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Systems Review > Cranial nerves > Flashcards

Cranial nerves Flashcards

1
Q

3 parts of brainstem?

A

midbrain, pons, medulla

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2
Q

example of disease in which lesion is in the brainstem?

A

MS- may also affect optic tract

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3
Q

example of disease in which lesion at NMJ?

A

myasthenia gravis: AI destruction of end-plate ACh receptors by autoantibodies

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4
Q

what can be given to treat myasthenia gravis?

A

AChesterase inhibitors e.g. neostigmine- more ACh around to bind to end-plate receptors so less likely that autoantibodies will bind so less receptors destroyed

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5
Q

how is 1st cranial nerve tested for?

A

ask patient if they have noticed any changes in their sense of smell, can test ability of each nostril to distinguish smells e.g. peppermint- left nostril supplied by L olfactory nerve, R by R nerve, but patient may think that they can smell fine if sense of smell only lost from inside 1 nostril

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6
Q

how is 2nd cranial nerve tested for?

A

visual acuity: snellen chart, test each eye separately
visual fields: movement of finger from side
pupils: size, shape, symmetry, pupillary response to light- sensory limb= optic nerve, motor limb= oculomotor, and accomodation reflex
opthalmoscopy- view optic disc- pale or swollen- papilloedema?

remember to check if patient normally wears glasses, can ask to put these on if so.

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7
Q

how are 3rd, 4th and 6th cranial nerve tested for?

A

eye movements- H shape with finger

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8
Q

characteristics of oculomotor nerve palsy?

A

down and out eye, dilated pupil (mydriasis), ptosis (full), loss of accomodation reflex, loss of pupillary reflex

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9
Q

common infection of the trigeminal nerve and how does this occur?

A

Shingles- herpes-zoster infection
Reactivation of the latent varicella-zoster virus in dorsal root ganglia, possible as a result of a compromised IS e.g. on corticosteroids. Virus causes chickenpox, and then remains latent in the body located in the dorsal root ganglion= location of cell body of 1st order afferent neurones in acsedning tracts of somatosensory system.

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10
Q

causes of space occupying lesions (SOLs)?

A 
tumour
abscess
aneurysm
cyst
chronic SD haematoma
granuloma
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11
Q

signs of SOLs?

A 
headaches- worse on walking and lying down
vomiting
seizures
irritability
papilloedema
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12
Q

functions of frontal lobe?

A

memory

voluntary movements

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13
Q

functions of parietal lobe?

A

speech

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14
Q

functions of temporal lobe?

A

sound awareness

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15
Q

functions of occipital lobe?

A

interpretation of visual stimuli

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16
Q

clinical presentation of SOL in frontal lobe?

A

hemiparesis
dysphasia
personality change

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17
Q

what is guillain barre syndrome?

A

IS attack on part of peripheral nervous system

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18
Q

pathophysiology of Parkinson’s?

A

degeneration of dopaminergic neurones in substantia nigra pars compacta

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19
Q

3 cardinal signs of Parkinson’s disease?

A

resting tremor
bradykinesis
muscular rigidity

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20
Q

causes of bilateral hemianopia?

A

optic chiasm compression e.g. pituitary adenoma and ICA aneurysm

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21
Q

what is a homonymous hemianopia and what are its causes?

A

1/2 of visual field lost in each eye which is contralateral to the side of lesion. Lesions lie beyond chiasm in tracts, radiation, or occipital cortex e.g. stoke, tumour, abscess

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22
Q

causes of nystagmus?

A

involuntary eye oscillations, often jerky.
vestibular lesion- acute- nystagmus away from lesion, chronic=towards
cerebellar lesion- if unilateral, nystagmus is towards affected side
MS
up and down nystagmus- maybe midbrain lesion

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23
Q

causes of optic neuritis?

A

pain on movement of eye, loss of central vision
demyelination e.g. MS
syphilis- can also cause poster column degenerative changes, leading to loss of fine touch and conscious proprioception- causes +ve Romberg sign and sensory ataxia.

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24
Q

causes of papilloedema (swollen optic disc)

A

tumour
abscess
hydrocephalus
idiopathic IC hypertension

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25
Q

how might the oculomotor nerve be compressed alone?

A 
uncal herniation (part of parahippocampal gyrus)
also tumour, and aneurysm of posterior communicating artery
along with other nerves e.g. abducens and trochlear- could be cavernous sinus thrombosis and superior orbital fissure lesion.
26
Q

which side of the brain is dominant in most people?

A

left, * write with right hand

so Broca’s area and Wernicke’s area for speech usually on L side of brain. visual fields affected?

27
Q

how can mild ptosis in horner’s syndrome be overcome by patient?

A

if patient looks up

28
Q

what ptosis generally occurs with myasthenia gravis?

A

bilateral partial ptosis

* contrast to unilateral full ptosis with oculomotor nerve lesion, and unilateral partial ptosis with Horner’s syndrome.

29
Q

causes of conductive hearing loss?

A 
otitis externa
acute otitis media
chronic otitis media with effusion
foreign body
ruptured TM
otosclerosis
cholesteatoma
30
Q

causes of sensori-neural hearing loss?

A

meniere’s disease
vestibular schwanoma
damage to hair cells by loud noises
hair cell death by ototoxic drugs e.g. gentamicin and furosemide

31
Q

what am I looking for on general inspection of pateint?

A

pain/discomfort
facial asymmetry
loss of expression
muscle wasting

32
Q

what might patient with trochlear nerve palsy complain of?

A

diplopia (double vision) on looking down and in, often noticed on descending stairs, head tilting compensates for this- head tilted away from side where superior oblique affected.

33
Q

resting gaze of someone with trochlear nerve palsy?

A

eye slightly elevated

SO normally causes depression when the eye is adducted

34
Q

patient has +ve weber’s test in right ear, and +ve rinne’s tests in both ears, what type of hearing loss?

A

left ear sensorineural hearing loss

35
Q

a patient has right ear conductive hearing loss, what would their results be with weber’s and rinne’s?

A 
weber's= sound heard loudest in right ear
rinne's= rinne +ve in left ear, and rinne -ve in right ear= sound heard loudest when tuning fork placed on mastoid process compared to when placed just in front of the EAM.
36
Q

resting gaze of someone with abducens nerve palsy?

A

slightly adducted

37
Q

functions of superior oblique muscle?

A

intorsion of eye when abducted, depression of eye when adducted

38
Q

functions of inferior oblique muscle?

A

extorsion of eye when abducted, elevation of eye when adducted

39
Q

functions of superior rectus muscle?

A

elevation of eye when abducted, intorsion of eye when adducted

40
Q

functions of inferior rectus muscle?

A

depression of eye when abducted, extorsion of eye when adducted

41
Q

problem patient may complain of if abducens nerve palsy?

A

horizontal double vision (diplopia) when looking outwards

42
Q

if damage to trigeminal nerve, what would happen when patient asked to open their mouth?

A

jaw would deviate towards side of lesion

43
Q

on asking ptnt to say ‘aaahh’ what would happen to the uvula if lesion of the left vagus nerve?

A

palate pulled to normal side, so the right.

44
Q

causes of olfactory nerve lesions?

A

frontal love tumour
meningitis
respiratory tract infection, common cold
trauma e.g. fracture of cribiform plate of ethmoid bone- would also expect CSF rhinorrhoea

smell loss= anosmia

45
Q

causes of monocular blindness?

A

lesion of 1 eye or optic nerve e.g. MS, giant cell arteritis

46
Q

causes of bilateral blindness?

A

neurosyphillis

47
Q

causes of optic atrophy (pale optic discs and reduced acuity)?

A

MS

frontal tumours

48
Q

cause of oculomotor nerve palsy without dilated pupil?

A

diabetes mellitus

hypertension

49
Q

cause of oculomotor nerve palsy with down+out eye, ptosis AND dilated pupil?

A

tumour

posterior communicating artery from ICA (anterior circulation to brain) aneurysm

50
Q

causes of damage to just trochlear or abducens nerve alone?

A 
trochlear= trauma to orbit
abducens= MS, pontine stroke
51
Q

what may cause sensory loss in face?

A

herpes zoster

nasopharyngeal cancer

52
Q

cause of LMN lesion of facial nerve?

A

bell’s palsy
skull fracture
infection e.g. herpes zoster
acoustic neuroma

53
Q

causes of UMN lesion of facial nerve?

A

stroke

tumour

54
Q

causes of glossopharyngeal, vagus and hypoglossal nerve individual damage?

A

neck tumours
trauma
brainstem lesions

55
Q

causes of accessory nerve damage?

A

trauma
tumour
stroke
polio

56
Q

cause of damage to both IX,X and XI cranial nerves?

A

jugular foramen lesion

57
Q

what features of parkinson’s disease might you see on a patient when doing a cranial nerve examination?

A

lack of facial expression

as muscles in face become rigid*

58
Q

causes of optic neuritis?

A

multiple sclerosis

drugs e.g. isoniazid

59
Q

motor component of glossopharyngeal nerve?

A

supplies stylopharyngeus muscle= elevates pharynx during swallowing and speech

60
Q

skeletal muscles innervated by vagus nerve?

A 
cricothyroid
intrinsic laryngeal muscles
palatopharyngeus
salpingopharyngeus
3 constrictors of the pharynx

Systems Review (8 decks)

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