Cranial Nerves I & II (& some general info) Flashcards
things that are given by the patient in the history/exam
soft clues
sharp pain on motion or constant pain
joint pain
burning, hot feeling, sharp pain not on motion, stabbing, tingling/numbness
nerve pain
cramping, spasm, dull ache
muscle pain
radiating dull or deep ache
referred pain
deep burning/dull pain
bone pain
throbbing pain
vascular pain
well localized pain
peripheral
diffuse pain
central
pain that’s there less than 25% of the time
intermittent
pain that’s there 25-50% of the time
occasional
pain that’s there 50-75% of the time
frequent
pain that’s there 75-100% of the time
constant
radiating, sharp, stabbing, well demarcated pain
dermatome pain
pain referral within muscular or fascial tissue
myogenous pain
dull, achy, diffuse pinpoint pain
scleratogenous pain
muscle strength that’s graded 0
no muscle contraction
muscle strength that’s graded 1
0-10% of normal movement
muscle strength that’s graded 2
11-25% of normal movement
muscle strength that’s graded 3
26-50% of normal movement
muscle strength that’s graded 4
51-75% of normal movement
muscle strength that’s graded 5
76-100% of normal movement
cranial nerve fibers arise bilaterally from
the precentral gyrus of the cerebral motor cortex
cranial nerve fibers descend along
the corticobulbar tract of the brain
movements that are mainly unilateral receive innervations from this hemisphere
the contralateral hemisphere
the cranial nerves that have motor function take their origin from
cells deep within the brain stem
the sensory cranial nerves originate from
cells outside the brain stem
unilateral abnormalities of CN V, VII, and VIII =
cerebellopontine angle lesion
unilateral abnormalities of CN III, IV, V and VI =
cavernous sinus lesion
combined unilateral abnormalities of CN IX, X, and XI =
jugular foramen syndrome
combined bilateral abnormalities of CN X, XI, and XII if lower motor neuron =
bulbar palsy
combined bilateral abnormalities of CN X, XI, and XII if upper motor neuron =
pseudobulbar palsy
most common cause of intrinsic brain stem lesion in a younger patient
multiple sclerosis
most common cause of intrinsic brain stem lesion in an older patient
vascular disease
edinger-westphal nucleus at the level of
superior colliculus
nucleus of trochlear nerve in mid brain at level of
inferior colliculus
motor nucleus of trigeminal nerve at level of
mid pons
nucleus of abducens nerve in
dorsal pons
motor nucleus of facial nerve near
near caudal border of pons
nucleus salivatorius superior and inferior at border of
pons and medulla
dorsal motor nucleus of vagus nerve in
dorsal medulla
nucleus ambiguous located in
dorsal medulla
nucleus of hypoglossal nerve located in
medulla beneath 4th ventricle
mesencephalic nucleus of trigeminal located in
mid brain
main sensory nucleus of trigeminal nerve located in
pons
vestibular and cochlear nuclei of acoustic nerve located in
pons and medulla
nucleus of tractus solitarius located in
dorsal medulla
nucleus of spinal tract of trigeminal nerve located in
dorsal lateral medulla
anosmia
complete loss of smell
anosmia is commonly associated with
viral infections, aging, head trauma
hyposmia
decreased sense of smell
hyperosmia
increased sense of smell
parosmia
perversion of smell
cacosmia
abnormally disagreeable smell
common causes of anosmia in both nostrils
blocked nasal passage, common cold, trauma
may be caused by tumors at the base of the frontal lobe
Foster Kennedy syndrome
is characterized by ipsilateral blindness, anosmia, contralateral papilledema
Foster Kennedy syndrome
associated with blindness, optic atrophy, a dark cherry red spot in place of the macula lutea
Tay-Sachs disease
small pupil constricts poorly to direct light, but reacts to accommodation
Argyll Robertson
characterized by a tonic pupillary reaction and the absence of one or more tendon reflexes
Holmes-Adie syndrome
heterotropia
deviation of bilateral eye alignment
exotropia
outward/lateral eye movement
esotropia
inward/medial eye movement
hypertropia
up eye movement
hypotropia
down eye movement
cranial nerves at the level of the midbrain
3 and 4
cranial nerves at the level of the pons
5, 6, 7, 8
cranial nerves at the level of the medulla
9, 10, 11, 12
function of CN 1
smell
function of CN 2
vision
function of CN 3
light accommodation
function of CN 3, 4, 6
eye movements
function of CN 5
sensation/wink
function of CN 7
facial muscles/taste
function of CN 8
auditory/balance
function of CN 9
taste/gag
function of CN 10
voice/swallow
function of CN 11
shoulder shrug
function of CN 12
tongue movement
the only sensory modality with direct access to cerebral cortex without going through the thalamus
olfaction
tract that projects mainly to the uncus of the temporal lobe
olfactory tract
CN 1 lesions commonly result in
parosmia and anosmia
most frequent cause of dysfunction of CN 1
common cold
Foster Kennedy syndrome causes optic atrophy in this eye
ipsilateral eye
Foster Kennedy syndrome causes papilledema in this eye
contralateral eye
Foster Kennedy syndrome causes central scotoma (central vision loss) in this eye
ipsilateral eye
Foster Kennedy syndrome causes anosmia (ipsilaterally or contralaterally)
ipsilaterally
rods detect
low light
cones detect
color
with visual field testing 60 degrees is
nasal view
with visual field testing 50 degrees is
superior view
with visual field testing 90 degrees is
lateral view
with visual field testing 70 degrees is
inferior view
the standard light setting on the ophthalmoscope is for
general inspection
the narrow light setting on the ophthalmoscope is for
looking at the macula
the target light setting on the ophthalmoscope is for
measuring the optic cup
the green light setting on the ophthalmoscope is for
looking for hemorrhages
the slit light setting on the ophthalmoscope is for
papilledema (looking at elevation changes)
the blue light setting on the ophthalmoscope is for
looking at cornea scratches
optic disc swelling that is secondary to elevated intracranial pressure
papilledema
2nd most common cause of blindness
glaucoma
loss of vision in the center of visual field, blurry vision
macular degeneration
causes blurred vision, floating stars, shadows
diabetic retinopathy
causes double vision, headaches, visual disturbances
hypertensive retinopathy
causes dark spot, blurred vision, pupil shape change
melanoma
signs are ptosis, pupilloconstriction, facial anhydrosis, ipsilateral facial vasodilation
Horner’s syndrome
amaurosis fugax associated with this CN dysfunction
2
involuntary eye oscillations
nystagmus
Definition of a diagnostic red flag
something that presents the need for further investigation
What are the 3 categories of red flags and what do they mean?
Category I requires immediate attention (blood in sputum or loss of consciousness)
Category II require further questioning (fever, gait deficits, non-healing wounds)
Category III require further physical tests (abnormal reflexes, unexplained referred pain)
Example of a red flag from each category in the cervical spine
Category I = worst headache they’ve ever had
Category II = bone disorders
Category III = radiculopathy
How is intermittent pain graded
less than 25%
How is occasional pain graded
25-50%
How is frequent pain graded
50-75%
How is constant pain graded
75-100%
lesion that involves optic nerve or tract and is the most common cause of multiple sclerosis
retrobulbar neuritis
lesion that includes various forms of retinitis
bulbar neuritis
lesion that is a common symptom of increased intracranial pressure
papilledema
lesion that is associated with decreased visual acuity and a change in the color of the optic disc
optic atrophy
type of optic atrophy that involves the optic nerve but does. not produce papilledema
primary
type of optic atrophy that is a sequel of papilledema and may be due to glaucoma or increased intracranial pressure
secondary
abnormality with CN II that almost always presents as bilateral and may develop over hours to weeks
papilledema
demyelinating inflammation of optic nerve that presents in patients with MS
optic neuritis
CN I travels here
cribriform plate
CN II travels here
optic canal
