Cranial Nerves Flashcards by Lian Dimaro

List the effected nerves (in order) in a Cerebellopontine angle tumour

Corneal reflex lost first (V)
Then VII & VIII
Then rest of V
Sometimes IX & X

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What nerves are effected by Paget’s?

V, VII, VIII

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What nerves does Gradenigo’s syndrome effect?

V & VI

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Syringobulbia effects what nerves? What symptoms are each associated with?

Bulbar palsy (IX, X, &amp; XII)
VIII - vertigo and nystagmus 
V - facial pain/sensory loss
VII - sparing
May have Horner's syndrome
May have syringomyelia

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Which nerves is a sinus thrombosis associated with?

III, IV, & VI (VI most common)
V - pain (especially ophthalmic division)
Corneal Reflex may be lost (V)

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What symptoms might you see with a cavernous sinus thrombosis?

Headache, periorbital oedema, proptosis

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Causes of any cranial nerve palsy

Diabetes
Stroke
MS
Tumour
Sarcoid
SLE
Vasculitis

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Ddx unilateral ptosis

CNIII palsy
Horners syndrome
Congenital

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Ddx bilateral ptosis

Myasthenia gravis
Myotonic dystrophy
Congenital

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Features of CNIII palsy

Eye deviated ‘down and out’
Ptosis
Dilated pupil of complete

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Ddx olfactory nerve palsy

Trauma
Frontal lobe tumour
Meningitis

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Ddx optic nerve palsy - optic blindness

MS, GCA

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Ddx optic nerve palsy - bitemporal hemaniopia

pituitary tumour

Internal carotid artery aneurysm

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Ddx optic nerve palsy - homonymous hemianopia

Anything behind chiasm

Stroke / tumour/ abscess

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Ddx partial occulomotor palsy

Pupil spared - diabetes

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Ddx complete occulomotor palsy

PCA aneurysm

Raised ICP with Tentorial herniation

Ddx trochlear palsy

Single palsy rare - usually due to orbit palsy

Ddx trigeminal palsy

Idiopathic (trigeminal neuralgia)
Acoustic neuroma
Herpes zoster

Ddx abducens palsy

Skull # involving petrous temporal bone

Nasopharyngeal carcinoma

Raised ICP (false localising sign)

Ddx facial nerve palsy

LMN:

Bell’s palsy
parotid tumour
herpes zoster (Ramsey Hunt)
Sarcoid (often bilateral)

UMN:
- stroke / tumour

Ddx vestibulocochlear palsy

Excessive noise levels

Ménière’s disease

Furosemide

Amino glycoside antibiotics (gentamicin)

Ddx IX, X, XII - lower motor lesion (bulbar palsy)

MND
diphtheria 
Polio
Guillain-Barré syndrome
Syringobulbia

Ddx IX, X, XII - UMN lesion (pseudobulbar palsy)

Motor neurone disease
Bilateral strokes
MS

Causes of groups cranial nerve palsies

Cerebellopontine angle tumour (acoustic neuroma or meningioma)
Paget’s disease of bone (bony impingement on nerves)
Gradenigo’s syndrome (complication of otitis media)
Syringobulbia
Cavernous sinus thrombosis

Ddx opthalmoplegia

Myaesthenia gravis | Cranial nerve palsy

Rinne - bone>air (left ear) | Weber - lateralises to left ear

Conductive hearing loss in left ear

Rinne - Air > bone (both ears) | Weber - lateralises to left ear

Sensorineural hearing loss in right ear

Rinne - bone > air (right ear) | Webber - lateralises to right ear

Conductive loss is right ear

Air > bone in both ears | Lateralises to right ear

Sensorineural hearing loss in left ear

Describe the features and aetiology of a bulbar palsy

Lesion - LMN Tongue appearance - flaccid, wasted, fasciculating Other features - drooling, dysphonia, tremulous lips Aetiology - MND, diphtheria, polio, Guillain-Barré syndrome, Syringobulbia

Describe the features and aetiology of a pseudobulbar palsy

Lesion - UMN Tongue appearance - spastic, contracted Other features - drooling, dysphonia, emotional lability Aetiology - MND, bilateral strokes (eg internal capsule), MS

Describe Horner's syndrome

Results from the interruption of sympathetic fibres to one eye --> unilateral pupillary constriction, slight ptosis (levator palpebrae suprioris), exophthalmos backward displacement of eye ball), loss of sweating on ipsilateral side of the face.

Causes of Horner's syndrome

Syringomyelia Involvement of the T1 root by apical lung cancer (Pancoast tumour) Lesions in the neck - trauma, surgical resection, or malignant lymph nodes

Classic signs of cerebellar lesion?

DANISH ``` Dysdiadochokinesis Ataxia (limb/trunk) Nystagmus Intention tremor Speech (slurred, staccato) Hypotonia ```

Features of cerebellar limb ataxia?

Dysmetria Past-pointing Intention tremor Dysdiadochokinesis

Ddx nystagmus

Congenital Brainstem or cerebellar problem - MS, stroke, tumour Vestibular apparatus problem - labyrinthitis, Ménière's disease, CN VIII lesion

Ddx dysarthria

Facial nerve palsy - look for facial weakness Bulbar palsy - look for flaccid wasted fasciculating tongue Pseudobulbar palsy - look for spastic contracts tongue Myasthenia gravis Cerebellar disease