Cranial Nerves Flashcards
Infarcts, circulation
Total ACS - hemip, hemianopia, higher cort ie dysphasia/visiosp
Partial ACS - 2-3
Posterior circ POCS - ipsilat CN palsy + contralat sensory/motor OR bilat sensory/motor OR eye mvt OR cerebellar OR isolated homon vf
Lacunar ACS = pure: motor, sensory, sm, ataxic hemip
2-3 face, arm, leg
Spinal = aprupt bilat paresis
80% are ischaemic!!
Haemorrhagic if anticoag, seizure, loc
Symptoms
Dizzy - non specific ie postural, CVD, arrhyth,anx
Vertigo - vestibular
…FND
TLOC - syncope ie reduced perfusion = most common
Vasovagal ie pns
CVS ie exercise induced
Standing ie postural/drugs/ANS or neuropathy
Seizures
Generalised - ie tonic clonic
Focal ie partial
General examination
Consciousness
State ie GCS - RAS
Context ie awareness - cerebral cortex/thalamus
Meningism - inf/SAH, uti/pneumonia
Neck stifness
Kerning’s sign - straighten leg
??rash
Speech Dysarthria ie slurred/strangulated Local = tongue/mouth PSEUDOBULBAR = slow, harsh, strangulated BULBAR lmn Cn 9-12 = weak tongue, nasal Cerebellar = slow, slurred PD = dysphonia
Dysphasia
Expressive = Brocas (rt inf frontal)
Receptive = Wernicke’s (superior post temporal)
Dyslexia ie parietal - written#s
Cortex = cognition
MMSE
MOCA
ACER
Brain regions
Frontal = personality/behaviour
DISINHIBITION, LABILITY or reduced
Cognitive
Dysphasia = dominant
Temporal = aud cortex
WERNICKE’S - dominant = receptive dysphasia
LImbic
Memory, focal seizures
Parietal = language, spacial awareness, cortical sensory inhibition, contralat lev Dyslexia/calc Apraxia Focal sensory Visiospacial
Occipital = VFs HEMIANOPIA
Agnosia ie reduced recognition
Visual perception
CN1
Olfactory - ask about sense of smell
CN2
Optic
Inspect eyelids/pupils ?ptosis Eye appearance eg proprosis VISUAL ACUITY- ?GLASSES distance NEAR VISION normal =n6 COLOUR ISCHIHARA EACH EYE ?pinhole
SENSORY INATTENTION
VF ie diagonals
ACCOMODATION
LIGHT REFLEXES
FUNDOSCOPY
Light reflexes - direct, consensual, SWINGING = afferent defect loss of CONSENSUAL
ACCOMMODATION if depressed
Fatiguability - sustain up gaze
FUNDOSCOPY - red reflex ?retract upper lid
Fovea look at light
CENTRAL - red hat pin you cover op
COLOUR DESATURATION four central qs
MAP BLIND SPOT compare,
CN 3 4 6
3 = occulomotor LIGHT ACCOM REFLEX AFFERENT
ALL = eye movements ?nystagmus or diplopia, divergence
CN5
Trigeminal
Sensation ? Fine touch/pain
3 branches - ophthalmic FOREHEAD, maxillary CHEEKBONE, mandibular CHIN
brainstem = onion skin
CORNEAL REFLEXES damp whisp direct and consensual
Ant 2/3 tongue Touch orange stick
Muscles -temporalis/ masseter - JAW WEAK DEVIATES TOWARDS
Pterigoids JAW POWER
JAW JERK hanging forefinger = closes
Problem pupils
Argyll Robertson - neurosyphillis = accommodates, doesn’t react
Horners ie neck ca - miosis = constricted, mild ptosis,
Holmes Adie - tonic pupil synd = dilated, slow to react PLUS depressed deep tendon reflexes
Relative afferent pupillary defect ie OPTIC NEURITIS
CN2 between retina and optic tract
Dilates as torch swungON from sound eye
CN7
Facial
LOOK FOR FACIAL ASSYMMETRY
TASTE ant 2/3
Muscles of expression (UMN = spares upper as bilat innervated)
Bells palsy - ideopathic LMN ?taste, hyperacusis
Ramsay Hunt - Herpes zoster inf facial ganglion
=LMN, ipsilat taste/sensation, ulceration ie buccal
Cerebellopontine angle tumours ie acc neuroma
Raise eyebrows
Eyelid power
Cheek lip power tap!
CN8
vestibulocochlear
Gross hearing - whisper, repeat, move further n?60cm(press on other ear)
WEBBER - 512 midline if intact , unaff= sn, affected = conductive
RINNE 512 - mastoid p when stops, then adjacent to pinna
N AIR louder, reversed in conductive = NEGATIVE
Ask re vertigo/dizzy
?CLOSED EYE MARCHING
?head impulse
?positional nystagmus
?hallpike manoeuvre ext 30, rotate 45 ? Inner ear re higher
CN9
Glossopharyngeal test with VAGUS!
Sensation = pharynx
Sensation+ taste = post 1/3 tongue
GAG REFLEX
CN10
Vagus
Motor = upper larynx/pharynx
Speech ie tongue twisters ?dysphonia/dysarthria, (fatigue = count to 30, name objects, follow instruction, read/write sentence
Cough
Swallow
PALATE DEVIATION to OTHER side = paralysis of SAME side
BILAT ie bulbar/pseudobulbar - SEVERE nasal regurge/aphonia
RNL palsy more common= left, longer ie aaa, thyroid surgery, mediastinal malig
MG
CN11
Accessory
SCM, upper traps Ie palpate, ten behind
Shoulder shrug +- resistance
SCM + resistance
SCM wasted inMD
Neck weak MND, MG, myopathy
Winging scap?
CN12
Hypoglossal
Tongue
FIRST AT REST
STICK OUT SIDE TO SIDE
POWER
Tongue twisters ie lingual speech
Swallow
LMN
wasting, fasiculation
DEVIATION TOWARDS if unilat
Bilat? Bulbar
UMN
Unilat = little effect
Bilat = Pseudobulbar, dysphasia, dysarthria, emotional lability,
SPASTIC - stiff immobile tongue, weak palate, brisk gag
PD tremor
Neuroleptics TDs
