Disorders of Cranial Nerves

Question 1

Which cranial nerves carry special sensory information?

Answer 1

I - olfaction
II - vision
VII, IX, X - taste
VIII - hearing (and balance)

Question 2

What nerve carries the majority of the general sensory information form the face?

Answer 2

V

Question 3

What nerves control the muscles of the eye?

Answer 3

III
IV
VI

Question 4

What nerve controls the muscles of mastication?

Answer 4

V

Question 5

What nerve controls the muscles of facial expression?

Answer 5

VII

Question 6

What nerve controls the muscles of the pharynx and larynx?

Answer 6

X

Question 7

What nerve controls the sternocleidomastoid and trapezius muscles?

Answer 7

XI

Question 8

What nerve controls pupillary constriction?

Answer 8

III

Question 9

What nerve controls lacrimation?

Answer 9

VII

Question 10

What nerve controls salivation from the submandibular and sublingual glands?

Answer 10

VII

Question 11

What nerve controls salivation from the parotid gland?

Answer 11

IX

Question 12

How can the optic nerve be tested?

Answer 12

Visual acuity
Visual fields
Pupillary reactions
Fundoscopy

Question 13

How can nerves III, IV and VI be tested?

Answer 13

Ptosis?
Pupils of equal size?
Pupillary reactions
Eye movements - vertical and horizontal

Question 14

How can the trigeminal nerve be tested?

Answer 14

Sensation in V1, V2 and V3
Powers in the muscles of mastication
Corneal reflex
Jaw jerk

Question 15

How can the facial nerve be tested?

Answer 15

Muscles of facial expression
Corneal reflex
(Taste)

Question 16

How can the vestibulocochlear nerve be tested?

Answer 16

Hearing using Rinne’s and Weber’s test

Vestibular function using Hallpike-Dix manoeuvre and Untenberger’s test

Question 17

How can the glossopharyngeal and Vagus nerves be tested?

Answer 17

Movement of the palate
Gag reflex
(Quality of speech and cough)

Question 18

How can the spinal acc4essory nerve be tested?

Answer 18

Head turning and shoulder shrugging

Question 19

How can the hypoglossal nerve be tested?

Answer 19

Appearance and movement of the tongue

Question 20

What are the four cranial nerve reflexes?

Answer 20

Pupillary light reflex
Corneal reflex
Jaw jerk
Gag reflex

Question 21

What does the combination of III, IV and VI signs suggest in terms of damage to the head?

Answer 21

SOF disruption

Question 22

What is optic neuritis?

Answer 22

Demyelination within the optic nerve
Causes monocular visual loss and eye is painful on movement
Reduced visual acuity and colour vision

Question 23

What degenerative disease is optic neuritis often associated with?

Answer 23

MS

Question 24

What is the result of loss of parasympathetic innervation to the eye?

Answer 24

Fixed, dilated pupil e.g. III nerve palsy

Question 25

What are some nerve disorders that cause eye movement disorders?

Answer 25

Isolated third nerve palsy Isolated fourth nerve palsy Isolated sixth nerve palsy Nystatgmus

Question 26

What are the two forms of third nerve palsy?

Answer 26

Microvascular - diabetes, hypertension - painless, pupil spared Compressive - posterior communicating artery aneurysm, raised ICP - painful, pupil affected

Question 27

Give some causes for isolated sixth nerve palsy

Answer 27

Idiopathic Diabetes Meningitis Raised ICP

Question 28

What are some causes of nystagmus?

Answer 28

Congenital Secondary to serous visual impairment Secondary to peripheral vascular problem

Question 29

What is trigeminal neuralgia?

Answer 29

Paroxysmal attacks of lancinating pain | Trigger is usually a vascular loop compressing the fifth nerve in the posterior fossa

Question 30

How is trigeminal neuralgia treated?

Answer 30

With carbamazepine or surgery if severe

Question 31

What is Bell's palsy?

Answer 31

A unilateral facial weakness of LMN type Often preceded by pain behind the ear Eye closure is affected = risk of corneal damage Treated with steroids

Question 32

What is vestibular neuronitis?

Answer 32

Sudden onset disabling vertigo Vomiting Gradual recovery Cause uncertain

Question 33

What is dysarthria?

Answer 33

Disordered articulation, slurring of speech

Question 34

What is dysphagia?

Answer 34

Difficulty swallowing

Question 35

Is bulbar palsy LMN or UMN?

Answer 35

LMN

Question 36

Is pseudobulbar palsy LMN or UMN?

Answer 36

UMN

Question 37

What is pseudobulbar palsy?

Answer 37

Bilateral UMN lesions e.g. in vascular lesions of both internal capsules, MND Results in - dysarthria, dysphonia, dysphagia, spastic, immobile tongue, brisk jaw jerk, brisk gag reflex

Question 38

What is bulbar palsy?

Answer 38

Bilateral LMN lesions affecting IX-XII Causes include MND, polio, tumours Results in - wasted, fasciculating tongue, dysarthria, dysphonia, dysphagia