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NBB2 > Cranial nerves > Flashcards

Cranial nerves Flashcards

1
Q

For corticobulbar tracts, which do not follow the conventional rule of bilateral innervation of nuclei

A

Crossed for:
-nucleus of CN 12 (hypoglossal)

-nucleus ambiguus of CN 10 - (vagus)

Ipsilateral for
-CN 11 (accessory)

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2
Q

One motor and one sensory will make synapses in the medulla.

One motor and one sensory will travel through the medulla

A
  1. Corticobulbar
  2. Dorsal column-medial meniscus

Through:

  1. Corticospinal
  2. Spinothalamic
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3
Q

Describe the different motor and sensory nuclei

Somatic
Visceral
general and special

A

GSE: skeletal muscle that originate from somites

GVE - preganglionic parasympathetics for cranial, thoracic and abdominal smooth muscle.

SVE - activates STRIATED muscles (not from embryonic somites but from embryonic branchial arches)
ex. muscle of facial expression, jaw muscles, laryngeal/pharyngeal muscles, sternocleidomastoid, trapezius
________________________________________

GSA: sensation from body surface: pain, temp, touch and pressure

GVA: reports physical or chemical features of substances or organ walls

SSA: light and sound

SVA: smell and taste

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4
Q

Hypoglossal nerve

A

GSE - ipsilateral

Function: movements of
tongue and maintains muscle tone

Innervates: *all muscles of tongue except
palatoglossus (vagus)

Innervated by:

a) corticobulbar for voluntary movements
b) reticular neurons for automatic/reflex movements like during eating

Test: stick out tongue, genioglossus - will deviate to side of lesion

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5
Q
  1. Lesion the left corticobulbar
  2. Lesion of left hypoglossal nerve

Presentation of both on protrusion of tongue?

A
  1. Tongue deviates to right
  2. Tongue deviates to left

Tongue deviates to the side where the muscle is weaker.

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6
Q

Spinal Accessory nerve (XI)

A

SVE! *

Function - moves neck and shoulder, scapula elevation and rotation
__________________________
Innervates: ipsilateral sternomastoid and trapezius
_________________________________
Visceral motor: joins vagus to control larynx

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7
Q

Lesion of Accessory presents as 2.

A
  1. Cannot rotate head to healthy side against pressure (right sterno weak, can’t turn to left)
  2. weakened voice or hoarseness
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8
Q

Vagus nerve (mixed) 5/7

A

GVE, SVE, GSA, GVA, SVA

Functions:
(SVE): swallowing, vocalization: pharyngeal muscles, laryngeal muscles
***Nucleus Ambiguus - dorsal to inferior olive

(GVE): preganglionic parasympathetics for heart, lungs, GI to splenic flexure
DORSAL MOTOR NUCLEUS OF X
_____________________________________
GSA - touch pain and temp from small part of ear, meninges of posterior fossa, pharynx + larynx
***SPINAL TRIGEMINAL NUCLEUS

_________________________________
SVA - taste from epiglottis and pharynx
**ROSTRAL: taste

GVA-chemoreceptors and baroreceptors of aortic arch, visceral signals from thoracic and abdominal viscera

  • *CAUDAL
  • **both are NUCLEUS SOLITARIUS
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9
Q

Left lesion of vagus nerve

A
  1. Right Uvula deviation: towards healthy side because palate rises
  2. Right vocal muscles paralysis
  3. Loss of gag reflex with glossopharyngeal (vagus is efferent control)
  4. Nasal regurgitation (during swallowing)
  5. Loss of cough reflex
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10
Q

Glossopharyngeal nerve - also 5/7 exactly like vagus

A

GVE, SVE, GSA, GVA, SVA

  1. GVE - preganglionic parasympathetic for parotid gland
    * **INFERIOR SALIVATORY NUCLEUS: found in pons not medulla
  2. SVE -stylopharyngeal muscle
    **N.ambiguus
    ______________________________________
  3. GSA
    -posterior one third of tongue
    -middle ear/tympanic membrane/eustachian tube
    -small region of external ear
    -tonsils
    -    upper pharynx (gag reflex afferent)
    unknown?
    **SPINAL TRIGEMINAL NUCLEUS

____________________________________
4. SVA: taste from posterior 1/3 of tongue

  1. GVA: chemoreceptors and baroreceptors of the CAROTID

both are **N.soltarius

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11
Q

N. ambiguus

A
  1. Vagus - SVE, swallowing and vocalization

2. Glossopharyngeal - SVE - stylopharyngeal (elevating pharynx)

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12
Q

N. Solitarius - also what does the track do?

A
  1. Vagus
    - SVA - taste from epiglottis and pharynx
    * *ROSTRAL: taste

GVA-chemoreceptors and baroreceptors of aortic arch, visceral signals from thoracic and abdominal viscera
**CAUDAL
____________________________

  1. Glossopharyngeal
    - SVA: taste from posterior 1/3 of tongue

-GVA: chemoreceptors and baroreceptors of the CAROTID
____________________________
-the tract connects to the dorsal nucleus of vagus to get the parasympathetics to influence the heart.

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13
Q

Gag reflex;

A
  1. Touch posterior oropharynx
  2. Glossopharyngeal provides afferent, sensory portion of gag reflex
  3. Afferents act on nucleus ambiguous motor neurons of Vagus
  4. Palate elevates symmetrically, pharynx constricts, larynx closes
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14
Q

Wallenberg syndrome

A

Lateral medullary syndrome - PICA

  • ipsilateral face pain and temp loss: trigeminal spinal nucleus
  • ipsilateral Horner’s syndrome: lesion of descending hypothalamic fibers (which are always lateral)
  • ipsilateral ataxia - lesion of ICP
  • taste loss: N. solitarius
  • paralysis of larynx, pharynx, palate, dysarthria (slurred speech) - nucleus ambiguus
  • loss of gag reflex - N.ambiguus & N- solitarius
  • also spinothalamic tract
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15
Q

Medial Medullary syndrome

A

Anterior spinal artery:

  1. Ipsilateral flaccid paralysis of tongue with deviation - hypoglossal
  2. Contralateral decreased position, tactile and vibration sensation: DCML
  3. Contralateral arm or leg weakness: CST
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16
Q

Facial nerve 5/7 same as all the others

A

SVE, GVE, GSA, GVA, SVA

  1. SVE - muscles of facial expression, stapedius, digastric
    * **facial nucleus
  2. GVE - parasympathetic preganglionics for lacrimal, sublingual, submandibular (all salivary except parotid)
    ***SSNucleus (Superior salivary)
    ____________________________________
  3. GSA: sensation from small region of outer ear (7,9,10)
    **SPINAL TRIGEMINAL NUCLEUS
  4. GVA: mucous membrane of nasopharynx
  5. SVA - taste from anterior 2/3 of tongue
    * *still rostral S. solitary nucleus
17
Q

Reflexes involving facial nerve

A
  1. Corneal reflex
    Cornea (trigeminal)
  2. Sucking reflex
    Lips (trigeminal)
  3. Blinking to light
    Retina (trigeminal)
  4. Blinking to noise
    Cochlea (vestibulocochlear
  5. Sound attenuation
    Cochlea (vestibulocochlear)

Facial are all the efferents

18
Q

Bell’s Palsy

A
  • Unilateral facial weakness LMN
  • acute (overnight)
  • retroauricular pain
  • hyperacusis - loss of stapedius
  • dry and red eye
  • loss of taste
19
Q

Trigeminal nerve (2/7)

A

SVE, GSA

  1. SVE - muscles of mastication and tensor tympani muscle
    **MOTOR NUCleus of V
    _________________________________
  2. GSA

touch and pressure: principal sensory nucleus

pain and temp: trigemino-thalamic pathway (trigeminal ganglion > **SPINAL nucleus > VPM)

proprioception:
MESENCEPHALIC nucleus of trigeminal- afferent for jaw jerk reflex, control force of bite
**the only primary sensory neuron in the CNS
________________________________
Ophthalmic division V1:
Cornea, eye, orbit, forehead, Dura

Maxillary division V2: 
Upper teeth
Nasal cavity
Maxilla and overlying skin
Palate 
Mandibular division V3
-buccal region 
-entire lower jaw
-lower teeth
anterior 2/3 of tongue,
-cornea 
pain for: 
-supratentorial dura mater-anterior
20
Q

Spinal nucleus of V

A

Collecting ipsilateral impulses of pain and temperature

  • Glossopharyngeal: GSA for back of ear, posterior 1/3 of tongue, upper pharynx (gag reflex)
  • Vagus: GSA - sensation of pharynx, larynx, external ear, dura of posterior fossa
21
Q

Uncommon Trigeminal lesion presentation

A

Pterygoid muscle - draws mandible forward and towards midline, chin deviates in direction of the paralyzed side when jaw opens.

22
Q

Medial pontine syndrome

A
  1. Fibers of abducens (medial strabismus) - odd alignment of eyes
  2. Contralateral arm/leg weakness (CST) contralateral decreased position, tactile and vibration sense (medial lemniscus)
23
Q

Lateral pontine syndrome AICA deficit

A
  1. Contralateral body pain and temperature loss spinothalamic
  2. Ipsilateral face pain and temp loss because lesion of SPinal nucleus V
  3. Ipsilateral horners bc lesion of descending hypothalamic
  4. Ipsilateral ataxia bc lesion of middle cerebellar peduncles
  5. Ipsilateral loss of taste (anterior 2/3), lacrimation, salivation, corneal reflex, hyperacusis bc lesion of facial nucleus and axons
24
Q

Oculomotor nerve (2/7)

A
  1. GSE - superior, inferior, medial rectus, inferior oblique, levator palpebrae superioris
  2. GVE - Edinger Westphal nucleus -for sphincter pupillae, ciliary muscle.
25
Q

Ventral midbrain syndrome - Weber

A
  1. CST
  2. Contralateral hemiparesis of lower face bc lesion of corticobulbar

3*ipsilateral oculomotor palsy (lateral strabismus, dilated pupil, ptosis

26
Q

Dorsal midbrain syndrome (Perinauds)

A

Caused by increased pressure on the dorsal, rostral mid-brain, including posterior commissure.
ex pineal tumor

  1. Paralysis of upward gaze (pressure on vertical gaze center-dorsal for upward)
  2. Hydrocephalus (cerebral aqueduct), headaches (intracranial pressure), nystagmus
  3. Large, irregular pupils (posterior commissure fibers goes to E-W nucleus). Light-near dissociation
    possible
    -posterior commissure contains the crossing fibers from the pretectal nucleus that coordinates response to light.

(MLF).

  1. Loss of convergence
27
Q

Spinal Nucleus V

3 inputs

A
  1. Trigeminal - pain, temperature from the head, face, and neck
  2. Glossopharyngeal - sensation from back of ear, posterior 1/3 tongue, upper pharynx with reflex
  3. Vagus - sensation from pharynx, larynx, external ear, and dura of posterior fossa.
28
Q

Jaw jerk reflex

A

Mesencephalic nucleus of V- receives unconscious proprioception from trigeminal.

29
Q

There are four nuclei to know for the trigeminal what are they?

A
  1. Spinal nucleus of V
    - pain and temperature sensation
    - crossed projection to VPM
  2. Principal nucleus
    - touch and pressure face, mouth, anterior 2/3 of tongue, nasal sinus
    - crossed projection to VPM
  3. Mesencephalic nucleus
    - proprioception and controls bite strength
    - ipsilateral
    - *primary neuron in CNS
  4. Motor nucleus of V
    - muscles of mastication, tensor tymapni
    - ipsilateral, maintains bite strength
30
Q

Which cranial nerves have a lateral arrangement?

A

5 & 8

Trigeminal and Vestibulocochlear

31
Q

What are the 3 nuclei for trigeminal sensation

A

Spinal nucleus - pain and temperature

Principal sensory nucleus aka main sensory nucleus - touch and pressure

Mesencephalic nucleus of V- unconscious proprioception - afferent loop for jaw jerk
-from teeth, hard palate, muscles of mastication - control force of bite

NBB2 (20 decks)

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