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NMS > CN 5 > Flashcards

CN 5 Flashcards

1
Q

Largest CN?

A

Trigeminal

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2
Q

CN has a _____ motor portion and ______ sensory

A

Small, large

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3
Q

V1-ophthalmic- M/S?

A

Sensory

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4
Q

V2-maxillary-M/S?

A

Sensory

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5
Q

V3-mandibular-M/S?

A

Both

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6
Q

CN fibers originate in _____ _____ and descend in _____ ______ to ______ nucleus in the ________

A

Precentral gyrus
Descend in corticobulbar tract
To motor nucleus

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7
Q

Trigeminal motor nucleus receives projections from where?

A

Both cerebral hemispheres

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8
Q

Motor root exits _______ ______ and passes beneath _____ _____ and exits skull through _____ _____

A

Lateral pons
Trigeminal ganglion
Foramen ovale

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9
Q

What does the motor (V-3) pathway supply?

A

Muscles of mastication (temporalis, masseter, med/lat pterygoid)

Tensor tympani, tensor evil palatine, mylohyoid, anterior belly of digastric

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10
Q

Because trigeminal motor nucleus receives projections from both hemispheres, if there was a lesion on one side, what will the affects be?

A

Not much affect-redundancy

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11
Q

Function of temporalis

A

Close jaw

Retract

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12
Q

Internal/medial pterygoid function

A

Syncs: close and protrude
Unilateral: side to side jaw movement

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13
Q

Masseter

A

Close and protrude

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14
Q

External/lateral pterygoid

A

Sync: open and protrude jaw

Unilateral: pulls mandible contralaterally

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15
Q

What does unilateral trigeminal motor weakness cause during opening?

A

Jaw to deviate toward the side of weakness

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16
Q

If you had a weak right pterygoid what would you find?

A

Jaw deviates to the right on opening

Inability to move jaw to the left on command

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17
Q

Unilateral weakness of CN5 signifies a lesion potentially where?

A
  • brain stem (dismally)
  • trigeminal ganglion
  • motor root of CN 5
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18
Q

Will there be weakness with UMN lesion of CN5?

A

No

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19
Q

Besides muscle weakness, what else might you find with a LMN lesion of CN 5

A

Atrophy
Fasciculations
Decreased jaw jerk reflex

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20
Q

Atrophy of masseter

A

Flattening of jowl

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21
Q

Atrophy of temporalis

A

Hallowing of the temple on ipsilateral Sid

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22
Q

Severe bilateral weakness of muscles of mastication with inability to close mouth suggest

A

Bilateral corticobulbar lesions

  • motor neuron disease (ALS)
  • neuromuscular transmission disorder (MG)
  • myopathy
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23
Q

CN V1,2,3 converge on trigeminal ganglion aka _____ aka ______ ganglion located in _____ ______

A

Semilunar
Gasserian
Meckel’s cave

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24
Q

After converging at the trigeminal ganglion, a large sensory root of trigeminal nerve enters brainstem at the _______. Some _____ their branches and terminate on the ____ ______ nucleus and others ______ and terminate in the _____ _____

A

Pons
Ascend and terminate on main sensory nucleus
Descend and terminate in the spinal nucleus

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25
Q

Fibers with what sensations terminate in the main sensory nucleus

A

Touch and pressure

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26
Q

Fibers with what sensations pass to the spinal nucleus

A

Pain and temperature

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27
Q

From the main sensory and spinal nuclei axons ascend in the _____ and _____ ______ ______ to the ____ ____ ___ _____ nucleus

A

Dorsal and ventral trigeninothalamic tract

Ventral posterior medial (VPM) thalami nucleus

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28
Q

Once ascending to the VPM, fibers project to the _____ cortex in the ____ ___ ____

A

Sensory

Post central gyrus

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29
Q

What does CN v-1 supply?

A 
Bridge and side of nose
upper eyelid
forehead
scalp to vertex
eyeball-superior 1/2 cornea
Lacrimal gland
Nasal septum
Lateral wall of nasal cavity
Ethmoid sinus
Tentorium cerebelli
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30
Q

What does CN 5-2 supply

A 
Cheek
Lateral forehead
Side of nose
Upper lip
Upper teeth/gums
Palate
Nasopharynx
Posterior nasal cavity
Meninges of anterior/middle cranial fossa
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31
Q

What does CN 5-3 sensory part supply

A 
Inner cheek
Temple
Lateral scalp
EAM
tympanic membrane
TMJ
Mandible
Lower teeth/gums
Anterior 2/3tongue (GEN SENSORY)
Lower lip
Chin
Anterior and middle cranial fossa
32
Q

Does CN 5-3 supply sensory innervation to the angle of the jaw?

A

No

33
Q

Sensory fibers from where synapse in the inferior (caudal) aspect of the spinal nucleus?

A

pre-auricular

34
Q

Sensory fibers from where synapse in the middle aspect of the spinal nucleus?

A

Middle ring of the face

35
Q

Sensory fibers from where synapse in the superior/rostral aspect of the spinal nucleus?

A

Perioral ring

36
Q

If patient presents with unilateral or bilateral onion skin distribution of sensory loss it suggests a lesion where?

A

Spinal nucleus.

Outer face—lower parts of spinal nucleus

Inner face—upper part of spinal nucleus

37
Q

Lesions distal to trigeminal ganglion will involve what?

A

Isolated divisions ex: V1,2,3

38
Q

Lesions central to the trigeminal ganglion will affect what

A

All 3 branches of sensory distribution of CN 5

39
Q

Lesions involving the spinal nucleus of the brainstem will cause what

A

Sensory dysfunction in an “onion skin” appearance

40
Q

CN 7 function types

A

Parasympathetic
Visceral sensory
General somatosensory

41
Q

Parasympathetic innervation to what CN7

A

Tears and saliva

42
Q

Visceral sensory function of CN7

A

Taste (ant 2/3)

43
Q

CN 7. Main trunk carries ____ _____ fibers that control ____ ____ and smaller branchL ____ ____ carries fibers for ______, _____ ____, and _____ _____

A

Brachial motor that control facial expression

Nervous intermedius

Parasympathetic, visceral sensory and general somatosensory function

44
Q

CN 7 path.

Primary motor cortex in ____ _____. ________ tracts descend to ____ _____ in ______ and synapse with _______

A

Precentral gyrus in corticobulbar tracts

Descend to facial nucleus in pons

Synapse with LMNs’ (facial N)

45
Q

Facial N exits ____ at ______ _____ and transverse ____ _____ and enters the ____ ____ ____ and travels in the _____ _____ with CN ____

A

Brainstem at cerebellopontine angle

Transverse subarachnoid space

Enter the internal AM

Travels in auditory canal with CN 8

46
Q

After CN 7 travels in auditory canal with CN8, it runs inferiorly in the ____ ___. The main portion then ______ the skull through the ______ ____ and passes through the _____ _____. Here it divides into _____ major ____ _____ branches to supply ______ of facial expression

A

Facial canal
Exits skull through stylomastoid foramen

Pass through parotid gland

Divides into 5 brachial motor branches

Supply muscles of facial expression

47
Q

What muscles of facial expression does CN 7 supply

A
  • frontalis
  • orbicularis oculi/oris
  • buccinator
  • platysma
  • posterior/digastric
  • stapedius muscle
48
Q

What does the platysma do

A

Frown

49
Q

What does the stapedius muscle do

A

Dampens movement of middle ear ossicles

-protective mechanism of sound at loud events

50
Q

Preganglionic fibers of CN7 originate in the ____ ____ ____ and branch into ___ nerves: ____ ___ and _____ ____

A

Superior Salvatore nucleus

  1. Greater petrosal
  2. Chorda tympani
51
Q

Greater petrosal nerve goes through ___ ganglion and has ____ _____ fibers to the _____ ___ and ____ ___

A

Sphenopalatine ganglion

Postganglionic parasympathetic fibers to lacrimal gland and nasal mucosa

52
Q

Chorda tympani exits skull through ____ ____ and joins ___ ___ to reach ______ ganglion. Has ____ ____ supply to ____ and ____ _____ glands

A

Petrotympanic fissure

Joints lingual nerve to reach submandibular ganglion

Postganglionic parasympathetic supply to submandibular and sublingual salivary glands

53
Q

Submandibular and sublingual glands receive parasympathetic innervation from? And sympathetic?

A

Para: chorda tympani
Symp: superior cervical ganglion and carotid plexus

54
Q

Sympathetic innervation causes what from submandibular/sublingual glands?

A

Vasoconstriction and scant, thick, mucoid secretion low in enzyme

55
Q

Lesion in internal acoustic meatus would cause what.

A

Look up! Slide 42

56
Q

Visceral sensory pathway for CN7. ______ _____ carries fibers from ant 2/3 tongue that has cell bodies in the _____ ganglion. It synapses with secondary neurons in the ____ _____/_____ _____ and ascends via ____ ______ tract where it reaches the _______ and these neurons protect to _____ ___ ____ in the ______ gyrus

A

Chorda tympani
Geniculate
Nucleus solitaries/gustatory nucleus

Ascends via central tegmental tract and reaches the VPM nucleus

Project to cortical taste area in the postcentral gyrus

57
Q

General somatosensory pathway of CN7. Primary sensory neurons located in _____ ganglion and synapse in the _____ nucleus where they then continue to the ______ cortex in the ______ gyrus

A

Geniculate
Synapse in trigeminal nucleus

Somatosensory cortex in the postcentral gyrus

58
Q

Where does the facial nerve provide somatic sensation

A

Region near the EAM

59
Q

UMN lesion in CN7 cause what?

A

Contralateral face weakness sparing the forehead

**recall upper face has both hemispheres contributing and unaffected hemisphere can compensate

60
Q

Where could the lesion be if there is left sided facial weakness—sparing the forehead?

A

CN 7 UMN lesion on the R

61
Q

Where could the lesion be if the entire left side of the face is weak?

A

CN7 LMN lesion on the left

62
Q

What part of the face has innervation from both hemispheres?

A

Upper part—forehead

Why UMN lesion results in sparing of the forehead, and LMN lesion doesn’t

63
Q

What pathology cause loss of facial movement on entire side of face

A

Bell’s palsy-LMN issue

64
Q

What pathology causes facial weakness sparing the forehead?

A

Stroke—UMN lesion

65
Q

What should be considered if patient can raise both eyebrows?

A

Stroke

66
Q

Two types of lesions of CN7

A

Peripheral/nuclear/infranuclear
(Aka at nucleus or below)

Central/supranuclear

67
Q

Where is the lesion in CN7 in a peripheral lesion?

A

From the facial nucleus and distal

68
Q

S/s of peripheral/nuclear/infranuclear lesion of CN7

A

Ipsilateral to lesion

  • complete facial paralysis
  • smoothening of brow
  • difficulty closing eye
  • flat nasolabial fold
  • drooping of mouth
69
Q

Where might the lesion be in a central/supranuclear lesion of CN 7

A

Lesion of motor cortex or corticobulbar tracts

70
Q

S/s of central/supranuclear lesion of CN7

A
  • contralateral to lesion
  • lower portion of face
  • spare forehead/can raise eyebrow
  • drooping mouth
  • flattened nasolabial fold
71
Q

The 5Ds. 3Ns, and A for stroke

A

D: dysarthria, dysphasia, diplopia, dizziness, drop attacks

N: numbness, nystagmus, nausea

A: Ataxia

72
Q

Aguesia

A

Complete loss of taste

73
Q

Cause of aguesia

A

Olfaction dysfunction (Vit A, b6,12,zinc,copper def)

  • viral infection
  • aging
  • toxic
  • metabolic
74
Q

Unilateral deficits in taste causes?

A

Lesions of nucleus solitarious or facial nerve

** if peripheral lesion it must be proximal to stylomastoid foramen because if distal would only affect muscles

75
Q

Lesion distal to stylomastoid foramen would cause what>

A

Weakness of muscles of facial expression

NMS (12 decks)

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