Crainal nerves and their diseases Flashcards
Wht nerves have special senses?
I - Olfaction (smell)
II - OPtoc (vision)
VII, IX, X - Taste
VIII - Hearing (and balance)
Ordinary sensation for the face
V
except ear - VII and IX
Which eye muscles?
Abducence = lateral rectus
superior oblique = troclear
all the rest (inc. lps) = occuluormotor
Muscles of mastication
V3
Muscles of fcial expression
VII
Muscles of larynx and pharynx
mainly X
Sternocleidomastoid and trapezius
XI
Autonomic innervation of the face are all what type of innervation?
Parasympathetic
Automonic: pupillary constriction due to which nrve?
III
Automonic: Lacrimation
VII (facial)
Automonic:Salvation
Parotid = glossopharyngeal (IX)
Submandibular and sublingual = VII (facial)
How to examine optic nerve?
Eye tests:
Acuity
Visual fields
Pupillary restrictions (need a pen torch etc)
Fundoscopy
Colour vision
How to test eye movements
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)
WHat else do you need to test ifor nerves III,IV and VI
Look for signs of ptosis
Sizes of pupils
pupillary reactions
How to test V
-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
How to test VII
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
How to test vestibular cochlear nerve (VIII)
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)
How do we test IX and X
-palate movements (look)
-gag reflex (awful for the patient)
-SPEECH QUALITY
-cough quality
How to test XI
Head turning and shoulder shrugging (sternocleido mastoid and trapezius function)
What are the cranial reflexes (4)
-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)
-
Location of the cranial nerve nuclei:
III and IV are where?
V, VI, VII?
VIII
IX x XI XII?
III and IV = mid brian
V, VI, VII = pons
VIII = pontomedullary junction
IX, X, XI, XII = medulla
Comon combinationsof cranial nerve issues origninate where:
Bilateral III
III,IV and VI
VI and VII
V and VIII
Unusual combinations
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
Purely motor signs could be due to what?
Myasthenia Gravis
Double vision coule be due to what conditions?
Myasthenia or Thyroid eye disease
