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Head and Neck > Cranial Nerves > Flashcards

Cranial Nerves Flashcards

1
Q

Which two cranial nerves are extensions of the forebrain?

A

Olfactory and optic nerves (I and II)

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2
Q

What is cranial nerve I responsible for?

A

Special sense of smell (Olfactory nerve)

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3
Q

Which area of bone does the olfactory nerve run through to innervate the nose?

A

Cribiform foramina of ethmoid bone

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4
Q

What is cranial nerve II responsible for?

A

Sense of sight (optic nerve)
Some relation to pupillary size and response to light
Visual acuity

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5
Q

How would a patient with damage to the optic nerve present?

How could you confirm this

A

Blurred or absent vision in one eye
Abnormalities in pupillary reflexes
Poor visual acuity

Opthalmoscope - swollen optic disc

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6
Q

What occurs at the optic chiasm?

A

Mixing of sensory fibres from left and right optic nerves - so both sides contain information from both eyes

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7
Q

What is a common cause of bitemporal hemianopia?

A

Pituitary tumour

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8
Q

What is cranial nerve III responsible for?

A

Movement of extraocular muscles (Oculomotor nerve)
Movement of levator palpabrae superioris (retracts eyelid)
Movement of sphincter pupillae (constricts pupil)

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9
Q

What common signs are found in Oculomotor nerve defect?

A

Double vision (diplopia)
Drooping of eyelid (ptosis)
“Down and out” eye position

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10
Q

What would cause pupil sparing injury of the Oculomotor nerve?

What would cause pupil involving injury?

A

Microvascular ischaemia: diabetes, hypertension cause pupil sparing

Posterior communicating artery aneurysm, head injury, herniation cause pupil involving

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11
Q

What is cranial nerve IV responsible for?

A

Movement of superior oblique - movement of the eye downwards (Trochlear nerve)

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12
Q

How would a person with injury to the Trochlear nerve present?

A

Diplopia
Abnormal eye position (often raised)
Head tilt

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13
Q

What is cranial nerve VI responsible for?

A

Movement of lateral rectus - moves eyes laterally (Abducens nerve)

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14
Q

What is the false localising sign in Abducens nerve injury? What causes it?

A

Commonly damaged by a raise in ICP even when nothing directly compresses the nerve, due to stretching of the nerve fibres leaving the pons before entering the cavernous sinus

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15
Q

Which three cranial nerves share a commonality in route through the cavernous sinus and enter the orbit via the superior orbital fissure?

A

Occulomotor
Trochlear
Abducens

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16
Q

What are the functions of the trigeminal nerve?

A

Sensory supply to skin of face and scalp
Sensory information to anterior 2/3 of tongue
Motor innervation to muscles of mastication
Corneal reflex

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17
Q

What are the three branches of the trigeminal nerve?

A

Va -Opthalmic
Vb - Maxillary
Vc - Mandibular

18
Q

What is the corneal reflex?

What use is this clinically?

A

Touching the surface of the eye causes both eyes to blink

Can be used to assess trigeminal nerve function alongside other tests

19
Q

What pathologies are associated with the trigeminal nerve?

A

Trigeminal herpes zoster - shingles

Trigeminal neuralgia - shooting pains

20
Q

What structures do each of the branches of the trigeminal nerve pass through respectively?

A

Opthalmic - cavernous sinus - superior orbital fissure

Maxillary - cavernous sinus - foramen rotundum

Mandibular - foramen ovale

21
Q

What does the frontal nerve branch of the Opthalmic division of the trigeminal nerve give rise to?

A

The supraorbital and supratrochlear nerves that supply the forehead

22
Q

Which nerve is responsible for hutchingsons sign?

A

Nasociliary nerve (branch of Va)

23
Q

What is hutchingsons sign?

A

Shingles rash on tip of the nose - likely indicates eye involvement in future and therefore severity of disease

24
Q

Which nerve carries general sensation to the anterior 2/3 of the tongue?

A

Lingual nerve (branch of Vc)

25
Q

Which nerves supply the upper teeth and gums?

A

Superior alveolar nerves (branches of Vb)

26
Q

Which nerves supply the lower teeth and gums?

A

Inferior alveolar nerve and mental nerve (extension of inferior alveolar nerve that passes through mental foramen)

27
Q

What are the target tissues of the facial nerve?

A

Muscles of facial expression
Anterior 2/3 tongue (taste)
Lacrimal glands, salivary glands (excluding parotid) and mucosal glands

28
Q

What sign indicates facial nerve damage?

How is this different to what is seen in a stroke?

A

Unilateral face droop,

Strokes are forehead sparing, whereas facial nerve lesions are not

29
Q

What is Ramsay-Hunt syndrome?

A

Unilateral facial droop with shingles rash found in external ear

30
Q

What structure does the facial nerve pass through to get into the petrous bone?

From which foramen does it emerge from the base of the skull?

A

Internal acoustic meatus.

Stylomastoid foramen.

31
Q

Which three branches does the facial nerve give off inside the petrous bone?

A

Greater petrosal - lacrimal, nasal and oral mucosal glands
Nerve to stapedius - stapedius in the ear
Chorda tympani - tongue

32
Q

What is the vestibulocochlear nerve responsible for?

A

Balance and hearing (CN VIII)

33
Q

What symptoms would a person with CNVIII damage present with?

How would we test nerve function?

A

Hearing loss, dizziness, tinnitus.

Whisper or finger rub, tuning fork testing.

34
Q

Why might an acoustic neuroma present with numbness down one side of the face as well as CNVIII dysfunction?

A

May also compress the trigeminal nerve.

35
Q

Why are the glossopharyngeal and vagus nerves often examined together?

A

Very similar routes through posterior cranial fossa, jugular foramen and carotid sheath, so pathologies are more likely to affect both.

36
Q

What does the Glossopharyngeal nerve supply?

A

Sensory supply to oropharynx, tonsils and posterior 1/3 tongue,
Parasympathetic innervation to parotid glands,
Afferent from carotid sinus and body

37
Q

What does the Vagus nerve broadly supply?

A

Motor and sensory to larynx/pharynx and split palate.

Parasympathetic innervation to multiple tissues around the body eg heart, neck, abdomen

38
Q

What do patients with damage to cranial nerves IX and X present with?
How would we test nerve function?

A

Difficulty swallowing, weak cough, change in voice.

Test speech, swallowing and coughing. Asses soft palate and uvula position and gag reflex

39
Q

What is often a source of damage to the recurrent laryngeal nerve (branch of CNX)?

A

Thyroid pathology or surgery

Damage to superior thorax

40
Q

What is the Hypoglossal nerve responsible for?

How is damage to it assessed?

A

Tongue movement and protrusion.

Ask patient to protrude tongue, if deviation to one side, that Hypoglossal nerve is damaged.

41
Q

What is the Spinal accessory nerve (CN XI responsible for?)

How do we test its action?

A

Motor supply to sternocleidomastoid and trapezius.

Test actions of these muscles (turn head and shrug shoulders against resistance).

42
Q

Which cranial nerves may be damaged with pathology or surgery within the carotid sheath?

A

IX - Glossopharyngeal,
X - Vagus,
XI - Accessory,
XII - Hypoglossal.

Head and Neck (12 decks)

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