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DMD 5221 > Cervical Plexus and CN I, II, IV, VIII, XI, X > Flashcards

Cervical Plexus and CN I, II, IV, VIII, XI, X Flashcards

1
Q

What spinal nerves comprise the cervical plexus?

A

Ventral rami of spinal nerves C1-C5

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2
Q

What does the cervical plexus innervate?

A

Neck
Thoracic Cavity
Diaphragmatic muscles

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3
Q

Where is the cervical plexus located?

A

Deep to the SCM

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4
Q

How many major branches does the cervical plexus have?

A

6

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5
Q

What are the major branches of the cervical plexus?

A

Sensory, Motor, Mixed

  • Lesser occipital n.
  • Greater auricular n.
  • Supraclavicular n.
  • Phrenic n.
  • Ansa cervicalis
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6
Q

What cranial nerve is the cervical plexus associated with?

A

CN XII

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7
Q

What are the 4 major cutaneous branches of the cervical plexus? (sensory)

A

Lesser occipital n.
Great auricular n.
Transverse cervical n.
Supraclavicular n.

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8
Q

`Lesser occipital n.

A

One of the major cutaneous branches of the cervical plexus

C2
Skin of neck and scalp posterior to ear

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9
Q

Great auricular n.

A

One of the major cutaneous branches of the cervical plexus

C2, C3
Skin of inferior parotid region, ear, mastoid area

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10
Q

Transverse cervical n.

A

One of the major cutaneous branches of the cervical plexus

C2, C3
Lateral and anterior parts of neck

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11
Q

Supraclavicular n.

A

One of the major cutaneous branches of the cervical plexus

C3, C4
Skin over clavicle and shoulder

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12
Q

What is Erb’s point?

A

The point where the 4 branches of the cervical plexus emerge from behind the SCM

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13
Q

What is the clinical significance of Erbs’ point?

A

Surgical landmark

Injury can occur there during birth or a fall on the shoulder

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14
Q

Phrenic n.

A

Mixed - sensory and motor
Very important nerve - you’ll die without this

  • C3, C4, C5
  • Runs along anterior scalene muscle, deep to the carotid sheath
  • Sensory and motor to DIAPHRAGM
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15
Q

Ansa Cervicalis

A

Motor
Most complicated because of the loop

  • Loop of nerve fibers
  • – Superior and inferior roots
  • – C1, C2, C3
  • Travels with CN XII
  • Innervates 3 of 4 infrahyoid muscles
  • – Omohyoid
  • – Sternohyoid
  • – Sternothyroid
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16
Q

Which cranial nerve is within the carotid sheath or a content of the sheath?

A

CN X

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17
Q

What branch of the cervical plexus is embedded in the carotid sheath?

A

Ansa cervicalis

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18
Q

Which cranial nerve is associated with the carotid sheath?

A

CN XII runs with C1

SOO close together that they are wrapped together at some point

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19
Q

Which cranial nerves are special sensory nerves only?

A

I
II
VIII

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20
Q

Which cranial nerves are motor nerves only?

A 
III
IV
VI
XI
XII
21
Q

Which cranial nerves are mixed nerves (both sensory and motor)?

A

V
VII
IX
X

22
Q

Which cranial nerves contain parasympathetic motor fibers?

A

III
VII
IX
X

23
Q

Which cranial nerve is mixed with only somatic motor and sensory? (i.e. no parasympathetic)

A

V

24
Q

Olfactory Nerves (CN I): course and distribution

A

Olfactory nerve cells (hanging through the cribiform plate) > Pass through cribiform plate > Olfactory bulb > Olfactory tract > Olfactory area of the cerebral cortex (temporal lobe)

25
Q 
Olfactory Nerve (CN I)
Functional group, Primary function, Origin, Path through skull
A

Special Visceral Afferent, Special Sensory

Primary function: Olfaction

Origin: Olfactory receptor cells in nasal mucosa

Path through skull: Olfactory foramina of cribiform plate of ethmoid

26
Q 
Optic Nerve (CN II)
Functional group, Primary function, Origin, Path through skull
A

Special Somatic Afferent, Special Sensory

Primary function: Vision

Origin: Ganglion cells of retina

Path through skull: Optic canals of sphenoid

27
Q

Optic Nerve (CN II): course and distribution

A

Rods and cones to ganglion cells of retina > Optic canal > Optic chiasm (nasal fibers flip to opposite side; temporal fibers stay on the same side) > Optic tract > Lateral geniculate body (thalamus) > Visual cortex of the brain (occipital lobe)

28
Q

What would a runny nose after head trauma indicate? What nerve would be affected?

A

Runny nose = CSF leakage

Indicate torn dura mater near cribiform plate
Torn olfactory neurons

CN I

29
Q

How would vision be affected if you had a lesion on the optic nerve?

A

Blindness

30
Q

How would vision be affected if you had a lesion on the optic chiasm?

A

Bitemporal hemianopsia

31
Q

How would vision be affected if you had a lesion on the optic tract?

A

Homonymous hemianopsia

32
Q

Vestibulocochlear Nerve (CN VIII): course and distribution

A

Two sets of sensory fibers (vestibular and cochlear) > leave anterior surface of brain at the pontomedullary junction > cross posterior cranial fossa > internal acoustic meatus with facial nerve

33
Q 
Vestibulocochlear Nerve (CN VIII)
Functional group, Primary function, Origin, Path through skull, Associated Nuclei
A

Special Somatic Afferent, Special Sensory

Primary function: Vestibular branch (balance and equlibrium); Cochlear branch (hearing)

Origin: Vestibular and cochlear ganglia (where the cell bodies are)

Path through skull: Internal acoustic meatus of temporal

Associated Nuclei: To vestibular and cochlear nuclei

34
Q

What is an acoustic neuroma and what can it lead to?

A

Benign tumor of Schwann cells

  • Hearing loss and gait ataxia
  • Block CSF drainage of 4th ventricle = hydrocephaly
  • – Vomiting, loss of consciousness and death if it compresses important structures
35
Q

Trochlear Nerve (CN IV): course and distribution

A

Posterior surface of midbrain > Middle cranial fossa > Lateral cavernous sinus > Superior orbital fissure > Superior oblique

36
Q 
Trochlear Nerve (CN IV)
Functional group, Primary function, Origin, Path through skull
A

General Somatic Efferent, Somatic Motor

Primary function: Motor to superior oblique (down and out, depression and abduction)

Origin: Trochlear nucleus

Path through skull: Superior orbital fissure of sphenoid

37
Q

Trochlear Nerve Lesions can cause what?

A

Dipolopia - double vision
Eye is adducted and elevated
Strabismus

38
Q

Abducens (Abducent) Nerve (CN VI): course and distribution

A

Anterior surface of hindbrain, at pontomedullary junction > passes forward with internal carotid artery through cavernous sinus > Enters orbit through superior orbital fissure > Lateral rectus

39
Q 
Abducens Nerve (VI)
Functional group, Primary function, Origin, Path through skull
A

General Somatic Efferent, Somatic Motor

Primary function: Motor to lateral rectus (abduction)

Origin: Abducens nucleus

Path through skull: Superior orbital fissures of sphenoid

40
Q

Abducens Nerve Lesions

A

Diplopia

Medial strabismus

41
Q

What is the cavernous sinus?

A

Venous blood flow in a little pouch surrounding the sella turcica

  • Receives blood from the superior and inferior ophthalmic veins
  • Drains into the superior and inferior petrosal sinuses
42
Q

What nerves pass through the cranial sinus?

A 
III
IV
V1
V2
VI

And internal carotid artery (ICA)

43
Q

Accessory Nerves (CN XI): course and distribution

A

Cranial Root: Anterior surface of medulla
- Runs laterally in posterior cranial fossa and joins spinal root

Spinal Root: Anterior gray horn of upper 5 segments of spinal cord

  • Ascends along spinal cord
  • Enters skill through foramen magnum
  • Turns laterally to join cranial root

The 2 roots unite, leaving the skull through the jugular foramen, then roots separate.

  • Cranial root joins vagus (pharyngeal plexus)
  • Spinal to SCM and trapezius
44
Q 
Accessory Nerves (CN XI) - CRANIAL ROOT
Functional group, Primary function, Origin, Path through skull
A

Special Visceral Efferent, Branchial Motor

Primary function: Motor to muscles of soft palate, pharynx, and intrinsic muscles of larynx (via vagus, pharyngeal plexus)

Origin: Nucleus ambiguus

Path through skull: Jugular foramina between occipital and temporal bones

45
Q 
Accessory Nerves (CN XI) - SPINAL ROOT
Functional group, Primary function, Origin, Path through skull
A

General Somatic Efferent, Somatic Motor

Primary function: Motor to SCM and trapezius

Origin: Spinal accessory nucleus, spinal cord segments C1-C5

Path through skull: Jugular foramina between occipital and temporal bones

46
Q

Accessory Nerve Lesions

A

Lead to partial paralysis of trapezius

  • Drooping of shoulder on the affected side
  • Also innervated by C3-C5

Lead to complete (flaccid) paralysis of SCM

  • Torticollis (wry neck)
  • – Unilateral injury - difficulty turning head to opposite side
  • – Bilateral injury, difficult holding head up
  • Only innervated by CN XI
47
Q

Hypoglossal Nerves (CN XII): course and distribution

A

Anterior surface of medulla as rootlets > Rootlets join and form CN XII > Travel through hypoglossal canal > Enter the root of the tongue superior to the hyoid bone and lateral to hyoglossus

48
Q 
Hypoglossal Nerves (CN XII)
Functional group, Primary function, Origin, Path through skull
A

General Somatic Efferent, Somatic Motor

Primary function:

  • Motor to all intrinsic and extrinsic muscles of the tongue, except palatoglossus (innervated by CN X)
  • Controls shape and movement of the tongue

Origin: Hypoglossal nucleus

Path through skull: Hypoglossal canals of occipital bone

49
Q

Hypoglossal Nerve Lesions

A

Supranuclear lesions (i.e. in the brain) cause contralateral paralysis

Peripheral lesions cause ipsilateral paralysis
- Unilateral injury, the tongue deviates to the side of the lesion on protrusion; “lick your wounds”
(If lesion is on CN XII)

DMD 5221 (8 decks)

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