Cranial Nerves Flashcards
CN1.
Olfactory
- Q. symptoms
- scent markers
CN2.
Optic -visual acuity -visual fields -visual inattention -accomidation -pupilarly reflex direct and consensual (-colour vision/ishihara plates) (-fundoscopy)
CN3.
Occulomotor
TEST: H shape tracking- double vision
Palsy: visible strabismus, double vision in most directions, down and out. ptosis.
CN4.
Throchlea
H shape tracking- double vision
Palsy: Vertical double vision, tilting of head, unable to look down and it (convergence)
CN5.
Trigeminal
TEST: soft touch forehead, cheek and jawline
Clench jaw, open mouth against resistance
(-corneal reflex)
(-jaw jerk)
CN6.
Abducens
H shape tracking- double vision
convergent squint on distance vision, unable to abductt
CN7.
Facial
- raise eybrows
- close eyes
- puff out cheecks
- smile show teeth
CN8
Vestibulocochlear
-whisper
-rinnes
webber
CN9
Glossopharengeal
(-gag reflex)
any changes to your sense of taste?
CN10
Vagal
- open your mouth and say ahh (deviation uvula)
- give me a cough
CN 11
Accessory
- shrug shoulders against resistance
- turn head, sternocleinomastoid, against resistance
CN 12
Hypoglossal
- stick your tongue out
- leave it there for a while (fasciculations)
Noticeable stabismus (cock eye) with double vision (side by side) in most directions and eye rests down and out
Cranial Nerve 3
Occulomotor nerve palsy (if pupils fixed surgical cause, if pupil spared medical cause)
(congenital / diabetes / posterior communicating artery occlusion/ infection / inflammation/ tumour / MG/ MS/ Cavernous sinus thrombosis / iatrogenic)
vertical plain diplopia, patient unable to converge eyes and tilts head to focus
Fourth nerve / trochlear palsy
longest intracranial and thinnest nerve, traumatic damage common. congenital
Convergent squint and unable to look outward on affected side, diploplia on transverse gaze.
6th nerve / abducens/ palsy
Early sign of raised ICP
vasculopathic (giant cell arteritis /cavernous sinus mass / multiple sclerosis, sarcoidosis/vasculitis, postmyelography/ lumbar puncture, stroke /Chiari Malformation, hydrocephalus, tuberculosis meningitis)
Altered sensation in the face, weakness of jaw muscles
Trigeminal (5th) nerve palsy
tumour aneurysm chronic meningitis a lesion of the trigeminal ganglion:(acoustic neuroma meningioma) fracture of the middle fossa a lesion in the cavernous sinus
Hemifacial paresis
7th /Facial/ palsy
Bells palsy (idiopathic) most common, often spares forehead. Central causes (stroke, tumour) do not spare forehead. other peripheral causes: Ramsay Hunt syndrome (herpes) Lyme disease, petrous bone fractures, chronic meningitis
Hearing loss which is louder on air conduction and localises to unaffected side +/- tinnitus
Vestibulocochlear (8th) nerve palsy
Sesorineural hearing loss
Neurofibromatosis 2 vestibular schwanoma / acoustic neuroma pagets disease of bone meneires disease lead / asprin poisoning
Hearing loss which is louder on bone conduction and localises to affected side
Conductive hearing loss (infection, foreign body, eardrum damage)
Loss of gag reflex unilaterally and altered sense of taste
cranial nerve 9 / glossopharyngeal palsy
very rare, normally combined with CNX
deviation of uvula, ipsilateral loss of gag reflex and altered voice
Vagal nerve palsy
rare in isolation, can be severed surgically
Loss of gag reflex, swallowing difficulties, strangled cough hoarse voice, wasted fasiculating tongue
Bulbar palsy (pseudobulbar palsy)
Lesion in cranial nerve motor nuclei
(supranuclear lesion affecting lower CN nerves -will have other symptoms too)
Causes: polio / MND / vascular insufficiency / brain stem tumour
weak shoulder shrug and head turn
11th / accessory nerve palsy
commonly injured during surgery to the neck
MN symptoms in tongue
wasting /tongue deviation /flacid /fasiculations /spastic
12th / hypoglossal/ palsy
Extremely rare in isolation
