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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
Q

What can cause 1st nerve palsy damage

A

Fracture of cribriform plate
Anterior cranial fossa tumour
Association with Parkinson / Alzeheimers and COIVD

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26
Q

What does this result in

A

Anosmia

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27
Q

What can cause 2nd nerve palsy and what does it cause

A

Optic neuritis
Papilloedema/ raised ICP
Tumour if bitemporal hemianopia - problem at optic chiasm

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28
Q

What does 4th nerve palsy cause

A

Defective downward gaze
Eye up and out
May have head tilt to compensate
Vertical diplopia - double vision when look down

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29
Q

What does 6th nerve palsy cause

A

Defective abduction
Medial deviation as lose LR which abducts
Horizontal diplopia

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30
Q

What are common causes of 4+6th nerve palsy

A 
DM
Hypertension
Trauma 
Raised ICP - as such long course (6th not 4th) 
Tumour 
Infection
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31
Q

What does 3rd nerve palsy cause

A

Ptosis
Eye down and out
Dilated fixed pupil (mydriasis)
No pupil reflex or accommodation if para fibres damaged

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32
Q

What causes dilated pupils

A 
Dim light
Anxiety / excitement
Mydriatic eye drops
Cocaine
3rd nerve palsy
Brain death
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33
Q

What causes constricted pupils

A

Bright light
Miotic eye drop
Opiate
Horner’s

34
Q

What are microvascular causes of 3rd nerve palsy

A 
DM - pupil is spared 
Hypertension
Vasculitis - SLE / GCA
Weber syndrome 
MS
35
Q

What are microvascular causes typically 3rd nerve palsy

A

Painless

Pupil reflex spared

36
Q

What are compressive causes

A 
Aneurysm - posterior communicating 
SAH 
Malignancy 
Cavernous sinus thrombosis 
Raised ICP - start of nuclear herniation
37
Q

What are compressive causes typically

A

Painful - headache
Pupil affected
Known as hutchinson pupil - feared by neurosurgeon

38
Q

What does 5th nerve palsy cause

A

Loss of corneal reflex (afferent)
Loss of sensation
Paralysis muscles mastication
Deviation of jaw to weak side

39
Q

What causes

A

Trigeminal neuralgia

40
Q

What nerve is commonly injured and why

A

Facial nerve as long path

41
Q

What does it cause

A

Flaccid paralysis of face as LMN
Loss of corneal reflex (efferent)
Loss of taste to anterior 2/3

42
Q

What causes facial nerve palsy

A

Bell’s palsy

43
Q

What can cause an 8th nerve palsy

A 
Acoustic neuroma (Schwann cell tumour of cochlear nerve) 
Vestibular neuritis (inflammation of vestibular part of nerve)
44
Q

What does 8th nerve palsy cause

A

Hearing loss
Vertigo
Nystagmus
Tinnitus

45
Q

What are other causes of nystagmus

A 
Macular degeneration
Vestibular problem
Brain stem
Cerebellar
Toxins
46
Q

What are symptoms of vestibular neuritis

A

Sudden onset vertigo
Vomiting
Blurred vision
Gradual recovery

47
Q

What are causes

A

MS

Viral = more common

48
Q

What does 9th palsy lead too

A

Hypersenstive carotid sinus reflex

Loss of gag reflex (afferent)

49
Q

What is also injured commonly with 9th palsy

A

X - vagus
XI - accessory
XII - hyoglossal

50
Q

What is this known as

A

Jugualr foramen syndrome if no XII

Bulbar palsy if all 4

51
Q

What does 10th palsy lead too

A

Uvular deviate away from lesion
Loss of gag reflex
Dysphagia
Dysphonia

52
Q

What does 11th palsy lead too

A

Weakness turning head to contralateral side + shrugging shoulder

53
Q

What does 12th palsy lead

A

Tongue deviates toward affected side as lose muscles on contralateral
Paralysis + atrophy

54
Q

What causes 12th palsy

A

Tonsillectomy

55
Q

What is dysarhtria

A

Slurring or slowed speech

Disorder articulation

56
Q

What can cause

A 
Stroke
Brain injury
Tumour
Facial paralysis
Tongue or throat muscle weakness
57
Q

What is dysphonia

A

Difficulty speaking due to physical problem through vocal cords

58
Q

What is responsible for corneal reflex

A 
V1 = afferent
Facial = efferent
59
Q

Jaw jerk reflex

60
Q

Gag

A 
Glossopharyngeal = afferent
Vagus = efferent
61
Q

Carotid sinus

A

Glossopharyngeal + vagus

62
Q

Pupil

A 
Optic = afferent
Occulomotor = efferent
63
Q

Lacrimation

A 
V1 = afferent
Facial = efferent
64
Q

What is bulbar palsy

A

Bilateral LMN lesion of glossopharyngeal, vagus, accessory and hypoglossal nerve

65
Q

What causes

A 
MND
Polio
Tumour
Syphillis
Vascular 
CN palsy
66
Q

What does it cause

A

Wasted tongue
Dysarthria
Dysphonia
Dysphagia

67
Q

What should you beware of

A

NOT feeding till assessed by SALT

68
Q

What is pseudo bulbar

A

UMN damage

Same symptoms + brisk reflexes - gag and jaw

69
Q

What causes bilateral LMN facial nerve palsy

A

Sarcoid
GBS
Lyme’s
Bilateral acoustic neuroma

70
Q

What causes unilateral LMN facial nerve palsy

A 
Bell's palsy 
Ramsay Hunt
Cholesteatoma
Otitis media  
Acoustic neuroma
Brainstem stroke / tumour 
MS 
Parotid gland tumour
Meningitis 
TB
HIV
MS
DM
71
Q

What causes UMN unilateral facial palsy

72
Q

What is Bell’s palsy and what causes / RF

A

Idiopathic acute unilateral facial nerve palsy
If not idiopathic then not Bell’s
Increased risk in pregnancy and DM

73
Q

What are the symptoms

A 
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
Q

What might you query

A

Shingles

Stroke

75
Q

How do you Dx and Rx

A

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
Q

What differentiates from stroke

A

Forehead has bilateral innervation so as stroke is UMN lesion it is not affected

77
Q

Important sign

A

If can’t wrinkle forehead = BELL’s

78
Q

What tests can you do to rule out other cause

A

Bloods - ESR + glucose
CT / MRI for SOL
CSF but rare

79
Q

What causes unilateral UMN palsy

A

Stroke

Tumour

80
Q

What causes bilateral UMN palsy (rare)

A

Psuedobulbar

Monitor neurone

Neuro (19 decks)

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