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Clinical Prep > Cranial nerve examination > Flashcards

Cranial nerve examination Flashcards

1
Q

CN-1

A

Olfactory, sensory
Any change in sense of smell

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2
Q

CN-2

A

Optic - sensory
Visual acuity

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3
Q

CN-3

A

Occulomotor - motor
EOM except superior oblique and lateral rectus
Pupillary constriction

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4
Q

CN-4

A

Trochlear - motor
Superior oblique

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5
Q

CN-5

A

Trigeminal - mixed
Sensation to face
Muscles of mastication
Jaw-jerk and corneal reflex

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6
Q

CN-6

A

Abducens - motor
Lateral rectus

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7
Q

CN-7

A

Facial nerve - mixed
Muscles of facial expression, stapedius muscle
Taste - anterior two-thirds of tongue

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8
Q

CN-8

A

Vestibulocochlear - sensory
Balance and hearing

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9
Q

CN-9

A

Glossopharyngeal - mixed
Sensation to pharynx, posterior third of tongue
Motor to stylopharyngeus

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10
Q

CN-10

A

Vagus - mixed
sensation to pharynx and larynx
Muscles of pharynx, larynx and palate

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11
Q

CN-11

A

Accessory - motor
Trapezius, SCM

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12
Q

CN-12

A

Hypoglossal - motor
Muscles of the tongue

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13
Q

Corneal reflex

A

Afferent - CN5
Efferent - CN7

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14
Q

Jaw-jerk reflex

A

Afferent - CN5
Efferent - CN5

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15
Q

gag reflex

A

Afferent - CN9 (glossopharyngeal)
Efferent - CN10 (vagus)(

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16
Q

Eye exam process

A

Visual acuity
Visual fields
Fundoscopy

Pupils - size, reactivity (direct and consensual), RAPD
Movements
Accommodation

17
Q

Causes of RAPD

A

Optic nerve disease:
Demyelination - Multiple sclerosis, Neuromyelitis optica spectrum disorder, anti-MOG
Ischaemia - including GCA
Compression - orbital tumours, thyroid eye disease
Other optic nerve inflammation: sarcoidosis, SLE, sjogrens

Eye disease:
Retina - ischaemia (retinal artery or vein), retinal detachment,
Other - intra-occular tumour, glaucoma

18
Q

Causes of absent light reflex with preserved accommodation reflex

A

Midbrain lesion - Argyll Robertson pupil of syphilis
Ciliary ganglion lesion - Adie’s pupil

19
Q

Types of eye movements

A

Pursuit - following a moving object (cerebellum and brainstem)
Saccadic - rapid movement to fix on an object (frontal lobe, brainstem, cerebellum)
Convergence - midbrain
Vestibulo-occular reflex - compensate for movements of the head to remain fixed on a target (vestibular organs, cerebellar and vestibular nuclei)

20
Q

Six eye muscles

A

Superior rectus
Lateral rectus
Inferior rectus
Superior oblique
Medial rectus
Inferior oblique

21
Q

Features of third nerve palsy

A

complete or partial ptosis
down and out eye
dilated pupil, unreactive to direct light and accommodation

22
Q

causes of third nerve palsy

A

Central causes: brainstem lesions (tumours, demyelination, vascular)
Peripheral causes: compressive lesions (aneurysm, usually posterior communicating artery), tumour, basal meningitis, nasopharyngeal carcinoma, orbital lesions. Ischaemia or infarction, migraine

23
Q

features of fourth nerve lesion

A

paralysis of the superior oblique muscle (causes weakness of downward movement)

24
Q

causes of fourth nerve lesion

A

idiopathic or trauma

25
Q

Features of sixth nerve lesion

A

failure to abduct eye

26
Q

causes of sixth nerve lesion

A

bilateral lesions - wernicke’s encephalopathy, mononeuritis multiplex, raised intracranial pressure
unilateral lesions - idiopathic, trauma related, vascular lesion, raised intracranial pressure, diabetes

27
Q

What distinguishes supranuclear palsy from cranial nerve lesions

A
  1. both eyes affected
  2. pupils may be fixed
  3. Usually no diplopia
  4. reflex eye movements are usually intact (flexing / extending the neck)
28
Q

PSP eye findings

A

loss of vertical gaze then later horizontal gaze
associated with extrapyramidal signs, neck rigidity, dementia

29
Q

Localising lesions - unilateral 3, 4, V1 and 6 nerves

A

cavernous sinus involvement

30
Q

Localising lesions - unilateral 5, 7 and 8 lesions

A

cerebellopontine angle lesion

31
Q

Localising lesions - unilateral 9, 10 and 11

A

Jugular foramen lesion

32
Q

Localising lesions - bilateral 10, 11, 12

A

Bulbar palsy - if lower motor neurone changes are present
Pseudobulbar palsy - if upper motor neurone signs present

Clinical Prep (7 decks)

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