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year 2 neuro - Robbie > Disorders of Cranial Nerves > Flashcards

Disorders of Cranial Nerves Flashcards

1
Q

What are the Functions of the Cranial Nerves?

A
  • Special” senses
  • “Ordinary” sensation
  • Control of muscle activity
  • Autonomic functions
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2
Q

What are the special sense?

A

Olfaction (I)

Vision (II)

Taste (VII, IX and X)

Hearing - and balance (VIII)

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3
Q

What is responsible for ordinary sensation?

A

Mainly the Vth (trigeminal nerve)

The ear from the VIIth (facial) and IXth (glossopharyneal) nerves

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4
Q

What is in control of msucle activity?

A

Eye muscles – III (oculomotor), IV (trochlear) and VI (abducence) (LR6,SO4, rest 3)

Muscles of mastication – V (trigeminal)

Muscles of facial expression – VII (facial)

Muscles of larynx and pharynx – mainly X (vagus)

Sternomastoid and trapezius muscles - XI (accessory)

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5
Q

What are the autonomic functions
(all parasympathetic) and what is respobisble for them?

A

Pupillary constriction – III (oculomotor)

Lacrimation – VII (facial)

Salivation – submandibular and sublingual glands – VII (facial)

Salivation – parotid gland - IX (glossopharyngeal)

Vagal (X) input to organs in thorax and abdomen

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6
Q

What is used to test CN I - Olfactory?

A

smell – unilateral or bilateral loss

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7
Q

What is used to test CN II – Optic?

A

visual acuity

visual fields

pupillary reactions

fundoscopy

colour vision

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8
Q

What dow e test in CN III, IV and VI – oculomotor, trochlear and abducence?

A

any evidence of ptosis?

pupil of equal size?

pupillary reactions

eye movements – vertical and horizontal

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9
Q

What do we for for in regards to CN V – Trigeminal?

A

sensation in the ophthalmic, maxillary and mandibular divisions

power in the muscles of mastication

corneal reflex

•aw jerk

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10
Q

What do we test for in CN VII – Facial?

A

Muscles of facial expression

Corneal reflex

Taste

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11
Q

What do we test for in CN VIII – Vestibulocochlear nerve?

A

Hearing using Rinne’s and Weber’s tests

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

(untenbergers test – close eyes and march on spot and will start to turn to side that is dyfunctioning and need to go to ENT clinic)

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12
Q

What do we test for in CN IX (glossopharyngeal) and CN X (vagal)?

A

movement of the palate

gag reflex

quality of speech

quality of cough

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13
Q

WHat do we test for in CN XI – Accessory nerve?

A

Head turning and shoulder shrugging - sternomastoid and trapezius function

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14
Q

How is CN XII – Hypoglossal nerve tested?

A

Appearance, movement and power of tongue

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15
Q

What cranial nerves are responsible for:

Pupillary light reaction

A

afferent – II ; efferent – III

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16
Q

What cranial nerves are responsible for:

Corneal reflex

A

afferent – V ; efferent – VII

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17
Q

What cranial nerves are responsible for:

jaw jerk

A

afferent and efferent – V

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18
Q

What cranial nerves are responsible for:

gag reflex

A

afferent – IX ; efferent - X

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19
Q

III and IV (Oculomotor and Trochlear) nuclei lie in the ________

A

MID-BRAIN

20
Q

V, VI AND VII (Trigeminal, Abducent and Facial) lie in the ______

A

PONS

21
Q

VIII (Vestibulocochlear) lie at the __________ junction

A

PONTOMEDULLARY

22
Q

IX, X XI and XII (Glossopharyngeal, Vagus, Accessory and Hypoglossal ) lie in the ________

A

MEDULLA

23
Q

What may be some Combinations of Cranial Nerve Signs?

A

Bilateral III - midbrain

III +IV+VI - superior orbital fissure

VI +VII -pons

V + VIII - cerebellopontine angle

Unusual combinations - ?chronic or malignant meningitis

Pure motor signs - ?myasthenia gravis - affects neuromuscular junction

24
Q

What different ways can cranial nerves be damaged?

A

within the brain - e.g. by ischaemia, tumour

crossing the sub-arachnoid space - e.g by meningitis

outside the skull e.g. by base of skull tumours arising in nasopharynx

25
Q

What is optic neuritis?

A

demyelination within the optic nerve

an inflammation that damages the optic nerve

26
Q

What are the signs and symptoms of optic neuritis?

A

monocular visual loss

pain on eye movement

reduced visual acuity

reduced colour vision

optic disc may be swollen

often associated with multiple sclerosis

27
Q

How does parasympathetic effect pupillary response?

A

constriction of the pupil

loss of parasympathetic input results in a fixed, dilated pupil

e.g. complete third nerve palsy

28
Q

How would sympathetic effect pupillary response?

A

pupillary dilatation

damage anywhere within the sympathetic pathway can lead to a constricted pupil

29
Q

What are causes of dilated pupils?

A

Youth

Dim lighting

Anxiety, excitement

“Mydriatic” eye drops

Amphetamine, cocaine overdose

Third nerve palsy

Brain death

30
Q

What are the causes of small pupils?

A

Old age

Bright light

“Miotic” eye drops

Opiate overdose

Horner’s Syndrome - rare disorder characterized by a constricted pupil (miosis), drooping of the upper eyelid (ptosis), absence of sweating of the face (anhidrosis), and sinking of the eyeball into the bony cavity that protects the eye (enophthalmos)

31
Q

What are some eye movement disorders?

A

Isolated third nerve palsy

Isolated fourth nerve palsy

Isolated sixth nerve palsy

Combination of the above

Supranuclear gaze palsy

Nystagmus

32
Q

WHat are the causes of isolated third nerve palsy?

A

• Microvascular - diabetes, hypertension

Painless, pupil spared

• Compressive - posterior communicating artery aneurysm, raised ICP

Painful, pupil affected

33
Q

What are the causes of isolated sixth nerve palsy?

A

Numerous causes including:

  • idiopathic
  • diabetes
  • meningitis
  • raised intracranial pressure
34
Q

What is nystahmus?

A

Congenital

Serious visual impairment

Peripheral vestibular problem

Central vestibular/brainstem disease

Cerebellar disease

Toxins (medication and alcohol)

35
Q

What is Trigeminal Neuralgia?

A

Paroxysmal attacks of lancinating pain

a chronic pain condition that affects the trigeminal nerve, which carries sensation from your face to your brain

36
Q

What causes Trigeminal Neuralgia?

A

Triggers

Middle age and older

Caused by vascular loop - Compression fifth nerve in the posterior fossa

37
Q

What is the treatment of Trigeminal Neuralgia?

A

Treated medically with carbamazepine

Surgical options if medication resistant

38
Q

What is bells palsy, cause, symptoms and treatment?

A

Idiopathic facial nerve palsy

Unilateral facial weakness

Lower motor neurone type

Often preceded by pain behind ear

Eye closure affected

Risk of corneal damage

Treated with steroids

Usually good recovery

39
Q

What are examples of UMN and LMN disease?

A

UMN - stroke or tumour

LMN - Bell’s Palsy, Lyme, sarcoid

40
Q

What is Vestibular Neuronitis?

A

Sudden onset

Disabling vertigo

Vomiting

Gradual recovery

Cause uncertain ? viral

41
Q

What is dysarthria ?

A

disordered articulation, slurring of speech

42
Q

What is dysphagia?

A

difficulty swallowing

43
Q

Both dysarthia and dysphagia occur in bulbar and pseudobulbar palsy, are they UMN or LMN?

A

Bulbar – lower motor neurone

Pseudobulbar palsy – upper motor neurone

44
Q

What is Pseudobulbar Palsy and what does it cause?

A

Bilateral UMN lesions e.g. in vascular lesions of both internal capsules, MND

  • dysarthria
  • dysphonia - difficulty in speaking due to a physical disorder of the mouth, tongue, throat, or vocal cords. refers to sound production
  • dysphagia
  • spastic, immobile tongue
  • brisk jaw jerk
  • brisk gag reflex
45
Q

WHat is bulbar palsy and what does it cause?

A

Bilateral LMN lesions affecting IX - XII, eg. MND, polio, tumours, vascular lesions of the medulla and syphilis

  • wasted, fasciculating tongue
  • dysarthria
  • dysphonia
  • dysphagia

BEWARE OF FEEDING THESE PATIENTS

year 2 neuro - Robbie (48 decks)

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