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Neuroanatomy > Cranial Nerves > Flashcards

Cranial Nerves Flashcards

1
Q

what side of the brain are the cranial nerves

A

ventral side

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2
Q

name of cranial nerve 1

A

CNI
olfactory nerve

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2
Q

how many cranial nerves

A

12 pairs

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3
Q

name of cranial nerve 2

A

CNII
optic nerve

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4
Q

name of cranial nerve 3

A

CNIII
oculomotor

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5
Q

name of cranial nerve 4

A

CNIV
trochlear nerve

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6
Q

name of cranial nerve 5

A

CNV
trigeminal nerve

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7
Q

name of cranial nerve 6

A

CNVI
abducens nerve

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8
Q

name of cranial nerve 7

A

CNVII
facial nerve

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9
Q

name of cranial nerve 8

A

CNVIII
vestibulocochlear nerve

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10
Q

name of cranial nerve 9

A

CNIX
glossopharyngeal nerve

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11
Q

name of cranial nerve 10

A

CNX
vagus nerve

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12
Q

name of cranial nerve 11

A

CNXI
(spinal) accessory nerve

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13
Q

name of cranial nerve 12

A

CNXII
hypoglossal nerve

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14
Q

what nerves are eye related

A

2
3
4
6

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15
Q

cranial nerves 2 3 4 and 6 are related to what?

A

eye

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16
Q

number of olfactory nerve

A

1

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17
Q

number of optic nerve

A

2

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18
Q

number of oculomotor nerve

A

3

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19
Q

number of trochelar nerve

A

4

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20
Q

number of trigeminal nerve

A

5

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21
Q

number of abducens nerve

A

6

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22
Q

number of facial nerve

A

7

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23
Q

number of vestibular cochlear nerve

A

8

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24
Q

number of glossopharyngeal nerve

A

9

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25
Q

number of vagus nerve

A

10

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26
Q

number of spinal accessory nerve

A

11

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27
Q

number of hypoglossal nerve

A

12

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28
Q

are the cranial nerves in the CNS or PNS?

A

PNS

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29
Q

role of cranial nerve 1- olfactory

A

special sense of smell

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30
Q

where is CNI?

A

olfactory nerve fibres project into the mucosa of the nasal cavity through the cribriform plate of the ethmoid bone

olfactory bulb is superior to the cribriform plate

olfactory tract connects bulb with forebrain e.g. amygdala (memory and associative learning)

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31
Q

which nerve is the only one directly connecting to the cerebrum?

A

CNI - olfactory

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32
Q

route of olfaction

A

When you take a big breath in through the nose, small particles and chemicals land on the moist nasal mucosa consisting of olfactory epithelium and contains chemoreceptors.
- Nasal lining is stimulated and therefore stimulate the olfactory sensory neurons which transmit signals to the brain via the olfactory nerve (cranial nerve 1) and the brain interprets the information (the smell)

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33
Q

what type of nerve is CNI?

A

sensory

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34
Q

damage to the olfactory nerve

A

hyposomnia
anosmia
cacosmia

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35
Q

hyposmia

A

reduced sense of smell

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36
Q

anosmia

A

complete loss of olfaction

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37
Q

cacosmia

A

persistent offensive smell with no obviously offensive external stimulus

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38
Q

role of CNII - optic nerve

A

vision

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39
Q

where is CNII?

A

single optic nerve leave posterior eye and joins with contralateral nerve from the other side

forms an x-shape called optic chiasm (located superior to the pituitary gland and sella turcica of the sphenoid bone).

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40
Q

lateral route of vision

A

single optic nerve leave posterior eye and joins with contralateral nerve from the other side to form the optic chiasm (located superior to the pituitary gland and sella turcica of the sphenoid bone).

at the chiasm, some visual info crosses over and some remains on the same side.

a left and right optic tract forms in which nerves project to the left and right lateral geniculate ganglion/nucleus (LGN) of the thalamus.

from the thalamus, optic radiations travel to occipital lobe (primary visual cortex)

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41
Q

what is the lateral route of vision involved in?

A

conscious vision or sight

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42
Q

medial route of vision

A

bypasses the LGN of the thalamus, instead projecting neurons to midbrain (pretectal nucleus and superior colliculus)

destination of 10% of neurons

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43
Q

what is the medial route of vision for?

A

non-conscious functions of the eye e.g. light reflex (afferents)

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44
Q

medial route of vision connects to which cranial nerves?

A

3 4 6 so plays a role with smooth pursuit and gaze

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45
Q

what type of nerve is CNII?

A

sensory

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46
Q

foramina for CNI

A

cribiform plate

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47
Q

foramina for CNII

A

optic canal

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48
Q

clinical relevance for CNI

A

anosmia

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49
Q

clinical relevance for CNII

A

bitemporal hemianopia

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50
Q

role of CNIII - oculomotor nerve

A

eye movements, pupillary constriction and accommodation (motor innervation of the superior, inferior, and medial recti muscles and inferior oblique muscle) (parasympathetic fires to ciliary muscles, constrictor pupillae)

innervates the muscle of the upper eyelid (parasympathetic fibres to elevator palpebrae superioris)

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51
Q

route of CNIII

A

leaves ventral side of the midbrain

passes through cavernous sinus via superior orbital fissure at the posterior orbit (formed by sphenoid bone of the skull)

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52
Q

3rd nerve palsy

A

pupil down and out at rest (depressed and abducted)

ptosis of eyelid and dilated pupil (parasympathetic switched off and therefore sympathetic causes dilation)

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53
Q

light relfex involves which cranial nerves

A

2 and 3

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54
Q

afferent part of light reflex

A

via optic nerve - info passes into midbrain via medial route of optic pathway

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55
Q

efferent part of light reflex

A

via oculomotor nerve and specifically the parasympathetic fibres passing along its route (provides motor supply to constrictor pupillae muscles of iris).

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56
Q

difference between limbs of the light reflex

A

the two nuclei that facilitate it are different

pretectal nucleus and Edinger-Westphal nucleus

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57
Q

what is the accommodation reflex?

A

provides dynamic changes to the lens of the eye allowing us to focus on near or far objects

constriction of iris and ciliary muscles

partly conscious - somatic nucleus from brainstem realys info to occipital lobe to cause convergence via extraocular muscles to converge the eyes

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58
Q

role of nerves in the accommodation reflex

A

optic and oculomotor nerves act as the afferent and efferent fibres for the reflexive function

Edinger-Westphal and pretectal nuclei vital for relaying and coordinating a bilateral and simultaneous response.

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59
Q

what type of nerve is CNIII

A

motor

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60
Q

foramina for CNIII

A

superior orbital fissure

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61
Q

clinical relevance of CNIII

A

ptosis of the eyelid

deviation of the pupil to down and out position

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62
Q

role of CNIV - trochlear nerve

A

innervates superior oblique extraocular muscle of eye to pull eye down and out (intorsion and downwards gaze)

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63
Q

route of CNIV

A

leaves the dorsal midbrain transverse the cavernous sinus and leaves the cranial cavity via the superior orbital fissure

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63
Q

4th nerve palsy

A

weakens the ability of eyes to look down and out, causing vertical diplopia

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63
Q

only cranial nerve to leave the dorsal midbrain

A

CNIV

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64
Q

clinical relevance of trochlear nerve

A

vertical diplopia

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64
Q

vertical diplopia

A

duplicated images on top of one another (eye drifts up at rest) - due to 4th nerve palsy

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64
Q

foramina of trochlear nerve

A

superior orbital fissure

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64
Q

what type of nerve is CNIV?

A

motor

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65
Q

role of CNV - trigeminal

A

carry somatic sensory afferent neurons that provide sensations to the face, teeth, mouth (anteriorly), cornea, nasal cavity and dura mater of cranial activity.

smaller motor component, innervating muscles of mastication and four other muscles of the head and neck

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66
Q

how many trigeminal branches are there?

A

3

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66
Q

3 trigeminal branches

A

ophthalmic (CNV1)
Maxillary (CNV2)
mandibular (CNV3)

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67
Q

trigeminal branch 1 name

A

ophthalmic

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68
Q

trigeminal branch 2 name

A

maxillary

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69
Q

trigeminal branch 3 name

A

mandibular

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70
Q

role of trigeminal branch 1

A

sensation to cornea, nose, forehead

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71
Q

role of trigeminal branch 2

A

sensation to lower nasal passages, cheeks, upper lip

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72
Q

role of trigeminal branch 3

A

sensation to chin, lower lip, anterior jaw, muscles of mastication and touch to anterior 2/3 of tongue

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73
Q

foramina of CNV1

A

superior orbital fissure

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74
Q

foramina of CNV2

A

foramen rotundum and then inferior orbital fissure

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75
Q

foramina of CNV3

A

foramen ovale

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76
Q

damage to trigeminal nerve

A

sensory loss - paraesthesia
(depending on which branch is irritated)

neuropathic pain in one or more branches - trigeminal neuralgia

77
Q

what type of nerve is CNV?

78
Q

clincial relevance of CNV

A

facial neuralgia

79
Q

role of CNVI

A

motor innervation of the lateral rectus (extraocular muscle of the eye) (abducts the eye)

lateral gaze

80
Q

what muscle abducts the eye?

A

lateral rectus

81
Q

motor innervation of the lateral rectus

82
Q

Where does the abducens nerve emerge and travel?

A

emerges from the ventral pons and passes through the cavernous sinus, leaving the skull through the superior orbital fissure

83
Q

palsy of CNVI

A

eye drifts medially at rest (towards nose)

experienced as horizontal diplopia (double vision)

84
Q

horizontal diplopia

A

double vision with duplicated images side by side

85
Q

what type of nerve is CNVI?

86
Q

foramina of CNVI

A

superior orbital fissue

87
Q

clinical relevance of CNVI

A

unable to gaze laterally
horizontal diplopia

88
Q

what are cranial nerve nuclei

A

collections of neuronal cell bodies of the corresponding nerves

89
Q

where are the cranial nerve nuclei

90
Q

where are the nuclei for CNI?

A

above the midbrain - doesn’t have a nucleus but has multiple nerves projecting to the olfactory bulb and synapse in forebrain

91
Q

where are the nuclei for CNII?

A

above the midbrain - lateral geniculate nucleus (LGN) of the thalamus

92
Q

where are the nuclei for CNIII?

93
Q

where are the nuclei for CNIV?

94
Q

where are the nuclei for CNV?

A

pons - 4 trigeminal nuclei (2 in pons which are the principle sensory and motor and then the mesencephalic sensory is in the midbrain and the spinal sensory is in the medulla).

95
Q

where are the nuclei for CNVI?

96
Q

where are the nuclei for CNVII?

A

motor nucleus in the pontine segment - pons

97
Q

where are the nuclei for CNVIII?

A

two parts - vestibular nucleus in pons and medulla and cochlear nucleus in pontine-medullary junction

98
Q

where are the nuclei for CNIX?

A

solitary nucleus (inferior pons but mostly medulla) for special sense of taste

99
Q

where are the nuclei for CNX?

A

four nuclei all in medulla including the vagus nucleus, nucleus ambiguous nd solitary nucleus

100
Q

where are the nuclei for CNXI?

A

medulla - nucleus ambiguous for cranial component and nuclei in cervical spinal cord for spinal part.

101
Q

where are the nuclei for CNXII

102
Q

solitary nucleus role

A

sensory nucleus serving CNVII, CNIX, CNX

special sense of taste

chemoreceptors and mechanoreceptors from the carotid body, carotid sinus, aortic bodies, and SA node of the heart.

103
Q

nucleus ambiguus role

A

motor nucleus serving CNIX and CNX

motor to ipsilateral muscles of the soft palate, pharynx and larynx involving in speech and swallowing

cranial part of the accessory nerve

104
Q

blood supply to the pons

A

basilar artery runs over pons

pontine arteries run off of basilar artery and into pons

105
Q

damage to pons consequences

A

impairment to eyes, movements, etc

106
Q

locked in syndrome

A

blocking of basilar artery

cannot consciously or voluntary speak or make facial expression, make body movements below eyes, chew or swallow

can move eyes vertically but not laterally, blink, hear, think, and reason, have sleep and wake cycles, etc

107
Q

role of the medullary olive

A

inferior olivary nucleus either side of pyramids

movement regulation, sound location, etc

spiral shape

108
Q

test for CNI

A

sniffing sticks

109
Q

test for CNII

A

Snellen chart, pen torch
○ Accommodation reflex (convergence, constriction, contraction)

110
Q

test for CNIII

111
Q

test for CNV

A

brush face with cotton wool, clench teeth and check muscles of mastication, brush cotton wool on the cornea and check for blinking

112
Q

corpora quadrigemina

A
  • 2 superior colliculi: allow you to track something across your vision, reflexive action of looking at a flash etc. (abducens nerve), hand-eye coordination and saccades
    • 2 inferior colliculi: sound localisation and integration
113
Q

cranial palsy of abducens nerve

A
  • Paralysed lateral rectus
    • Other muscles unopposed
    • Eye turned in when trying to look straight
    • Horizontal double vision
114
Q

cranial nerve palsy of trochlear nerve

A
  • Vertical diplopia
    • Pupil drifts upwards
115
Q

cranial nerve palsy of oculomotor nerve

A
  • Unopposed action of other muscles
    • The eye looks down and out
    • Dilated pupil unopposed sympathetic supply (consensual reflex in opposite eye is intact
    • Unable to turn eye up, in or further out
    • Ptosis of eyelid is most obvious sign
116
Q

role of CNVII

A

innervating muscles of facial expression

parasympathetic supply to the glands of the face - lacrimal and salivary

taste from anterior 2/3 of tongue

117
Q

where does CNVII leave the brainstem and where does it pass?

A

leaves the pons (pontomedullary junction) passing into temporal bone via the internal acoustic meatus.

meanders through inner and middle ear in facial canal giving off branches.

leaves temporal bone via the stylomastoid foramen running through the parotid to give of final motor branches to facial muscles

118
Q

intratemporal branches of facial nerve

A

greater petrosal nerve
chorda tympani
nerve to stapedius

119
Q

greater petrosal nerve

A

intratemporal branch of facial nerve

parasympathetic innervation of lacrimal glands and glands of nasal mucosa

120
Q

chorda tympani

A

carries special sensory afferents of taste from anterior 2/3 of tongue

parasympathetic fibres to sublingual and submandibular salivary glands

121
Q

nerve to stapedius

A

motor innervation to stapedius muscle which dampens vibrations transmitted through ossicles during a loud sound (protective to noise damage od the cochlea)

122
Q

motor branches of the facial nerve

A

temporal
zygomatic
buccal
marginal mandibular
cervical

123
Q

where do the 5 branches of the facial nerve split?

A

parotid plexus - as the facial nerve passes through the parotid gland

124
Q

common facial nerve palsy

A

bells palsy

125
Q

Bell’s palsy

A

most common type of facial palsy caused by viral infection

LMN palsy resulting in loss of lacrimation, hyperacusis and facial weakness involving all motor branches

126
Q

where are LMN found?

A

below the facial nerve nucleus (inside the cranial nerve)

below the pons

127
Q

where are UMN found?

A

above the pons (facial nerve nucleus), projecting from the primary motor cortex (precentral gyrus) to the facial nerve nucleus.

128
Q

where are UMN lesions found?

A

brain or brainstem above the facial nerve nucleus

129
Q

example of UMN lesion condition

130
Q

is stroke UMN or LMN lesion?

131
Q

which motor branch of facial nerve is the focus for identifying an UMN or LMN injury and why?

A

temporal - only motor branch of the facial nerve to receive bicortical representation (both primary motor cortices provide neurones)

132
Q

only partial facial weakness represents what?

A

lesion above the facial nerve nucleus - UMN injury

133
Q

why is there only partial facial weakenss in one-sided UMN injury?

A

temporal branch of effected facial nerve will still receive motor innervation from unaffected cerebral hemisphere

134
Q

where is damage in LMN palsy?

A

after the facial nerve nucleus

135
Q

result of LMN palsy

A

whole face is weak as hemispheres have already crossed over

136
Q

paralysis of facial muscles effect on eyes

A

dry eyes are damage to the supply of lachrymal glands, but watery eyes are more common as a patient are unable to close their eyes so the windscreen wiper motion of blinking doesn’t happen

137
Q

explain what happens if a patient has a stroke on the left side of the brain

A

If a patient has a stroke on the left side of the brain the right side of the face will be weak
- As left-sided strokes damage the UMN in the left side of the brain stopping signals reaching the LMN innervating the right side of the face
- Right sided UMN are still able to innervate the right side of the face so despite facial weakness on the right side, they can still raise their eyebrows on the weak side
- UMN facial palsy

138
Q

what type of lesion if they can raise their eyebrows

A

UMN - e.g. stroke

139
Q

what type of lesion if they can’t raise their eyebrows

140
Q

explain the effect of right-sided UMN lesion

A
  • Right side of the face is mostly innervated by the left side of the brain
    • Going to effect the cortex, taking out the fibres as they cross over
    • But the temporal branch of the facial nerve on the right side of the brain will still innervate the right side of the face and therefore not the whole side will be effected
      ○ The forehead/eyebrow (temporal) region will remain unaffected.
141
Q

explain the effect of right-sided LMN lesion

A
  • Whole face effected including the eyebrows and forehead
    • Injury after the brainstem (in the LMN) so all innervations will be effected so the whole side of the face will be effected.
142
Q

what type of nerve is CNVII

143
Q

foramina for CNVII

A

internal acoustic meatus (IAM)

144
Q

clinical relevance of CNVII

A

bell’s palsy

145
Q

role of CNVIII

A

special sensory info about balance, acceleration, gravity and hearing

146
Q

hearing is which branch of CNVIII?

147
Q

balance is which branch of CNVIII?

A

vestibular

148
Q

CNVIII nerves pass through and travel to where?

A

internal acoustic meatus along with facial nerve and travel to petrous part of temporal bone where inner and middle ear are

reappears inside the cranial cavity and travels to auditory centres within brain

149
Q

damage to CNVIII can cause what?

A

vertigo
sensorineural hearing loss

150
Q

vestibular nerve of CNVIII

A

sensory info about movement
Scarpa’s (vestibular) ganglion in IAM
bipolar neurons here

151
Q

cochlear nerve of CNVIII

A

bipolar neurons
spiral ganglion
central processes form the cochlear nerve
bigger than vestibular nerve

152
Q

tests for CNVIII

A

tuning forks (Weber’s and Rinne’s tests)
balance tests

153
Q

what type of nerve is CNVIII?

154
Q

foramina of CNVIII

A

internal acoustic meatus (IAM)

155
Q

clinical relevance of CNVIII

A

hearing loss
vertigo

156
Q

role of CNIX

A

sensation and taste from posterior 1/3 of tongue and pharynx

innervates the parotid gland - parasympathetic

Sensory innervation: eustachian tube, middle ear, tonsils, soft palate, posterior tongue (last 3 are GAG reflex).

Carotid sinus/body: visceral sensory receptors monitor BP.

Motor to stylopharyngeus muscle as runs past styloid process

157
Q

where does CNIX emerge and travel?

A

emerges from medulla and passes through jugular foramen

158
Q

tests for CNIX

A
  • Test back of tongue by getting patient to say ahhhh and looking at the soft palate
    ○ Soft palate should raise symmetrically
    § Failure for soft palate to rise suggests a pathology on that side
    • Test cough and swallow
159
Q

nuclei of CNIX

A

solitary nucleus
spinal trigeminal nucleus
nucleus amibuus
inferior salivary nucleus

160
Q

neuralgia of CNIX

A

§ Pain will be localised in the posterior tongue and walls of the pharynx
§ Can be triggered by swallowing or speaking
§ Treat by severing the spinal trigeminal tract

161
Q

what type of nerve is CNIX?

162
Q

foramen of CNIX

A

jugular foramen

163
Q

clinical relevance of CNIX

A

dysphagia - difficulty swallowing

164
Q

longest cranial nerve and its route

A

CNX - vagus
runs from medulla to GI tract

165
Q

role of CNX

A

general sensation - larynx, EAM, baroreceptors and chemoreceptors around aortic arch

motor - muscles of soft palate, larynx and pharynx for swallowing, phonation (speech)

parasympathetic - thoracic and abdominal viscera (heart, lungs, GI tract)

special sense of taste - epiglottis

166
Q

where does CNX leave and travel?

A

leaves medulla and transverses the jugular foramen following the route of the internal jugular vein and internal carotid vessels inferiorly.

deep in the neck in a connective tissue tube of fascia called a carotid sheath

167
Q

what type of nerve is CNX?

168
Q

foramina of CNX

A

jugular foramen

169
Q

clinical relevance of CNX

A

dysphonia - speech impaired

170
Q

tests for CNX

A

test back of tongue by getting patient to say ahhhh and looking at the soft palate
○ Soft palate should raise symmetrically
§ Failure for soft palate to rise suggests a pathology on that side
- Test cough and swallow

Can also test the vagus nerve by:
- Testing speech:

171
Q

role of CNXI

A

carries somatic motor innervation to the sternocleidomastoid and trapezius muscles

172
Q

where does CNXI receive rootlets from and where do they go?

A

5 superior cervical segments of spinal cord

they ascend into the cranial cavity through foramen magnum and join neurons exiting the medulla which exits skull via jugular foramen

173
Q

damage to CNXI

A

unilateral damage causes weakness of muscles (winged scapula)

unable to shrug shoulders

174
Q

tests for CNXI

A

shrug shoulders

175
Q

where on medulla is CNXI?

A

posterior to olive

176
Q

what type of nerve is CNXI?

177
Q

foramen for CNXI

A

in through foramen magnum and out through jugular foramen

178
Q

clinical relevance of CNXI

A

winged scapula
inability to shrug shoulders

179
Q

role of CNXII

A

motor innervation to all intrinsic and extrinsic tongue muscles

180
Q

where does CNXII leave and go?

A

leaves ventral medulla and passes through Hypoglossal canal of occipital bone

181
Q

result of damage to CNXII

A

tongue muscle paralysis

182
Q

evidence of LMN palsy in CNXII

A

fasciculations and muscle atrophy

Deviates towards the injury (LMN) (UMN injury indicated by the tongue doing the opposite)

183
Q

tests for CNXII

A
  • Test for nerve weakness by asking patient to protrude their tongue (stick tongue out)
184
Q

why is spicy food spicy?

A

Hot and spicy foods taste hot because of capsaicin (active component of chilli peppers)
- Triggers temperature receptors in tongue (actually a general sensation of heat/temperature - temperature receptors are normally triggered at 42 degrees)
○ Carried by trigeminal nerve as general

185
Q

what type of nerve is CNXII?

186
Q

foramina for CNXII

A

hypoglossal canal

187
Q

clinical relevance of CNXII

A

hemiparalysis of the tongue

tongue deviates towards the damaged side

188
Q

which cranial nerves are sensory

189
Q

which cranial nerves are motor

190
Q

which nerves are mixed

191
Q

cribiform plate is foramina for which nerve

192
Q

optic canal is foramina for which nerve

193
Q

superior orbital fissure is foramina for which nerves

194
Q

superior orbital fissue, foramen rotundum and foramen ovale are the foramina for which nerve

195
Q

foramen rotundum is foramen for which nerve

196
Q

foramen ovale is foramina for which nerve

197
Q

IAM is foramina for which nerves

198
Q

jugular foramen is foramina for which nerves

199
Q

hypoglossal canal is foramen for which nerve

200
Q

foramen magnum is for which nerve

Neuroanatomy (7 decks)

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