Cranial Nerves 21% Flashcards
Sensory:
- Smell (coffee, mint) is tested one nostril at a time with eyes closed
Olfactory (I)
Lost sense of smell (CN I)
Anosmia
Distorted sense of smell (CN I)
Parosmia
Sensory:
- Vision is tested with Snellen Chart for visual acuity, visual fields (peripheral vision)
Optic (II)
Direct Light Reflex CN
CN II Optic & III Oculomotor
Indirect (consensual) Light Reflex CN
CN II Optic & III Oculomotor
Eyes converge, pupils constrict & lens convexity (CN II)
Accommodation
What cranial nerves are tested together with the Six Cardinal Fields of Gaze?
CN III Oculomotor, IV Trohlear, VI Abducens
LR6, SO4, O3
Motor:
Levator Palpebrae, Inferior Oblique, Superior, Medial and Inferior Rectus
Oculomotor (III)
Parasympathetic: Ciliary muscles (lens shape) and constrictor papillae
Oculomotor (III)
Which CN:
- Direct Light Reflex
- Indirect Light Reflex
- Accommodation
CN II Optic & III Oculomotor
Deviation of one or both eyes
Strabismus
Eyelids droop due to weakness or paralysis of levator palpebrae
Ptosis
Motor:
Superior Oblique muscle (down, in)
Ex: look at the tip of your nose
Trochlear (IV)
Sensory:
To Face (V1-3)
Touch forehead, cheekbone & chin with cotton wisp
Trigeminal (V)
Corneal Reflex
- What CN is for afferent & which is efferent?
Touch cornea with cotton wisp, both eyes blink or tear normally
TQ
CN V (Trigeminal) is afferent (sensory) CN VII (Facial) is efferent (motor)
Jaw Jerk Reflex CN?
The mandible is tapped with hammer and jaw draws upward
CN V Trigeminal
Oculocardiac Reflex CN for afferent & efferent?
Press on eye and heart rate decreases
CN V Trigeminal is afferent (sensory)
CN X Vagus is efferent (motor)
General sensation to the anterior 2/3 of the tongue (sensory)
TQ
CN V Trigeminal
Motor:
Muscles of Mastication
TQ
Trigeminal (V)
Extreme, sporadic, sudden burning or shock-like face pain that lasts anywhere from a few seconds to as long as 2 minutes per episode. Lightening like, excruciating pain is repetitive, occurring several times per day. Pain is typically felt on one side of the jaw or cheek.
Tic Douloureaux aka Trigeminal Neuralgia
CN V Trigeminal
Motor:
to Lateral Rectus Muscle
TQ
Abducens (VI)
Sensory:
Taste - anterior 2/3 of tongue
(sweet, sour, salty)
Facial (VII)
Motor:
Muscles of facial expression
Facial (VII)
Unilateral facial paralysis caused by trauma, virus, or immune mediated response and is not permanent. Initial pain behind ipsilateral ear, twitching, weakness or paralysis, drooping eyelid, drooping corner of mouth, drooling, dry eye & impairment of taste.
TQ
Bell’s Palsy
Facial VII CN
What is the difference between Bell’s Palsy and Stroke?
Bells: Ipsilateral Motor loss of entire face & forehead does NOT wrinkle
Stroke: contralateral motor loss below eye & forehead does wrinkle
Sensory:
Balance, Mittelemeyer, Barany Caloric Test, Rombergs
VIII. Vestibulocochlear - Vestibular part
Sensory:
Hearing, Weber, Rinne, Whisper, Auditory Acuity/Watch
TQ
VIII. Vestibulocochlear - Cochlear part
Cause is unknown, but probably results from an abnormality in the fluids of the inner ear. Symptoms are episodic rotational vertigo, hearing loss, & tinnitus.
Meniere’s Disease
aka Endolymphatic Hydrops
VIII. Vestibulocochlear CN
Sensory (Afferent):
- Gag (Pharyngeal) Reflex
- Uvula Reflex
- Carotid Reflex: massage carotids and heart rate drops
- Taste to posterior 1/3 of tongue (bitter)
TQ
IX. Glossopharyngeal
Motor:
Stylopharyngeus muscle elevates pharynx & larynx; dilates pharynx to permit swallowing
IX. Glossopharyngeal
Sensory:
Epiglottis & laryngeal muscles of swallowing (palate, pharynx, contracting muscles)
X. Vagus
Motor (efferent):
- Gag Reflex
- Uvular Reflex
- Carotid Reflex
TQ
X. Vagus
Uvular Reflex: palate and uvula deviate to the _____ side of lesion when patient says “AHHHH”
TQ
Opposite side of lesion (Vagus)
Motor:
Trapezius & SCM muscles
- Shoulder shrug against resistance
TQ
XI. Spinal Accessory
Spasm of SCM muscle?
Torticollis aka Wry Neck
XI. Spinal Accessory CN
Motor:
Tongue muscles
- Stick tongue out; tongue will deviate _____ side of lesion
- Look for atrophy & fasciculations
TQ
XII. Hypoglossal
Toward side of lesion
Involuntary motor responses to potentially harmful stimuli?
Reflexes
T/F - All reflex tests are done bilaterally with the normal side tested first.
True
Absence of any DTR, especially patellar (LMNL)
Westphal’s Sign
Brings out reflexes by cortical distraction?
Jendrassik’s Maneuver
aka Reinforcement Test
Deep Tendon Reflexes: Wexler Scale 0+ 1+ 2+ 3+ 4+ 5+
0+ Absent with reinforcement 1+ Hypoactive with no reinforcement 2+ Normal 3+ Hyperactive 4+ Hyperactive with transient clonus ~~ TQ 5+ Hyperactive with sustained clonus
DTR: Jaw Jerk
Trigeminal V
DTR: Biceps
Musculocutaneous (C5)
DTR: Brachioradialis
TQ
Radial (C6)
DTR: Triceps
TQ
Radial (C7)
DTR: Patella aka Knee Jerk
Femoral (L4)
DTR: Medial Hamstring
Sciatic (L5)
DTR: Achilles aka Ankle Jerk
Tibial (S1)
Superficial Reflexes:
Corneal - touch with cotton wisp produces blinking or tearing
V. Trigeminal (afferent)
VII. Facial (efferent)
Superficial Reflexes:
Gag/Pharyngeal - touch back of tongue with tongue blade to produce gagging
IX. Glossopharyngeal (afferent)
X. Vagus (efferent)
Superficial Reflexes:
Stroke inner thigh of male; ipsilateral rise in testes
Cremasteric (L1) Femoral Nerve (afferent) Genitofemoral Nerve (efferent)
Superficial Reflexes:
Stroke inner thigh of female; poupart’s ligament contracts
Geigel's (L1) Femoral Nerve (afferent) Genitofemoral Nerve (efferent)
Superficial Reflexes:
Stroke up sole of foot; see curling of toes & pulling away of foot
Plantar (L4-S2) Tibial Nerve (afferent & efferent)
Superficial Reflexes:
Abdominal - stroke in all 4 abdominal quadrants away from umbilicus.
Normal = umbilicus moves toward side stroked
Afferent & Efferent:
Upper T7-T9 & Lower T10-T12
Superficial Reflexes:
While observing the umbilicus, the pt does a partial sit up.
Normal = umbilicus stays midline
TQ
Beevor’s
Afferent & Efferent:
Upper T7-T9 & Lower T10-T12
Lesion of the brain and spinal cord not including the anterior horn cells
UMNL
Lesion of the anterior horn cells out to the myoneural junction
LMNL
Paralysis: UMNL? LMNL?
UMNL: Spastic
LMNL: Flaccid
Deep Tendon Reflexes: UMNL? LMNL?
UMNL: Hyperactive
LMNL: Hypoactive/Absent
Pathological Reflex: UMNL? LMNL?
UMNL: Present
LMNL: Absent
Clonus: UMNL? LMNL?
UMNL: Present
LMNL: Absent
Tone: UMNL? LMNL?
UMNL: Hypertonic
LMNL: Hypotonic
Reaction of Degeneration: UMNL? LMNL?
UMNL: Absent
LMNL: Present
Atrophy: UMNL? LMNL?
UMNL: Absent
LMNL: Present
Fasiculation: UMNL? LMNL?
UMNL: Absent
LMNL: Present
Superficial Reflexes: UMNL? LMNL?
UMNL: Absent
LMNL: Absent
Visceral Organic Reflexes:
Absent in UMNL & LMNL
Pinch neck while noting dilation of the eyes
Ciliospinal - Sensory from neck
Cervical sympathetics
Visceral Organic Reflexes:
Absent in UMNL & LMNL
Press on eye while noting the slowing of the heart by 10 bpm
Oculocardiac
V. Trigeminal
X. Vagus
Visceral Organic Reflexes:
Absent in UMNL & LMNL
Press on carotid sinus while noting the slowing of the heart & decreased pressure
Carotidcardio reflex
IX. Glossopharyngeal
X. Vagus
Which CN are sensory only?
I. Olfactory
II. Optic
VIII. Vestibulocochlear
Which CN are motor only?
III. Oculomotor IV. Trochlear VI. Abducens XI. Spinal Accessory XII. Hypoglossal
Which CN are both sensory & motor?
V. Trigeminal
VII. Facial
IX. Glossopharyngeal
X. Vagus
Pathological Reflex indicates UMNL:
Stroke up lateral aspect of foot to great toe
Babinski:
Dorsiflexion of great toe with splaying of other toes (+)