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Neuro 2 > Crainal nerves and their diseases > Flashcards

Crainal nerves and their diseases Flashcards

1
Q

Wht nerves have special senses?

A

I - Olfaction (smell)
II - OPtoc (vision)
VII, IX, X - Taste
VIII - Hearing (and balance)

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2
Q

Ordinary sensation for the face

A

V

except ear - VII and IX

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3
Q

Which eye muscles?

A

Abducence = lateral rectus
superior oblique = troclear
all the rest (inc. lps) = occuluormotor

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4
Q

Muscles of mastication

A

V3

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5
Q

Muscles of fcial expression

A

VII

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6
Q

Muscles of larynx and pharynx

A

mainly X

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7
Q

Sternocleidomastoid and trapezius

A

XI

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8
Q

Autonomic innervation of the face are all what type of innervation?

A

Parasympathetic

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9
Q

Automonic: pupillary constriction due to which nrve?

A

III

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10
Q

Automonic: Lacrimation

A

VII (facial)

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11
Q

Automonic:Salvation

A

Parotid = glossopharyngeal (IX)

Submandibular and sublingual = VII (facial)

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12
Q

How to examine optic nerve?

A

Eye tests:

Acuity
Visual fields
Pupillary restrictions (need a pen torch etc)
Fundoscopy
Colour vision

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13
Q

How to test eye movements

A

H pattern, so across and when across look up and down…

Lateral up and down tests for the superior and inferior rectus

Medial up and down tests for the inferior and superior oblique.

(remember that the oblique’s attach to the front of the eye and then track back and medially, which is why when looking medially and up and down they get tested. Also because they attach to the front of the eye, the superior oblique is tested looking medially and down, and the inferior oblique is tested by looking medially and upwards)

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14
Q

WHat else do you need to test ifor nerves III,IV and VI

A

Look for signs of ptosis
Sizes of pupils
pupillary reactions

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15
Q

How to test V

A

-sensation of the face, so cotton bud on forehead, below eye and chin.

-muscles of mastication, so clenching jaw and feeling for the muscles on the sides of the face, checking that they are equal and just as prominent as each other

-corneal reflex (cotton wool stroking the eye)

-jaw jerk (hit onto finger on jaw

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16
Q

How to test VII

A

facial expressions!!

-raise eyebrows
-frown
purse lips
-puff out cheeks
-teethy grin (check symmetry and teeth)
-squeeze eyes shut, examiner tries to open them (shouldn’t be able to )

-corneal reflex
-taste (ant. 2/3 tongue

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17
Q

How to test vestibular cochlear nerve (VIII)

A

hearing testing:
Rennes and Webers

Vestibular testing: dix hallpike manouvre and Untenberger’s test (March on spot and see if they rotate one way or another)

18
Q

How do we test IX and X

A

-palate movements (look)
-gag reflex (awful for the patient)
-SPEECH QUALITY
-cough quality

19
Q

How to test XI

A

Head turning and shoulder shrugging (sternocleido mastoid and trapezius function)

20
Q

What are the cranial reflexes (4)

A

-gag reflex (affferent IX, efferent X)
-corneal reflex (afferent V, efferent VII)
-Jaw jerk (afferent and efferent V)
-pupillary light reflex (afferent II, efferent III)
-

21
Q

Location of the cranial nerve nuclei:
III and IV are where?
V, VI, VII?
VIII
IX x XI XII?

A

III and IV = mid brian
V, VI, VII = pons
VIII = pontomedullary junction
IX, X, XI, XII = medulla

22
Q

Comon combinationsof cranial nerve issues origninate where:
Bilateral III
III,IV and VI
VI and VII
V and VIII
Unusual combinations

A

Bilateral III = midbrain (contricted pupil, ptosis, reduced eye movements)

III, IV and VI = Superior orbital fissure (completely unable to move the eye)

VI and VII = pons (eyes unable to externally rotate, unable to move muscles of the face)

V and VIII = cerebellopontine angle ( PAINFUL face, unable to chew, issues with hearing and balance)

If unusual combinations it is suggestive of chronic or malignant meningitis

23
Q

Purely motor signs could be due to what?

A

Myasthenia Gravis

24
Q

Double vision coule be due to what conditions?

A

Myasthenia or Thyroid eye disease

25
Q

What is optic neuritis?
What dies it cause
What might be seen on fundoscopy?
What disease its it associated with?

A

Demyelination of the optic nerve (optic nerve inflammation)

Causes:
-monocular visual loss
-pain on eye movement
-reduced visual acuity
-reduced colour vision

Fundoscopy findings:
-swollen optic disc

Associated with MS (Multiple Sclerosis)

26
Q

What does complete 3rd nerve palsy present with?

A

Ptosis, dilated pupils (no parasympathetic response)

27
Q

Causes of dilated pupils (7)

A

Youth
Dim lights
Eye drops (mydriatic)
Excitement/anxiety
Stimulant overdose (amphetamine, concaine)
Third nerve palsy
Brain death

28
Q

Causes of small pupils (5)

A

Old age
Bright lights
Miotic eye drops
Opiate overdose
Horners syndrome

29
Q

What is horners syndrome?

A

SYmpathetic nerve issue from T1/2 to the face, so causes constricted pupil, droopy eyelid, lack of sweating on that side etc)

Think horners -> hornet -> scary -> Sympathetic

30
Q

What is Bells palsy

A

Issue with the

31
Q

What is supranuclear gaze palsy ude to?

A

degenaeative diseases

32
Q

3rd nerve palsy can be due to ? What are the 2 types?

A

Compressive type -> compression on the occulormotor nerve, eg raised interoccular pressure/intracranial pressure , anneurysm. Painful, pupil is affected

Non compressive type -> due to microvasculr issues eg diabetes. hypertension. Painless, and spared pupil.

33
Q

Causes of isolated 6th nerve palsy

A

Ideopathic,
diabetes
meningitis
raised intracranial pressure

34
Q

What are the causes of Nystagmus?

A

Most commonly on a friday night = alcohol missuse

-Congenital
-Serious visual impairment
-Peripheral vestibular problem
-Central vestibular / brainstem disease
-Cerebellar disease
-Toxins (medication and alcohol)

35
Q

What is trigeminal neuralgia?

A

Compression fifth nerve in the posterior fossa causing difficulty chewing, and very painful face
(Paroxysmal attacks of lancinating pain)

Triggers
Middle age and older
Caused by vascular loop

36
Q

Treatment of trigeminal neuralgia

A

Carbamazapine
Surgery if medicine has no affect

37
Q

Bulbar vs Pseudobulbar palsy and symptoms

A

Bulbar – lower motor neurone
Pseudobulbar palsy – upper motor neurone

Both present with Dysarthia and Dysphagia

38
Q

Bulbar palsy nerves and what syconditions would you see this?

A

IX - XII

MND, polio, tumours, vascular lesions of the medulla and syphilis

39
Q

Bulbar dysfunction, what is really important to check for?

A

Ability to swallow and eat food -> dont just give food and hope for the best!! Get it checked out properly!

40
Q

Upper Motor Neuron vs Lower Motor Newuron diseases in the face

A

UMN = brain issue so stroke/tumour

LMR = motor innervation issue - lymes, Bell’s palsy, sarcoid

41
Q

Pseudobulbar Palsy symtoms

A

-dysarthria
-dysphonia
-dysphagia
-spastic, immobile tongue
-brisk jaw jerk
-brisk gag reflex

Neuro 2 (9 decks)

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