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Dundee MBChB Neuroanatomy + > Clinical Anatomy of Cranial Nerve Testing > Flashcards

Clinical Anatomy of Cranial Nerve Testing Flashcards

1
Q

List the ‘12’ Cranial Nerves and their modalities

A

CN I olfactory nerves (special sensory)

CN II optic nerves (special sensory)

CN III oculomotor nerves (motor & parasympathetic)

CN IV trochlear nerves (motor)

CN V trigeminal nerves (CN V1 & V2: sensory only*; V3 is sensory & motor*)

CN VI abducent nerves (motor)

CN VII facial nerves (special sensory; motor & parasympathetic)

CN VIII vestibulocochlear nerves (special sensory)

CN IX glossopharyngeal nerves (special sensory; sensory; motor & parasympathetic)

CN X vagus nerves (sensory; motor; parasympathetic)

CN XI spinal accessory nerves (motor)

CN XII hypoglossal nerves (motor)

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2
Q

Which part of the CNS do each originate from?

A

Forebrain - I, II

Midbrain - III, IV

Pons - V

Pontomedullary junction - VI, VII, VIII

Medulla - IX, X, XII

Spinal cord - XII

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3
Q

Label from view superior to cranial fossae

A
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4
Q

Through which cranial fossa do each of the Cranial nerves leave the crainial cavity?

A

Anterior fossa - CN I

Middle fossa - CN II, III, IV

Posterior fossa - CN V - CN XI

Foramen magnum - CN XII

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5
Q

Describe the divisions of the trigemninal nerve

A

3 divisions

  • Ophthalmic (CNV1) – sensory
  • Maxillary (CNV2) – sensory
  • Mandibular (CNV3) – sensory and motor
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6
Q

Describe and detail the course of the Trigeminal Nerve

A

CNS connection:

The only CN to attach to the pons (laterally, midway between midbrain & medulla)

Intracranial Course:

inferior to the edge of the tentorium cerebelli between the posterior and middle cranial fossae

Skull Base Foramen:

  • CN V1 - superior orbital fissure
  • CN V2 - foramen rotundum
  • CN V3 - foramen ovale

Extra-cranial Course:

  • Sensory axons from all 3 divisions course, from the superficial and deep structures of the face, posteriorly, towards their respective base of skull foraminae
  • motor axons from CNV3 course from the foramen ovale towards the skeletal muscle they supply
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7
Q

Label the somatic sensory innervation to the head

A
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8
Q

CN V1 deep sensory territory?

A
  • bones & soft tissues of the orbit (except the orbital floor & lower eyelid)
  • the upper anterior nasal cavity
  • all paranasal sinuses (except the antrum)
  • the anterior & posterior cranial fossae
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9
Q

CN V2 deep sensory territory?

A
  • the lower posterior nasal cavity
  • the maxilla & maxillary sinus (antrum)
  • the floor of the nasal cavity/palate
  • the maxillary teeth & associated soft tissues (gingivae & mucosae)
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10
Q

CN V3 deep sensory territory?

A
  • the middle cranial fossa
  • the mandible
  • the anterior 2/3rds of the tongue
  • the floor of the mouth
  • the buccal mucosa
  • the mandibular teeth & associated soft tissues
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11
Q

Name and detail the muscles of masstication

A

Close Jaw

  • Masseter
  • Temporalis
  • Medial Pterygoid

Open Jaw

-Lateral Pterygoid

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12
Q

Describe the origin and attachments to the muscles of masstication

A

Masseter - Angle of mandible - Aygomatic arch

Temproalis - coronoid process of mandible - lateral aspect of neurocranium

Medial Pterygoid - Medial mandible - Pterygoid plates fo the sphenoid bone

Lateral Pterygoid - Condyle of mandible and articular disc of TMJ - Pterygoid plates of the spenoid bone

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13
Q

List the key areas for testing the sensory afferent of the Trigmeninal Nerve

A
  • Ophthalmic (CNV1):
  • forehead, upper eyelid & tip of nose
  • Maxillary (CNV2):
  • mid-cheek, lower eyelid, upper lip & nostril of nose
  • Mandibular (CNV3):
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14
Q

How would you clinically test the Sensory afferent of the trigemnial nerve?

A
  1. Ask the patient to close their eyes
  2. Gently brush the skin in each dermatome with a fine tip of cotton wool
  3. Ask the patient to tell you when they feel their skin being touched
  4. Compare the 2 sides
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15
Q

How would you clinically test the motor efferent of the trigeminal nerve?

A
  1. Palpate the strength of contraction of the masseter & temporalis by asking patient to clench their teeth
  2. Ask the patient to open their jaw against resistance
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16
Q

Describe and detail the course of the Facial Nerve

  • Connection to the CNS
  • Intracranial course
  • Base of skull exit
  • Extracranial Course
A

Connection to the CNS

-anterolateral at pontomedullary junction

Intracranial course

-directly into internal acoustic meatus in the posterior cranial fossa

Base of skull exit

  • internal acoustic meatus of the temporal bone
  • stylomastoid foramen

Extracranial Course

-most somatic motor axons pass into the parotid gland then into 1 of the 5 branches that supply the muscles of facial expression

17
Q

Label the diagram of facial nerve course

A
18
Q

Label the facial nerve diagram

A
19
Q

Label and detail the muscles of facial expression

A
20
Q

Describe and detail the course of the Glossopharyngeal nerve

  • Connection to the CNS
  • Intracranial course
  • Base of skull exit
  • Extracranial Course
A

Connection to the CNS

-lateral aspect of superior medulla oblongata

Intracranial course

-directly towards jugular foramen in the posterior cranial fossa

Base of skull exit

-junction between temporal bone & occipital bone – jugular foramen

Extracranial course

-axons mainly pass to or from the tongue and palate

21
Q

List the modalities of the glossopharyngeal nerve

A

General somatic sensory

Special sensory

Visceral afferent

Somatic motor

Parasympathetic (secretomotor)

22
Q

List the general sensory of the glossopharyngeal nerve

A
  • the posterior 1/3rd of the tongue
  • the mucosa of most of the nasopharynx
  • the mucosa of all of the oropharynx
  • the mucosa of some of the laryngopharynx (some overlap with CN X territory)
  • the palatine tonsil
  • the eustachian tube
  • the middle ear cavity
23
Q

List the special sensory of the glossopharyngeal nerve

A

•the vallate papillae (with taste buds) of the posterior 1/3rd of the tongue

24
Q

List the visceral afferent of the glossopharyngeal nerve

A

visceral afferent to the carotid sinus baroreceptors & the carotid body chemoreceptors

(carotid massage relevance)

25
Q

List the somatic motor of the glossopharyngeal nerve

A

Somatic motor to 1 of the longitudinal muscles of the pharynx (stylopharyngeus)

26
Q

List the autonomic of the glossopharyngeal nerve

A

parasympathetic (secretomotor) to the parotid salivary gland

27
Q

Describe and detail the course of the Vagus nerve

  • Connection to the CNS
  • Intracranial course
  • Base of skull exit
  • Extracranial Course
A

Connection to the CNS

-lateral aspect of medulla oblongata, immediately inferior to CN IX

Intracranial course

-directly towards jugular foramen in the posterior cranial fossa

Base of skull exit

-junction between temporal bone & occipital bone – jugular foramen

Extracranial Course

-axons supply lots of structures between the palate and the midgut

28
Q

List the contents of the carotid sheath

A

Common Carotid Artery

Internal Jugular Vein

Vagus Nerve

Deep Cervical lymph nodes

29
Q

Describe the course of the Vagus Nerve in the thorax (right and left)

A

Both Nerves pass posterior to the lung roots and onto the surface of the oesophagus

Both pass through the diaphragm with the oesophagus

Branches pass into stomach, the celiac and superior mesenteric ganglia

Supply foregut and midgut up until splenic flexure of colon

30
Q

How do we clinically test the vagus nerves?

A

-ask patient to say ‘ah’ – also tests CNV3

motor function

uvula should lift straight up in midline

unilateral pathology will pull uvula away from the non-functioning side

-ask patient to swallow small amount of water

watch larynx movement

splutter may suggest abnormal swallow

-listen to speech

hoarseness may suggest abnormal function of muscles of larynx

-ask patient to cough

remember also requires diaphragm

31
Q

Describe and detail the course of the Spinal Accessory nerve

  • Connection to the CNS
  • Intracranial course
  • Base of skull exit
  • Extracranial Course
A

Connection to the CNS

  • via cervical spinal nerve anterior rootlets to the spinal cord

Intracranial course

-ascends through foramen magnum then travels towards jugular foramen in posterior cranial fossa

Base of skull Exit

-junction between temporal bone & occipital bone

Extracranial Course

-axons supply sternocleidomastoid on deep surface, then continue across the posterior triangle of the neck deep to the investing fascia and supply the trapezius

32
Q

Label the course of the Spinal Accessory Nerve

A
33
Q

Describe and detail the course of the Hypoglossal nerve

  • Connection to the CNS
  • Intracranial course
  • Base of skull exit
  • Extracranial Course
A

Connection to the CNS

  • via many rootlets that attach lateral to the pyramids of the medulla oblongata

Intracranial course

-passes anteriorly towards hypoglossal canal in the posterior cranial fossa

Base of skull Exit

-hypoglossal canal (anterior wall of foramen magnum)

Extracranial Course

  • descends in neck lateral to carotid sheath
  • at level of hyoid bone it passes anteriorly towards the lateral aspect of the tongue
  • supplies most of the muscles of the tongue
34
Q

How do we clinically test the SPinal Accessory Nerve?

A

Clinical testing:

  • ask patient to stick tongue straight out
  • if both CNXII’s are functioning normally the tongue tip remains in the midline on protrusion
  • if there is unilateral CN XII pathology the tongue tip will point towards the side of the injured nerve
35
Q

Summary of Cranial Nerve clinical Investigations

A

Dundee MBChB Neuroanatomy + (11 decks)

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