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Week 13 - neurology > Cranial nerves > Flashcards

Cranial nerves Flashcards

1
Q

What can cranial nerve abnormalities arise from?

A

Lesions affecting the:

  • communicating pathways to and from the cortex, cerebellum and other parts of the brainstem
  • nerve nucleus
  • nerve
  • neuromuscular junciton disorders
  • muscle
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2
Q

Name the cranial nerves

A 
I- olfactory 
II - optic 
III - oculomotor 
IV- trochlear 
V - trigeminal 
VI - abducens 
VII - facial 
VIII - vestibulocochlear 
IX - glossopharyngeal 
X- Vagus 
XI -spinal accessory 
XII - hypoglossal
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3
Q

State the components of each of the cranial nerves

A 
I-olfactoy - sensory 
II- optic - Sensory 
III - oculomotor - Motor 
IV- trochlear - motor 
V- trigeminal - both 
VI - Abduncens - motor 
VII - Facial - both 
VIII - Vestibulocochlear - sensory 
IX - Glossopharyngeal - both
X- Vagus - both 
XI- Accessory - motor
XII- hypoglossal - motor
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4
Q

What is the function of CN I?

A

Smell

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5
Q

What is the tract of CN I?

A

Olfactory cells of the nasal mucosa -> olfactory bulbs -> pyriform cortex

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6
Q

What is the function of the optic nerve?

A

Vision

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7
Q

What is the tract of the optic nerve?

A

Retinal ganglion cells -> optic chasm -> thalamus -> primary visual cortex in occipital lobe

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8
Q

How do you examine the optic nerve?

A
  • Optic disc via opthalmoscopy
  • Pupillary responses - consensual response
  • Visual acuity (snellen)
  • Visual fields and blind spot (confrontation)
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9
Q

Explain pupillary reflexes

A
  • optic nerve -> optic tract -> pretectal nucleus ->posterior commissure ->edinger-wetphal nucleus
  • oculomotor nucleus ->oculomotor nerve -> ciliary ganglion -> short ciliary nerve to ciliary muscle and constrictor papillae muscle
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10
Q

Severed optic nerve

A

Monocular vision loss on side of severed nerve

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11
Q

Lesion to optic tract

A

contralateral homonymous hemianopia

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12
Q

Lesion to optic chiasm

A

Bitemporal hemianopia

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13
Q

Where is the location of the motor nucleus of CN III?

A

Midbrain (oculomotor nucleus)

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14
Q

What is the motor function of CN III?

A

Movement of the eyeball and lens accommodation
•Inferior oblique
•Superior, medial and inferior recti muscles
•Levator palpebrae superioris

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15
Q

What is the parasympathetic function of CN III?

A

Pupil constriction

•Innervates ciliary muscles and pupillary constrictor muscles

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16
Q

Where is the location of the parasympathetic nucleus of oculomotor

A

Midbrain - edinger westphal

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17
Q

What is the result of a complete left oculomotor nerve palsy?

A
  • Dilation of the pupil
  • Eye down and out
  • complete ptosis
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18
Q

What is the function of CN IV?

A

Move the eyeball (depresses the adducted eye and introrts the abducted eye) - superior oblique muscle

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19
Q

Where is the location of the trochlear nucleus?

A

Midbrain (inferior colliculus)

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20
Q

What is the function of CN VI?

A

Eyeball movement - abducts the eye on the horizontal plane, innervates the lateral rectus

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21
Q

Describe abducens nerve palsy

A

Cannot look to the side of the affected nerve

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22
Q

Which cranial nerve has the longest intracranial course?

A

Trochlear

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23
Q

Which of the cranial nerves decussate to the contralateral side?

A

II and IV

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24
Q

What is the sign of a 4th nerve palsy?

A

Failure of downgaze

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25
Q

What is internuclear ophthalmoplegia?

A

Disorder of conjugate gaze - failure of adduction of affected eye with nystagmus on lateral gaze in contralateral eye

26
Q

What does internuclear ophthalmoplegia result from?

A

Lesion of medial longitudinal fasiculus

27
Q

What are the signs of horners syndrome?

A
  • Ptosis
  • miosis
  • anhydrosis
  • Aoparent epothalmos
28
Q

What are the causes of Horner’s syndrome?

A 
Results for ipsilateral disruption of the cervical/thoracic sympathetic chain:
•Congenital 
•Brainstem stroke 
•Cluster headache 
•Apical lung tumour 
•Multiple sclerosis 
•Carotid artery dissection 
•Cervical rib 
•Syringomyelia
29
Q

What are the branches of the trigeminal nerve?

A

Ophthalmic, maxillary and mandibular

30
Q

What is the sensory function of CN V?

A
  • Sensory input from the face
  • Ophthalmic, mandibular and maxillary divisions
  • Anterior 2/3 of the tongue
31
Q

What is the motor function of the trigeminal nerve?

A
  • Mastication

* Masseter, temporalis, medial and lateral pterygoids (mandibular branch)

32
Q

Where is the location of the sensory nucleus of the trigeminal nerve?

A

Pons and medulla

33
Q

Where is the location of the motor nucleus of the trigeminal nerve?

A

Pons

34
Q

What is herpes zoster ophthalmicus?

A

Herpes in the distribution of one of the branches of the trigeminal nerve (normally V1)

35
Q

What is the motor function of the facial nerve?

A

Muscles of facial expression

36
Q

Where is the motor nucleus of the facial nerve?

A

Pons

37
Q

Where is the sensory nucleus of the facial nerve?

A

Medulla

38
Q

What is the sensory function of the facial nerve?

A

Taste - anterior 2/3 of tongue

39
Q

What is the parasympathetic function of the facial nerve?

A

Salivation and lacrimation

40
Q

Where is the parasympathetic nucleus of the facial nerve?

A

Medulla

41
Q

What is bells palsy

A

Weakness of superior and inferior facial muscles

42
Q

Describe the difference in an upper and lower motor neurone facial weakness

A

Lower: upper and Lower muscle of the face
Upper: just weakness of the lower muscles of the face

43
Q

What nerves are involved in the corneal reflex?

A

Afferent - V
Efferent - VII (orbicularis oculi)
(tests pontine function)

44
Q

What is the function of CN VIII?

A
  1. Balance - nerve endings within semi-circular canals -> cerebellum and spinal cord
  2. Hearing - cochlear -> auditory cortex in the temporal lobes
45
Q

Where is the nucleus of the vestibulocochlear nerve?

A

Pons and medulla

46
Q

What is the sensory component of the CN IX?

A
  • Taste - innervates the posterior 1/3 of the tongue

* Proprioception for swelling and blood pressure receptors - innervated pharyngeal wall and carotid sinuses

47
Q

What is the motor component of CN IX?

A
  • Swallow and gag reflex - innervates the pharyngeal muscles
  • lacrimation - lacrimal gland
48
Q

What is the parasympathetic function of CN IX?

A
  • saliva production

* Innervates the parotid gland

49
Q

What is the presentation of a glossopharyngeal palsy?

A

Deviation of the uvula away from the side of the lesion

50
Q

What is the location of the nucleus of the glossopharyngeal nerve?

A

Medulla

51
Q

What is the location of the nucleus of the vagus nerve?

A

Medulla

52
Q

What is the sensory function of the vagus?

A
  • Chemoreceptors -innervates the carotid bodies monitoring blood oxygen concentration
  • Pain receptors in the dura - respiratory and digestive tracts
  • Sensation: external ear, larynx and pharynx
53
Q

What is the parasympathetic function of the vagus

A

Smooth muscle and glands of the same areas innervated by the motor component as well as thoracic and abdominal areas

54
Q

What is the motor function of the vagus?

A
  • Heart rate and stroke volume: pacemaker and ventricular muscles
  • Peristalsis: smooth muscles of the digestive tract
  • Air flow: Smooth muscles in the bronchial tubes
  • Speech and swallowing: muscles of the larynx and pharynx
55
Q

What is the function of CN XI?

A
  • Head rotation and shoulder shrugging

* Innervates sternocleidomastoid and trapezius

56
Q

What is the function of CN XII?

A

Speech and swallowing, motor innervation to the tongue

57
Q

What is the presentation of a hypoglossal palsy?

A

Tongue deviates to the side of the lesion

58
Q

If there is a lesion in the cavernous sinus, which cranial nerves are likely to be affected?

A
  • III - oculomotor - dilated eye, looking down and out, ptosis
  • IV - trochlear - failure of downgaze
  • V - trigeminal (V1 and V2) -sensory face, muscles of mastication
  • VI - Abducens - diplopia, can’t abduct eye on the horizontal plane
  • Horner’s syndrome
59
Q

What nerves can be affected if there is a lesion in the superior orbital fissure?

A
  • III - oculomotor - eye down and out
  • IV- trochlear - failure of downgaze
  • V1 - trigeminal, ophthalmic branch - sensory to face
  • VI - abducens - can’t abduct eye on horizontal plane
60
Q

What nerves can be affected if there is a lesion at the cerebellopontine angle?

A
  • V - Trigeminal - sensory, muscles of mastication
  • VII - Facial - facial expression, taste anterior 2/3 tongue, salivation
  • VIII - Vestibulocochlear - balance and hearing
  • Corneal reflex affected: afferent - V, efferent VII
61
Q

What nerves can be affected if there is a lesion at the jugular foramen?

A
  • IX - glossopharyngeal - swallowing proprioception, taste post 1/3, swallowing and gag reflex, saliva, BP receptors
  • X - vagus
  • XI - accessory - head rotation and shoulder shrugging
62
Q

What cranial nerves can be affected in a bulbar/pseudobulbar palsy?

A
  • IX - Glossopharyngeal
  • X - Vagus
  • XI - Accessory
  • XII - hypoglossal

Week 13 - neurology (12 decks)

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