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DPT 736 Neuroanatomy > Cranial Nerves and Testing > Flashcards

Cranial Nerves and Testing Flashcards

1
Q

Cranial Nerves

A
  • 12 pairs
  • part of PNS
  • pass thru foramina or fissures in cranial cavity
  • all except CN XI originate from brain
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2
Q

Cranial Nerves and the PT

A
  • some cranial nerves are assessed more often by PTs
  • CN II: optic
  • CN III, IV, VI: occulomotor, trochlear and abducens
  • CN V: trigeminal
  • CN VII: facial
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3
Q

CN I: Olfactory

A
  • sensory
  • transmits sense of smell
  • passes thru cribiform plate of ethmoid bone
  • connected directly to temporal lobe
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4
Q

CN I: Clinical Findings

A
  • loss of smell-anosmia
  • intercranial lesions in frontal lobe
  • unilaterally: head trauma, viral infections, obstruction of nasal passages
  • bilaterally: Parkinson’s or Alzheimer’s
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5
Q

CN I: Testing

A
  • test sense of smell with familiar/nonirritating odors (coffee, cloves, soap, vanilla)
  • normally perceives odor on each side and can often identify it: check for patency, close both eyes, occlude one nostril and test smell, test other side
  • not normally tested by PT
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6
Q

Eye-Orbit

A
  • margins formed by frontal, maxillary, zygomatic bones
  • walls formed by 7 bones
  • foramen/canals: optic canal (CN II), superior orbital fissure (CN III, IV, VI, V1 of V), inferior orbital fissure contains CN V (V2 maxillary nerve)
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7
Q

CN II: Optic

A
  • sensory
  • fx: vision
  • passes thru optic canal
  • goes thru thalamus to occipital lobe
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8
Q

CN II: Clinical Findings

A
  • blindness/visual field abnormalities
  • homonymous hemianopsia, bitemporal hemianopsia, blindness
  • loss of pupillary constriction
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9
Q

CN II: Testing

A
  • test visual acuity
  • inspect optic fundi with ophthalmoscope (special attention to optic discs)
  • test visual fields by confrontation-often tested with patients who have CVA or TBI
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10
Q

CN III: Oculomotor Nerve

A
  • motor
  • innervates all muscles of eye except superior oblique (CN IV) and lateral rectus (CN VI)
  • superior rectus clinical test: elevation
  • inferior rectus clincial test: depression
  • medial rectus clincial test: adducts eye
  • inferior oblique clinical test: elevates and adducts
  • lateral palpabrae superioris: elevates superior eyelid
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11
Q

CN III: Clinical Findings

A
  • dilated pupils
  • ptosis (can’t keep eyelid open)
  • loss of normal pupillary reflex
  • eye moves down inferiorly and laterally
  • diabetic neuropathies and aneurysm in post, communicating branch
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12
Q

CN II and III Testing

A
  • inspect size and shape of pupils (compare sides)
  • test pupillary reactions to light
  • check near response (pupillary constrictor muscle)
  • check convergence (medial rectus muscles)-bring finger to nose
  • check accommodation of lens (ciliary muscle)
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13
Q

CN IV: Trochlear Nerve

A
  • motor
  • innervates superior oblique (adducts and depresses eye) intorsion
  • passes thru superior orbital fissure
  • only nerve to exit from posterior surface of brainstem
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14
Q

CN IV: Clinical Findings

A
  • inability to look inferiorly when eye is adducted
  • held tilt away from lesion and chin tuck
  • vertical diplopia
  • hypertropia: extorsion; misalignment of eyes, visual axis higher in affected eye
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15
Q

CN III, IV, and VI Testing

A
  • test extraocular movements in six cardinal directions (look for loss of conjugate movements in any of six directions)
  • check convergence of eyes
  • identify an y nystagmus
  • look for ptosis
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16
Q

CN V: Trigeminal Nerve

A
  • sensory and motor
  • receives sensory info from face and innervates muscles of mastication
  • opthalmic, maxillary, mandibular branches pass thru superior orbital fissure, foramen rotundum, foramen ovale
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17
Q

CN V1: Opthalamic Nerve

A
  • sensory innervation to nose, eyes, skin of face above eyes
  • divides into many branches to supply this region of the face…a few listed below
  • nasociliary nerve, external nasal branch, infratrochlear nerve, frontal nerve (supratrochlear nerve and supraorbital nerve), lacrimal nerve
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18
Q

CN V2: Maxillary Nerve

A
  • provides sensory innervation to mid-face (lateral and below eye and above upper lip), palate, paranasal sinuses, and maxillary teeth
  • divides into many branches to supply this region of the face: infraorbital nerve, zygomaticofacial, zygomaticotemporal
19
Q

CN V3: Mandibular Nerve

A
  • provides sensory innervation to lateral and lower portion of face, jaw, mandibular teeth, anterior 2/3 tongue
  • divides into many branches to supply this region of face: buccal nerve, auriculotemporal nerve, mental nerve
20
Q

CN V: Clinical Findings

A
  • loss of sensation and pain in region supplied by three divisions of nerve over face
  • loss of motor function of muscles of mastication on side of lesion
  • trigeminal neuralgia (tic douloureux)-severe facial pain along sensory distribution of one of the three CN V branches; MC is maxillary division of CN V (most common one affected)
  • generally stays unilateral
21
Q

CN V Testing (Motor)

A
  • palpate temporal and masseter muscles (ask patient to clench teeth) note strength of muscle contraction
  • ask pt to move jaw side to side
22
Q

CN V Testing (Sensory)

A
  • test forehead, cheeks, jaw on each side for pain sensation (eyes closed)
  • use sharp object substituting blunt end for point; ask sharp or dull and compare sides; can confirm abnormality by testing temp sensation
  • test for light touch
23
Q

CN V: Testing Corneal Reflex

A
  • ask pt to look up and away
  • approach from other side and out of line of vision
  • look for blinking of eyes (normal)
  • sensory limb of this reflex is carried in CN V, and motor response in CN VII
  • not generally done by PT
24
Q

CN VI: Abducens Nerve

A
  • motor
  • fx: innervates lateral rectus that abducts eye
  • passes thru superior orbital fissure
25
Q

CN VI: Clinical Findings

A
  • inability to perform lateral eye movements

- symptoms would show on ipsilateral side because CN don’t cross over

26
Q

CN VII: Facial Nerve

A
  • sensory and motor
  • fx: innervates muscles of face not muscles of mastication
  • sense of taste from anterior 2/3 of tongue
  • innervates salivary and lacrimal glands
  • closes eyelid
  • passes thru internal acoustic meatus/stylomastoid foramen
  • divides into 5 branches as it passes through parotid gland: temporal, zygomatic, buccal, mandibular, cervical
27
Q

CN VII: Clinical Findings

A
  • paralysis of facial muscles
  • abnormal taste sensation from anterior 2/3 tongue
  • dry conjunctiva because eyelid can’t close
  • paralysis of CL facial muscles below eye
  • bell’s palsy: generally inflammation of CN VII; usually temporary
  • look at drawing
  • parotid gland tumor has potential to compress CN VII causing paralysis/weakness of facial muscles as can parotid gland surgery
28
Q

CN VII: Tesing

A
  • inspect face (at rest and during conversation) not any asymmetry, tics, abnormal movements
  • ask pt to raise both eyebrows, frown, close both eyes tightly (test muscular strength by trying to open them), show both upper and lower teeth, smile, puff out both cheeks
29
Q

CN VIII: Vestibulocochlear Nerve

A
  • sensory
  • vestibular component for balance and cochlear component for hearing
  • passes thru internal acoustic meatus
30
Q

CN VIII: Clinical Findings

A
  • progressive unilateral hearing loss and tinnitus
  • Weber’s and Rinne’s Tests: helps you to differentiate between hearing loss due to conductive (blockage, wax in ear, etc) and sensorineural (CN VIII damage-acoustic neuroma)
31
Q

Weber’s Test

A
  • tuning fork on midline of head
  • conduction loss: sound will be louder in ear that’s blocked
  • sensorineural loss: sound will be loudner in normal ear
32
Q

Rinne’s Test

A
  • used to confirm conduction loss
  • place tuning fork on mastoid process, have pt tell you when sould disappears immediately place tuning fork near external acoustic meatus
  • WNL: normal sound will travel thru air better than bone and will continue to be heard
  • conduction loss: pt will not be able to hear tuning fork as you place it near external acoustic meatus
33
Q

CN VIII Testing

A
  • assess hearing with whispered voice test or hearing finger tips moving
  • if hearing loss (determine if loss is conductive or sensorineural)
34
Q

CN IX: Glossopharyngeal Nerve

A
  • both
  • fx: taste posterior 1/3 tongue, innervates parotid gland, stylopharyngeus muscle of pharynx, sensory input from skin of external ear, internal surface of tympanic membrane and upper pharynx
  • passes thru jugular foramen
35
Q

CN IX: Clinical Findings

A
  • loss of taste to posterior 1/3 of tongue and sensation of soft palate
  • say ahhhh…uvula will deviate to stronger side if damage occured
36
Q

CN X: Vagus Nerve

A
  • both
  • innervates all laryngeal and most pharyngeal muscles (except stylopharyngeus)
  • innervates muscles and glands in pharynx, larynx, thoracic viscera, and abdominal viscera of foregut and midgut
  • sensory input from aortic body chemoreceptors and aortic arch baroreceptors, esophagus, bronchi, lungs, heart, and abdominal viscera
  • passes through jugular foramen
37
Q

CN X: Clinical Findings

A
  • soft palate deviation with deviation of uvula to normal side
  • vocal cord paralysis
  • dysphagia (difficulty swallowing)
38
Q

CN IX and X Testing

A
  • listen to voice (hoarse or nasal quality?)
  • ask pt to say ahh and watch movement of soft palate and pharynx
  • soft palate normally rises symmetrically
  • uvula remains in midline: palate fails to rise with lesion of vagus nerve, slightly curved uvula seen occasionally as normal variation
  • each side of posterior pharynx moves medially (like a curtain)
  • warn patient of testing of gag reflex (elevation of tongue/soft palate and constriction of pharyngeal muscles): stimulate back of throat lightly on each side in turn and note gag reflex; symmetrically diminshed or absetn
  • if gag reflex absent, patient at risk for aspiration
39
Q

CN XI: Accessory Nerve

A
  • motor
  • innervates SCM and trapezius
  • cranial and spinal roots
  • passes thru jugular foramen
40
Q

CN XI: Clinical Findings

A
  • paralysis of SCM and trapezius

- ipsilateral side affected cause cranial nerves don’t cross

41
Q

CN XI Testing

A
  • from behind look for atrophy or fasciculations in trapezius and compare
  • perform MMT of trapezius: ask pt to shrug upward against resistance and note strength and contraction
  • perform MMT of SCM: ask pt to turn head to each side against resistance; observe contraction of opposite SCM and note force of movement against resistance
42
Q

CN XII: Hypoglossal Nerve

A
  • motor
  • innervates muscles of tongue: extrinsic muscles-hypoglossus, styloglossus, and genioglossus (palatoglossus innervated by CN X)
  • all intrinsic muscles of tongue
  • passes thru hypoglossal canal
43
Q

CN XII: Clinical Findings

A
  • atrophy of ipsilateral muscles of tongue and deviation toward affected side; speech disturbance
  • speech and feeding difficulties
  • tongue goes toward side of deficit “licking the wound”
44
Q

CN XII Testing

A
  • listen to articulation of words
  • inspect tongue as it lies on floor of mouth (look for any atrophy or fasciculations)
  • some coarser restless movements often seen in normal tongue
  • protrude tongue (look for asymmetry, atrophy, or deviation from midline)
  • ask to move tongue from side to side (not symmetry of movement)-may ask to push tongue against inside of each cheek and palpate externally for strength

DPT 736 Neuroanatomy (14 decks)

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