It communicates by numerous small branches with its inferior ganglion.
Opposite the atlas it has communication with the superior cervical sympathetic ganglion
Also opposite the atlas it is joined by a nerve derived from a loop between C1 and C2, which brings its sensory fibres from the meningeal branches and provide muscular fibres for the suprahyoid and infrahyoid muscles which are innervated through the superior ramus of the ansa cervicalis

42
Q

What do the terminal branches of CNXII distribute to?

A

Styloglossus, hyoglossus, genioglossus, intrinsic muscles of the tongue - completely motor
Communicates with sensory branches of the lingual nerve

43
Q

What does damage to CNXII cause?

A

Causes dysarthria

44
Q

How do you inspect dysarthria?

A

Inspect by asking patient to protrude the tongue. Inspect for tongue wasting and fasciculations. In LMN lesions, the tongue deviates to the side of weakness.

45
Q

Brief course of hypoglossal nerve

A

Emerges from hypoglossal canal and is medial to ICA and IJV. Descends behind these vessels and passes posterior to the vagus.

CFB (34 decks)

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