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CN disorders Flashcards

1
Q

What is mnemonic for working out if CN are

  • Sensory
  • Motor - somatic vs visceral
  • Both
A 
Some
Say
Marry
Money
But 
My 
Brother 
Says 
Big 
Brains 
Matter
Motor
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2
Q

Where can CN be damaged

A

Brainstem where located

Route outside CNS

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3
Q

What is CN1 responsible for

A

Olfactory

Smell

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4
Q

Where does it pass through

A

Receptors in cribriform plate

Enter olfactory bulb in anterior cranial fossa

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5
Q

What is 2nd CN palsy for

A

VISION
Pupil reflex (afferent)
Optic

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6
Q

Where does it pass through and go

A

Optic canal in skull

Nerves joint at optic chiasm under pituitary

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7
Q

What is CN3 responsible for

A

Oculomotor
Movement of MR, IO, SR,IR
EPS of eyelid to open
Accommodation + pupil constriction via parasympathetic fibres

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8
Q

Where does it exit

A

Superior orbital fissure

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9
Q

What is CN4 responsible for

A

Trochlear
SO
Depresses eye and adducts

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10
Q

Where does it leave

A

Superior orbital fissure

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11
Q

What is CN6 responsible for

A

Abducens

LR eye movement

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12
Q

Where does it leave

A

Internal auditory meatus

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13
Q

What is CN5 / trigeminal nerve responsible for

A 
Facial sensation in all 3 areas
V1 - ophthalmic 
V2- maxillary
V3 - mandibular 
V3 = muscles of mastication
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14
Q

Where do trigeminal nerve roots come out of

A 
V1 = SOF
V2 = foramen rotundem
V3 = foramen ovale
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15
Q

What is facial nerve CN7 responsible for

A

Facial movement
Taste anterior 2/3 tongue
Lacrimation via para of sumandibular and sublingual glands
Salivaation from lacrimal gland

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16
Q

Where does it level

A

Internal auditory meatus

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17
Q

What is CN 8 / vestibular cochlear responsible for

A

Hearing and balance

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18
Q

Where does it come out from

A

Internal auditory meatus

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19
Q

What is CN 9/ glossopharyngeal responsible for

A 
Taste posterior 1/3 
Saliva from parotid
Swallowing 
Gag reflex 
Carotid snus input
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20
Q

Where does ti come out of

A

Jugular foramen

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21
Q

What is CN10 / vagus responsible for

A

Phonation
Swallowing - gag reflex
Innervating viscera - parasympahtetic

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22
Q

Where does it come out of

A

Jugular formane

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23
Q

What is CN11 / accessory responsible for and where does it come out from

A

Trapezius and SCM movement

Jugular foramen

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24
Q

What is CN12 / hypoglossal responsible for and where does it come out from

A

Tongue movement - somatic

Hypoglossal foramen

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25
What can cause 1st nerve palsy damage
Fracture of cribriform plate Anterior cranial fossa tumour Association with Parkinson / Alzeheimers and COIVD
26
What does this result in
Anosmia
27
What can cause 2nd nerve palsy and what does it cause
Optic neuritis Papilloedema/ raised ICP Tumour if bitemporal hemianopia - problem at optic chiasm
28
What does 4th nerve palsy cause
Defective downward gaze Eye up and out May have head tilt to compensate Vertical diplopia - double vision when look down
29
What does 6th nerve palsy cause
Defective abduction Medial deviation as lose LR which abducts Horizontal diplopia
30
What are common causes of 4+6th nerve palsy
``` DM Hypertension Trauma Raised ICP - as such long course (6th not 4th) Tumour Infection ```
31
What does 3rd nerve palsy cause
Ptosis Eye down and out Dilated fixed pupil (mydriasis) No pupil reflex or accommodation if para fibres damaged
32
What causes dilated pupils
``` Dim light Anxiety / excitement Mydriatic eye drops Cocaine 3rd nerve palsy Brain death ```
33
What causes constricted pupils
Bright light Miotic eye drop Opiate Horner's
34
What are microvascular causes of 3rd nerve palsy
``` DM - pupil is spared Hypertension Vasculitis - SLE / GCA Weber syndrome MS ```
35
What are microvascular causes typically 3rd nerve palsy
Painless | Pupil reflex spared
36
What are compressive causes
``` Aneurysm - posterior communicating SAH Malignancy Cavernous sinus thrombosis Raised ICP - start of nuclear herniation ```
37
What are compressive causes typically
Painful - headache Pupil affected Known as hutchinson pupil - feared by neurosurgeon
38
What does 5th nerve palsy cause
Loss of corneal reflex (afferent) Loss of sensation Paralysis muscles mastication Deviation of jaw to weak side
39
What causes
Trigeminal neuralgia
40
What nerve is commonly injured and why
Facial nerve as long path
41
What does it cause
Flaccid paralysis of face as LMN Loss of corneal reflex (efferent) Loss of taste to anterior 2/3
42
What causes facial nerve palsy
Bell's palsy
43
What can cause an 8th nerve palsy
``` Acoustic neuroma (Schwann cell tumour of cochlear nerve) Vestibular neuritis (inflammation of vestibular part of nerve) ```
44
What does 8th nerve palsy cause
Hearing loss Vertigo Nystagmus Tinnitus
45
What are other causes of nystagmus
``` Macular degeneration Vestibular problem Brain stem Cerebellar Toxins ```
46
What are symptoms of vestibular neuritis
Sudden onset vertigo Vomiting Blurred vision Gradual recovery
47
What are causes
MS | Viral = more common
48
What does 9th palsy lead too
Hypersenstive carotid sinus reflex | Loss of gag reflex (afferent)
49
What is also injured commonly with 9th palsy
X - vagus XI - accessory XII - hyoglossal
50
What is this known as
Jugualr foramen syndrome if no XII | Bulbar palsy if all 4
51
What does 10th palsy lead too
Uvular deviate away from lesion Loss of gag reflex Dysphagia Dysphonia
52
What does 11th palsy lead too
Weakness turning head to contralateral side + shrugging shoulder
53
What does 12th palsy lead
Tongue deviates toward affected side as lose muscles on contralateral Paralysis + atrophy
54
What causes 12th palsy
Tonsillectomy
55
What is dysarhtria
Slurring or slowed speech | Disorder articulation
56
What can cause
``` Stroke Brain injury Tumour Facial paralysis Tongue or throat muscle weakness ```
57
What is dysphonia
Difficulty speaking due to physical problem through vocal cords
58
What is responsible for corneal reflex
``` V1 = afferent Facial = efferent ```
59
Jaw jerk reflex
V3
60
Gag
``` Glossopharyngeal = afferent Vagus = efferent ```
61
Carotid sinus
Glossopharyngeal + vagus
62
Pupil
``` Optic = afferent Occulomotor = efferent ```
63
Lacrimation
``` V1 = afferent Facial = efferent ```
64
What is bulbar palsy
Bilateral LMN lesion of glossopharyngeal, vagus, accessory and hypoglossal nerve
65
What causes
``` MND Polio Tumour Syphillis Vascular CN palsy ```
66
What does it cause
Wasted tongue Dysarthria Dysphonia Dysphagia
67
What should you beware of
NOT feeding till assessed by SALT
68
What is pseudo bulbar
UMN damage | Same symptoms + brisk reflexes - gag and jaw
69
What causes bilateral LMN facial nerve palsy
Sarcoid GBS Lyme's Bilateral acoustic neuroma
70
What causes unilateral LMN facial nerve palsy
``` Bell's palsy Ramsay Hunt Cholesteatoma Otitis media Acoustic neuroma Brainstem stroke / tumour MS Parotid gland tumour Meningitis TB HIV MS DM ```
71
What causes UMN unilateral facial palsy
Stroke
72
What is Bell's palsy and what causes / RF
Idiopathic acute unilateral facial nerve palsy If not idiopathic then not Bell's Increased risk in pregnancy and DM
73
What are the symptoms
``` Ipsilateral as peripheral nerve Unilateral facial weakness / paralysis of whole side of face Can't close eye Can't raise eyebrow Mouth drop Unable to wrinkle forehead Ipsilateral numbness or pain around eye Taste decreased / altered Pain behind ear Hyperacusis as stapedius paralysis Dry eyes ```
74
What might you query
Shingles | Stroke
75
How do you Dx and Rx
FBC, ESR, glucose, Lyme serology ALWAYS EXAMINE parotid and ears to exclude cholesteatoma or Ramsay hunt MRI for SOL / MS Dx of exclusion so must rule out Rx STEROID Prednisoone 1mg/kg for 10 days Artificial tears and lubricants
76
What differentiates from stroke
Forehead has bilateral innervation so as stroke is UMN lesion it is not affected
77
Important sign
If can't wrinkle forehead = BELL's
78
What tests can you do to rule out other cause
Bloods - ESR + glucose CT / MRI for SOL CSF but rare
79
What causes unilateral UMN palsy
Stroke | Tumour
80
What causes bilateral UMN palsy (rare)
Psuedobulbar | Monitor neurone

Neuro (19 decks)

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