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x osces > Cranial Nerves > Flashcards

Cranial Nerves Flashcards

1
Q

How would you test CNI in a patient?

A

Ask them “Have you noticed any changes in your sense of smell?”
Rarely smell cards are used

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2
Q

How would you test CNII in a patient?

A 
Visual fields
Ask if any troubles with vision
Glasses/contacts?
Ichihara chart for colour vision
Blind spot testing
Visual acuity - Snellen chart
Opthalmosocpy
Pupillary response
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3
Q

How would you test CNIII, IV and VI in a patient?

A

Eye movements in H pattern.
Ask patient to report any double vision
Observe resting gaze

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4
Q

How would you test CNV in a patient?

A 
Test sensation in all 3 nerve areas
Test power of masseter and temporal muscles
Push jaw open against pressure
Jaw jerk reflex
Corneal reflex
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5
Q

How would you test CNVII in a patient?

A

Raise eyebrows, close eyes tight (against resistance), puff cheeks out, show teeth and whistle
Ask about changes in taste

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6
Q

How would you test CNVIII in a patient?

A 
Soft whisper hearing
Ask if noticed any hearing issues
Webers and Rinne's test
Vestibular ocular reflex
Gait, heel-to-toe walk and Romberg's
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7
Q

How would you test CNIX and X in a patient?

A

Cough, swallow and say AH

Gag reflex

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8
Q

How would you test CN XI in a patient?

A

Shoulder shrug and head turning against resistance

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9
Q

How would you test CNXII in a patient?

A

Open mouth and stick tongue out looking for tongue or uvular devaition
Power of tongue against side of cheek
Observe tongue for wasting or fasciculations

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10
Q

What nerve type(s) does CNI carry?

A

Sensory

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11
Q

What nerve type(s) does CNII carry?

A

Sensory

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12
Q

What nerve type(s) does CNIII carry?

A

Motor (somatic and parasympathetic)

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13
Q

What nerve type(s) does CNIV carry?

A

Motor

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14
Q

What nerve type(s) does CNV carry?

A

Sensory

Motor

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15
Q

What nerve type(s) does CNVI carry?

A

Motor

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16
Q

What nerve type(s) does CNVII carry?

A

Sensory

Motor (parasympathetic + somatic)

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17
Q

What nerve type(s) does CNVIII carry?

A

Sensory

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18
Q

What nerve type(s) does CNIX carry?

A

Sensory

Motor (somatic + parasympathetic)

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19
Q

What nerve type(s) does CNX carry?

A

Sensory (somatic and visceral)

Motor (parasympathetic + somatic)

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20
Q

What nerve type(s) does CNXI carry?

A

Motor

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21
Q

What nerve type(s) does CNXII carry?

A

Motor

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22
Q

What functions does CNI serve?

A

Sense of smell

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23
Q

What functions does CNII serve?

A

Vision

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24
Q

What functions does CNIII serve?

A

SOMATIC
Eye movement: Superior, medial and inferior rectus muscles, inferior oblique muscles. All eye movements apart from outwards, and medial and down.
Eyelid opening: levator palpebrae superioris

PARASYMPATHETIC
Pupillary constriction: sphincter pupillae
Accommodation: ciliary muscle

25
Q

What functions does CNIV serve?

A

Eye movement: abduction and internal rotation (superior oblique muscle). Moves eye medially and downwards.

26
Q

What functions does CNV serve?

A

SENSORY
Facial sensation: ophthalmic, maxillary and mandibular regions
Somatosensation of anterior 2/3 of tongue

MOTOR
Mastication: masseter, temporalis, medial pterygoid, lateral pterygoid muscles

27
Q

What functions does CNVI serve?

A

Eye movements: retracts the eye within the orbit (lateral rectus). Moves eye outwards.

28
Q

What functions does CNVII serve?

A

SENSORY
Taste perception of anterior 2/3 of tongue
Pain sensation: skin behind ear

PARASYMPATHETIC
Salivation (submandibular and sublingual glands)
Lacrimation

SOMATIC
Opening and closing of jaw (digastric)
Eyelid closing (orbicularis oculi)
Tongue elevation (stylohyoid muscle)
Movement of stapedius bone (stapedius muscle)
29
Q

What functions does CNVIII serve?

A

Balance and equilibrium

Hearing

30
Q

What functions does CNIX serve?

A

SENSORY
Taste: posterior 1/3 tongue
Somatosensation: middle ear and Eustachian tube (tympanic nerve)
Visceral sensation: carotid sinus (baroreceptors detect BP)
Chemoreception: carotid body (chemoreceptors detect partial pressure of O2 and CO2 and pH)

SOMATIC
Swallowing: pharyngeal muscles and muscles of upper GIT tract

PARASYMPATHETIC
Salivation: parotid gland

31
Q

What functions does CNX serve?

A

SOMATIC SENSORY
Somatosensation: external auditory canal, trachea, larynx

VISCERAL SENSORY
Taste perception: epiglottis and posterior tongue
Visceral sensation: aortic body (baroreceptors detect BP)
Chemoreception : aortic body (chemoreceptors detect partial pressure of O2 and CO2)

PARASYMPATHETIC
Lowering HR
Blood vessel dilatation
Promotes motility of oesophagus, stomach, intestines (up to splenic flexure) and other abdo organs

SOMATIC MOTOR
Swallowing: pharyngeal muscles and muscles of upper GIT tract
Speech: laryngeal muscles

32
Q

What functions does CNXI serve?

A 
Turn head (sternocleidomastoid)
Elevate shoulders (trapezius)
33
Q

What functions does CNXII serve?

A

Tongue protrusion: intrinsic and extrinsic muscles of the tongue

34
Q

How does a CNI palsy present?

A

Anosmia

35
Q

How does a CNII palsy present?

A

Impaired vision

36
Q

How does a CNIII palsy present?

A

Paralytic squint (eye looks down and out)
Ptosis
Horizontal diplopia
Non-reactive, dilated pupil

37
Q

How does a CNIV palsy present?

A

Inability to depress and addut eyeball simultaneously (eye shoots upwards in attempted adduction)
Diplopia (vertical or oblique) worse on down gaze or if head turned to affected side

38
Q

How does a CNV palsy present?

A

Absent corneal reflex
Anaesthesia of forehead/midface/jaw
Muscles of mastication paralysed
Jaw deviates towards side of lesion

39
Q

How does a CNVI palsy present?

A

Horizontal diplopia

Esotropia

40
Q

How does a CNVII palsy present?

A

Weakness of muscles of facial expression and eye closure
Face sags
Voluntary eye closure may not be possible
LMN - patient can’t wrinkle forehead
UMN - patient can wrinkle forehead and sagging less prominent

41
Q

How does a CNVIII palsy present?

A

Sensorineural hearing loss
Vertigo
Horizontal nystagmus
Motion sickness

42
Q

How does a CNIX palsy present?

A 
Flaccid paralysis of soft palate
Uvula deviates to normal side
Sensory loss of soft palate, upper pharynx and posterior 1/3 tongue
Mild dysphagia
Throat and ear pain
43
Q

How does a CNX palsy present?

A 
Flaccid paralysis of soft palate - nasal speech and deviation of uvula away from palate
Epiglottis paralysis (aspiration)
Dysphagia
Vocal cord paralysis
Dysfunction of vagal nerve of stomach
44
Q

How does a CNXI palsy present?

A

Weakness turning head to contralateral side

Weakness during elevation of ipsilateral shoulder and lateral winging of scapula

45
Q

How does a CNXII palsy present?

A

Atrophy and fasciculation of tongue on side of lesion

Tongue deviates to side of lesion when protruded

46
Q

What are the main potential causes of a CNI palsy?

A

Trauma
Neurodegenerative disease
Congenital
SOL

47
Q

What are the main potential causes of a CNII palsy?

A

Trauma
Tumours
impaired nutrition
Drugs

48
Q

What are the main potential causes of a CNIII palsy?

A 
Ischaemic microangiopathy (typically spares pupil involvement)
Compression or transection
49
Q

What are the main potential causes of a CNIV palsy?

A

Microvascular damage
Trauma
Cavernous sinus thrombosis

50
Q

What are the main potential causes of a CNV palsy?

A 
Tumour
Vascular compression
Oral surgery
Inflammation of nerve
Cavernous sinus thrombosis
51
Q

What are the main potential causes of a CNVI palsy?

A

Tumour
Trauma
Pseudotumour cerebri
Cavernous sinus thrombosis

52
Q

What are the main potential causes of a CNVIII palsy?

A

Bacterial meningitis
Lyme disease
Tumour

53
Q

What are the main potential causes of a CNIX palsy?

A

Often unknown

May be compression by blood vessel

54
Q

What are the main potential causes of a CNX palsy?

A

Trauma
Diabetes
Inflammation

55
Q

What are the main potential causes of a CNXI palsy?

A

Surgeries at the lateral cervical region

56
Q

What are the main potential causes of a CNXII palsy?

A

Tumours

Trauma

57
Q

What are the potential causes of an UMN lesion in CNVII palsy?

A 
Cerebrovascular disease
SOLs
MS
Syphilis
HIV
Vasculitides
58
Q

What are the potential causes of an LMN lesion in CNVII palsy?

A 
Idiopathic (Bell's palsy) - pregnancy and DM
Cerebrovascular disease
Iatrogenic
Infective
Trauma
Neurological
Neoplastic
HTN in pregnancy
Sarcoidosis
Sjogrens syndrome and RA

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