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neuro lectures > cranial nerves VII- XII > Flashcards

cranial nerves VII- XII Flashcards

1
Q

what is CNVII

A

facial

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2
Q

which fibres in facial nerve

A

sensory motor and parasympathetic

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3
Q

where is nucleus of facial nerve

A

in the tegmentum of the pons

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4
Q

where is facial nerve

A

attached to brain stem at the pontomedullary junction

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5
Q

somatic motor function of facial nerve

A

muscle of facial expression

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6
Q

visceral motor function of facial nerve

A

lacrimal glands (tears), submandibular & sublingual salivary glands

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7
Q

function of facial nerve

A

role of upper and lower motor neurones in the control of facial muscles

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8
Q

what causes facial weakness

A

differentiation between upper and lower motor neurone

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9
Q

what are the 2 roots of the facial nerve

A

medial - motor fibres
lateral - sensory and parasympathetic fibres (the nervus intermedius )

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10
Q

course of facial nerve

A

complex course through the temporal bone

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11
Q

special sensation of facial nerve

A

taste buds of the anterior 2/3rds of the tongue

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12
Q

fibre types in facial nerve

A

special sensory - taste anterior 2/3 tongue

motor - muscles of facial expression

parasympathetic- lacrimal glad, submandibular and sublingual salivary glands

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13
Q

how many branches of facial nerve

A

within the parotid, the terminal part of the facial nerve divides into 5 branches

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14
Q

how to test special sensory facial nerve

A

ask about taste, test taste sensation , anterior 2/3 tongue

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15
Q

what is the course of facial nerve closely related to

A

the middle ear

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16
Q

how does the facial nerve exit the skull

A

via the internal acoustic meatus

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17
Q

how to test lacrimation

A

is the eye dry

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18
Q

what do corticobulbar fibres of the facial nerve provide

A

*Contralateral innervation of the lower face
* Bilateral innervation of the upper face

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19
Q

how to test motor function of facial nerve

A

observe the face at rest - weakness, asymmetry, sagging

look for flattening of the nasolabial folds and drooping of the lower
eyelids

test the muscles and 5 branches
ask patient to:
frown and raise eyebrows
screw up eyes tightly
puff out cheeks
smile

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20
Q

how to test sensory function of facial nerve

A

touch the lateral aspect of the tongue with a cocktail stick
(dipped in sugar, salt, or vinegar)
and ask the patient to identify the taste

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21
Q

what is facial weakness a sign of

A

that someone’s had a stroke

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22
Q

what does injury of the facial nerve lead to

A

facial weakness

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23
Q

what is bell’s palsy

A

an idiopathic condition - unknown cause

inflammation of the facial nerve

thought to be related to viral infection

will see dribbling out the side of mouth

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24
Q

what is the most common lesion of the facial nerve

A

bells palsy

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25
Q

what problems are caused by injury to facial nerve (5)

A
  • bell’s palsy
  • inflammation or tumour of parotid gland
  • tumours
  • middle ear infection
  • fractures of the temporal lobe
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26
Q

describe motor cortex

A

part of it is dedicated to the upper face
part of it is dedicated to the lower face
the cell bodies of UMNS reside in the motor cortex
their axons travel to the facial motor nuclei in the pons

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27
Q

upper and lower motor neurones

A

the upper axons synapse with cell bodies of the lower neurones in the facial motor nuclei (pons)
axons of the umns for the upper and lower face cross the midline and synapse with the contra lateral fasciae motor nucleus
the facial motor nucleus also receives input from the ipsilateral motor cortex which controls the upper face

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28
Q

what is CNVIII

A

vestibulocochlear

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29
Q

is vestibulocochlear sensory or motor

A

sensory

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30
Q

function of vestibulocochlear nerve

A

conducts auditory and vestibular-related impulses from the organ of corti
(sound), semicircular canals, the utricle & the saccule (vestibular)

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31
Q

how does vestibulocochlear nerve exit the skill

A

via the internal acoustic meatus

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32
Q

how to test vestibulocochlear cochlear component

A
  • crude testing - covering each ear and whispering into the opposite one
  • rinne and webers tests
  • audiometry (specialist equipment)
33
Q

how to test vestibulocochlear nerve vestibular component

A
  • observe patients balance, gait
  • caloric testing
34
Q

what is a sign of vestibular disfunction

A

Nystagmus ( rapid involuntary abnormal eye movements)

35
Q

what are the 2 causes of deafness

A
  1. sound not getting to ear- (conductive deafness)
  2. problems with the nerves/organ of corti - (neurological deafness)
36
Q

effects of damage to vestibulocochlear nerve

A
  • Deafness
  • Dizziness
  • Nausea
  • Loss of balance
  • Nystagmus
37
Q

causes of damage to vestibulocochlear nerve

A
  • The vestibulocochlear nerve runs very close to the bone
  • Is also very affected by surrounding tumours - if a tumour arises in
    the internal acoustic meatus then this will press on the
    vestibulocochlear & facial nerve
  • Skull fracture
  • Toxic drug effects
  • Ear infections
38
Q

what is acoustic neuroma

A

tumour of vestibulocochlear nerve
benign
compresses the nerve
progresses to compress the facial nerve as they run together

39
Q

what is CN IX

A

glossopharyngeal

40
Q

which fibres in glossopharyngeal

A

sensory motor and parasympathetic
but motor is very minor

41
Q

how does glossopharyngeal exit the skull

A

via the jugular foramen along with the vagus & accessory

42
Q

where is glossopharyngeal

A

attached to the medulla via several small rootlets

43
Q

motor function of glossopharyngeal

A
  • Elevates the pharynx (motor to stylopharyngeus - swallowing & gag
    reflex)
  • Secretion of PAROTID GLAND (salivary) - via parasympathetic
    innervation
44
Q

sensory function of glossopharyngeal

A
  • Sensation from the external ear
  • Posterior 1/3 rd of tongue - touch, pain & temperature
  • Pharynx - touch, pain & temperature
  • Eustachian tube - touch, pain & temperature
  • Carotid sinus & body - baro & chemoreception
45
Q

what is CN X

A

vagus nerve

46
Q

which fibres in vagus

A

sensory, motor and parasympathetic

47
Q

where is vagus

A

attached to medulla via several small rootlets

between the pyramid & inferior cerebellar peduncle

48
Q

how does vagus nerve exit the skull

A

via the jugular foramen

49
Q

functions of vagus nerve

A
  • Taste - via posterior pharynx
  • Swallowing - muscles of the pharynx & larynx ( EXCEPT the
    stylopharyngeus (CN 9)
  • Cardiovascular & GI regulation
  • Sensation of hunger
  • Sensation of fullness
  • Sensation to external ear
50
Q

impact of vagus nerve on heart rate and blood pressure

A

causes a decreased heart rate & blood pressure when stimulated

51
Q

how to examine glossopharyngeal and vagus nerves (3)

A
  1. Observe quality of patients voice
  2. Ask patient to say “Ah” and observe the elevation of the palate
  3. Absence of the gag reflex suggests a lesion in the glossopharyngeal or
    vagus nerves
52
Q

what is hoarseness of voice a sign of

A

vocal cord paralysis - caused by
compression or damage of the RECURRENT LARYNGEAL NERVE
(vagus derivative) which supplies all the intrinsic muscles of the larynx
(except the cricothyroid muscle)

53
Q

what is nasal voice a sign of

A

paralysis of the palate

54
Q

how to identify bilateral lesions of the vagus nerve

A

palate fails to rise

55
Q

how to identify unilateral paralysis of the vagus nerve

A

both the palate and uvula deviate to the normal side AWAY from the lesion

56
Q

what is CN XI

A

accessory

57
Q

which fibres in accessory nerve

A

motor

58
Q

what does accessory nerve supply

A

the sternocleidomastoid & trapezius muscles

59
Q

where are cell bodies of accessory nerve

A

in the ventral horn of the upper 5 segments of the spinal cord

60
Q

course of accessory nerve

A

sends fibres through the foramen magnum which then exits the skull via
the jugular foramen with vagus & glossopharyngeal

61
Q

what does accessory nerve run in close proximity to

A

the internal jugular vein (which also exits the
jugular foramen)

62
Q

what does injury to accessory nerve result in

A

paralysis of the sternocleidomastoid and trapezius muscles on the same side as the lesion

63
Q

cranial part of accessory nerve

A

rootlets arise from the medulla
leaves via the jugular foremen by joining the vagus

64
Q

spinal part of accessory nerve

A

from ventral horn spinal cord C1-C5
travels up through the foremen magnum
leaves again through the jugular foremen
innervates sternocleidomastoid and trapezius

65
Q

how to test sternocleidomastoid of accessory nerve

A

ask patient to turn head against resistance -
paralysis is present is there is difficulty rotation head to the side
opposite to the lesion

66
Q

how to test trapezius

A

ask patient to shrug the shoulders against resistance -
paralysis is present if there is an inability to shrug

67
Q

what is CN XII

A

hypoglossoal

68
Q

describe hypoglossal nerve

A

motor nerve > muscles of the tongue
arises from the medulla, leaves through the hypoglossal canal

69
Q

is hypoglossal sensory or motor

A

motor

70
Q

what does hypoglossal nerve supply

A

the extrinsic & intrinsic muscles of the tongue

71
Q

where are cell bodies of hypoglossal nerve

A

in the hypoglossal nucleus which lies between the
dorsal motor nucleus of the vagus and the midline of the MEDULLA

72
Q

how does hypoglossol nerve exit the skull

A

through the hypoglossal cana

73
Q

function of hypoglossol nerve

A

tongue movements in speech, food manipulation and swallowing

74
Q

how to test hypoglossol nerve

A
  • Ask patient to protrude the tongue
  • Atrophy & fibrillations (rapid uncontrolled contraction of muscle) are
    the tell-tale signs of LOWER MOTOR LESION - which results in the
    tongue deviation TOWARDS the lesion
75
Q

what does damage to hypoglossol nerve cause

A

paralysis of the IPSILATERAL half of the tongue
- licks the lesion (tongue movement towards lesion)

76
Q

what is the motor supply to the posterior 1/3 of tongue

A

hypoglossol, except palatoglossus

pharyngeal branch of vagus

77
Q

what supplies sensory and taste. to posterior 1/3 of tongue

A

glossopharyngeal

78
Q

what is sensory supply to anterior 2/3 of tongue

A

lingual branch of V3 from trigeminal

79
Q

what supplies taste to anterior 2/3 of tongue

A

chorda tympani branch of facial nerve
carried by lingual branch

neuro lectures (15 decks)

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