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N - C > Cranial nerves > Flashcards

Cranial nerves Flashcards

1
Q

Which cranial nerves provide the special senses?

A

Olfaction (I)
Vision (II)
Taste (VII, IX and X)
Hearing and balance (VIII)

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2
Q

Which cranial nerves are general sensory?

A

Mainly V (Trigeminal) but some input to area around ear from the VII (Facial) and IX (glossopharyngeal)

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3
Q

Which cranial nerves have autonomic functions?

A 
III (Pupillary costriction)
VII (Lacrimation
VII (Submandibular and sublingual)
IX (Parotid)
X (input to organs in thorax and abdomen)
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4
Q

What do you test in Olfactory (I) palsy?

A

Senso of smell

  • Unilateral loss
  • Bilaterall loss
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5
Q

What do you test in Optic (II) nerve palsy?

A

Visual acuity
Visual fields
Pupilary reactions
Fundoscopy

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6
Q

What do we test in Oculomotor (III), Trochlear (IV) and Abducens (VI) nerve palsy?

A 
Any evidence of ptosis?
Pupil of equal size?
Pupillary reactions?
Eye movements
-Vertical and horizontal
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7
Q

What do we test in trigeminal (V) nerve palsy?

A
  • Sensation in the ophthalmic, maxillary and mandibular divisions
  • Power in the muscles of mastication
  • Corneal reflex
  • Jaw jerk
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8
Q

What do we test in facial (VII) nerve palsy?

A

Muscles of facial expression
Corneal reflex
(Taste)

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9
Q

What do we test in vestibulococlear (VIII) nerve palsy?

A

Hearing using Rinne’s and Weber’s tests

Vestibular function using Hallpike-Dix manoeuvre and Untenberger’s test

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10
Q

What do you test in Glossopharyngeal (IX) and Vagus (X) nerve palsy?

A

Movement of the palate
Gag reflex
(quality of speech)
(quality of cough)

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11
Q

What do you test in Accessory (XI) nerve palsy?

A

Head turning and shoulder shrugging (sternocleidomastoid and trapezius function)

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12
Q

What do you test for in Hypoglossal (XII) nerve palsy?

A

Appearance and movement of tongue

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13
Q

What cranial nerves are involved in the Pupillary light reaction?

A 
Afferent = II
Efferent = III
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14
Q

What cranial nerves are involved in the corneal reflex (blink reflex)?

A 
Afferent = V
Efferent = VII
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15
Q

What cranial nerve is involved in teh Jaw jerk?

A

Afferent and Efferent = V

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16
Q

What cranial nerves are involved in the Gag reflex?

A 
Afferent = IX
Efferent = X
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17
Q

Where do the nuclei of cranial nerves III and IV lie?

A

Midbrain

18
Q

Where do the nuclei of cranial nerves V, VI and VII lie?

A

Pons

19
Q

Where do the nuclei for the VIII cranial nerve lie?

A

Pontomedullary junction

20
Q

Where do the cranial nerve nuclei for IX, X, XI and XII lie?

A

Medulla

21
Q

Where can cranial nerves be damaged?

A

Within the brain (e.g. by ischaemia, tumour)

Crossing the sub-arachnoid space (e.g. by meningitis)

Outside the skull (e.g. by base of skull tumours arising in nasopharynx)

22
Q

Bilateral III palsy indicates a problem where?

A

Midbrain

23
Q

III + IV + VI palsy indicates a problem where

A

Superior orbital fissure

24
Q

VI + VII palsy indicates a problem where?

A

Pons

25
Q

V and VIII palsy indicates a problem where?

A

Cerebellopontine angle

26
Q

Unusual combinations of cranial nerve palsy may indicate what?

A

? chronic or malignant meningitis

27
Q

Pure motor signs indicates what?

A

?Myasthenia

28
Q

What is Optic neuritis?

A
  • Demyelination within the optic nerve
  • Monocular visual loss
  • Pain on eye movement
  • Reduced visual acuity
  • Reduced colour vision
  • Optic disc may be swollen
  • Often associated with MS
29
Q

Describe parasympathetic input into pupillary responses

A

Parasympathetic input leads to constriction of the pupil:

-Loss os parasympathetic input results in a fixed, dilated pupil (e.g. complete third nerve palsy)

30
Q

Describe the sympathetic input into pupillary responses

A

Sympathetic input leads to pupillary dilatation:

-Damage anywhere within the sympathetic pathway can lead to a constricted pupil

31
Q

What are the causes of dilated pupils?

A
  • Youth
  • Dim lighting
  • Anxiety, excitement
  • “Mydriatic” eye drops
  • Amphetamine, cocaine overdose
  • Third nerve palsy
  • Brain death
32
Q

What are the causes of constricted pupils?

A 
Old age
Bright light
"Miotic" eye drops
Opiate overdose
Horner's syndrome
33
Q

What are the causes of isolated third nerve palsy?

A

Microvascular:
-Diabetes
-Hypertension
(Pailess, pupil spared)

Compressive:
-Posterior communicating artery aneurysm
-Raised ICP
(Painful, pupil affected)

34
Q

What are the causes of isolated 6th nerve palsy?

A

Numerous causes including:

  • Idiopathic
  • Diabetes
  • Meningitis
  • Raised ICP
35
Q

What are the causes of nystagmus?

A
  • Congenital
  • Secondary to serious visual impairment
  • Secondary to peripheral vestibular problem
  • Secondary to central vestibular/ brainstem disease
  • Secondary to cerebellar disease
36
Q

What is trigeminal neuralgia?

A

Paroxysmal attacks of lancinating pain

Triggers

Middle age and older

Usual cause is vascular loop compressing the 5th nerve in the posterior fossa

Treated medically with carbamazepine

Surgical options if severe

37
Q

What is Bell’s Palsy?

A

Unilateral facial weakness

Lower motor neurone type

Often preceded by pain behind ear

Eye closure affected

Risk of corneal damage

Treated with steroids

Usually good recovery

38
Q

Describe Vestibular Neuronitis

A

Sudden onset

Disabling vertigo

Vomiting

Gradual recovery

Cause uncertain

39
Q

Describe Dysarthria

A

Disordered articulation

Slurring of speech

40
Q

Describe dysphagia

A

Difficulty swallowing

Both occur in bulbar and pseudo bulbar palsy

Bulbar = lower motor neurone

Pseudobulbar = upper motor neurone

41
Q

What is pseudobulbar palsy?

A

Bilateral UMN lesions (e.g. in vascular lesions of both internal capsules, MND)

  • Dysarthria
  • Dysphonia
  • Dysphagia
  • Spastic, ommobile tongue
  • Brisk jaw jerk
  • Brisk gag reflex
42
Q

What is bulbar palsy?

A

Bilateral LMN lesions affecting IX-XIII

Causes include MND, polio, tumours, vascular lesions of the medulla and syphilis

  • Wasted, fasciculating tongue
  • Dysarthria
  • Dysphonia
  • Dysphagia

BEWARE OF FEEDING THESE PATIENTS

N - C (35 decks)

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