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systems- neuro- oc > Disorders of Cranial Nerves > Flashcards

Disorders of Cranial Nerves Flashcards

1
Q

name the cranial nerves

A 
I - Olfactory		VII - Facial
 II - Optic			VIII-Vestibulocochlear
 III - Oculomotor	IX - Glossopharyngeal
 IV - Trochlear		X - Vagus
 V - Trigeminal		XI - Accessory
 VI - Abducens		XII - Hypoglossal
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2
Q

where does the olfactory nerve supply?

A

nose

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3
Q

where does the optic nerve supply?

A

eye

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4
Q

where do the oculomotor, trochlear and abducens supply?

A

eye muscles

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5
Q

where does the trigeminal nerve supply?

A

sensory to the face, sinuses, teeth etc

ophthalmic, maxilary and mandible

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6
Q

where does the facial nerve supply?

A

facial muscles of face

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7
Q

where does the vestibulocochlear supply?

A

ear

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8
Q

where does the glossopharyngeal supply?

A

sensory- posterior part of tongue, tonsil, pharynx

motor- pharyngeal, musculature

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9
Q

where does the vagus nerve supply?

A

motor- heart, lungs, bronchi, GI tract

sensory- heart, lungs, bronchi, trachea, larynx, external ear

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10
Q

where does the accessory nerve supply?

A

sternocleidomastoid, trapezius

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11
Q

where does the hypoglossal nerve supply?

A

tongue muscle

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12
Q

what are the functions of the cranial nerves?

A

“Special” senses
“Ordinary” sensation
Control of muscle activity
Autonomic functions

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13
Q

what nerves have “special” senses?

A

Olfaction (I)

  • Vision (II)
  • Taste (VII, IX and X)
  • Hearing - and balance (VIII)
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14
Q

what nerves have “ordinary” sensation?

A

Mainly the Vth (trigeminal nerve)

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

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15
Q

what muscles control the eye muscles?

A

III (oculomotor), IV (trochlear) and VI (abducence)

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16
Q

what muscles control mastication?

A

V (trigeminal)

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17
Q

what mucles control facial expression?

A

VII (facial)

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18
Q

what muscles control larynx and pharynx?

A

mainly X (vagus)

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19
Q

what is the parasympathetic innervation for pupillary contraction?

A

III (oculomotor)

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20
Q

what is the parasympathetic innervation for lacrimation?

A

VII facial

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21
Q

what is the parasympathetic innervation for salivation?

A

submandibular and sublingual glands – VII (facial)

parotid gland - IX (glossopharyngeal)

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22
Q

what is the parasympathetic innervation for organs in the thorax and abdomen?

A

vagus X

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23
Q

what do we test in olfactory nerve?

A

smell – unilateral or bilateral loss

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24
Q

what do we test in optic nerve?

A 
visual acuity
visual fields
pupillary reactions
fundoscopy
colour vision
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25
Q

what do we test in oculomotor, trochlear, abducens nerve?

A

any evidence of ptosis?
pupil of equal size?
pupillary reactions
eye movements – vertical and horizontal

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26
Q

what do we test in trigeminal nerve?

A

sensation in the ophthalmic, maxillary and mandibular divisions
power in the muscles of mastication
corneal reflex
jaw jerk

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27
Q

what do we test in facial nerve?

A

Muscles of facial expression

Corneal reflex

Taste

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28
Q

what do we test in vestibulocochlear nerve?

A

Hearing using Rinne’s and Weber’s tests
Vestibular function using Dix-Hallpike manoevre and Untenberger’s test
balance

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29
Q

what do we test in glossopharyngeal and vagus nerve?

A

movement of the palate

gag reflex

quality of speech

quality of cough
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30
Q

what do we test in accesory nerve?

A

Head turning and shoulder shrugging

31
Q

what do we test in hypoglossal nerve?

A

Appearance, movement and power of tongue

32
Q

what are the afferent and efferent reflexes of pupillary light reaction?

A

afferent – II ; efferent – III

33
Q

what are the afferent and efferent reflexes of corneal reflex?

A

afferent – V ; efferent – VII

34
Q

what are the afferent and efferent reflexes of jaw jerk

A

afferent and efferent – V

35
Q

what are the afferent and efferent reflexes ofgag reflex

A

afferent – IX ; efferent - X

36
Q

where does the III and IV (Oculomotor and Trochlear) nuclei lie?

A

in the MID-BRAIN

37
Q

where does the V, VI AND VII (Trigeminal, Abducent and Facial) lie ?

A

in the PONS

38
Q

where does the VIII (Vestibulocochlear) lie

A

at the PONTOMEDULLARY junction

39
Q

where does the IX, X XI and XII (Glossopharyngeal, Vagus, Accessory and Hypoglossal ) lie

A

in the MEDULLA

40
Q

what can cause double vision other than cranial nerve lesion?

A

myasthenia or thyroid eye

disease

41
Q

what can cause cranial nerve damage within the brain ?

A

ischaemia, tumour

42
Q

what causes cranial nerve damage crossing the sub-arachnoid space?

A

meningitis

43
Q

what causes cranial nerve damage outside the skull?

A

base of skull tumours arising in nasopharynx

44
Q

what happens as a result of optic neuritis?

A 
demyelination within the optic nerve
monocular visual loss
pain on eye movement
reduced visual acuity
reduced colour vision
optic disc may be swollen
often associated with multiple sclerosis
45
Q

what are the parasympathetic pupillary responses?

A

constriction of the pupil

46
Q

what would happen if there was a loss of parasympathetic input to pupillary response?

A

loss of parasympathetic input results in a fixed, dilated pupil
e.g. complete third nerve palsy

47
Q

what are the sympathetic pupillary responses?

A

pupillary dilatation

48
Q

what would happen if there was loss of sympathetic input to pupillary response?

A

constricted pupil

49
Q

what are the causes of dilated pupils?

A 
Youth
Dim lighting
Anxiety, excitement
“Mydriatic” eye drops
Amphetamine, cocaine overdose
Third nerve palsy
Brain death
50
Q

what are the causes of small pupils?

A 
Old age
Bright light
“Miotic” eye drops 
Opiate overdose
Horner’s Syndrome
51
Q

what are eye movement disorders?

A 
Isolated third nerve palsy
Isolated fourth nerve palsy
Isolated sixth nerve palsy
Combination of the above
Supranuclear gaze palsy
Nystagmus
52
Q

why would microvascular isolated third nerve palsy happen?

A

diabetes, hypertension

53
Q

what is the result of microvascular isolated third nerve palsy?

A

Painless, pupil spared

54
Q

why would compressive isolated third nerve palsy happen?

A

posterior communicating

artery aneurysm, raised ICP

55
Q

what are the result of a compressive isolated 3rd nerve palsy

A

painful, pupil affected

56
Q

what are the causes of isolated sixth nerve palsy?

A

idiopathic
diabetes
meningitis
raised intracranial pressure

57
Q

what is Nystagmus

A 
Congenital
Serious visual impairment
Peripheral vestibular problem
Central vestibular / brainstem disease
Cerebellar disease
Toxins (medication and alcohol)
58
Q

what is trigeminal neuralgia?

A

Paroxysmal attacks of lancinating pain

59
Q

what causes trigeminal neurlgia?

A

Caused by vascular loop

Compression fifth nerve in the posterior fossa

60
Q

how is trigeminal neuralgia treated?

A

with carbamazepine

Surgical options if medication resistant

61
Q

what is bells palsy?

A

Idiopathic facial nerve palsy)
Unilateral facial weakness
Lower motor neurone type
Often preceded by pain behind ear

62
Q

what is affected by bells palsy?

A

Eye closure affected

Risk of corneal damage

63
Q

how is bells palsy treated?

A

steroids

64
Q

give examples of UMN and LMN facial paralysis

A

UMN- stroke, tumour

LMN- bells palsy, lyme, saarcoid

forehead involvement is unilateral in LMN

65
Q

what are the symptoms of vestibular neuritis?

A 
Sudden onset
Disabling vertigo
Vomiting
Gradual recovery
Cause uncertain ? viral
66
Q

what is dysarthria?

A

disordered articulation, slurring of speech

67
Q

what is dysphagia?

A

difficulty swallowing

68
Q

does dysarthria and dysphagia occur in both bulbar and pseudo bulbar palsy?

A

yes

69
Q

which one out of bulbar- and pseudobulbar palsy are UMN

A

Pseudobulbar palsy – upper motor neurone

Bulbar – lower motor neurone

70
Q

what is pseudobulbar palsy?

A

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

71
Q

symptoms of pseudonulbar palsy?

A

dysarthria

  • dysphonia
  • dysphagia
  • spastic, immobile tongue
  • brisk jaw jerk
  • brisk gag reflex
72
Q

what is bulbar palsy?

A

Bilateral LMN lesions affecting IX - XII

eg. MND, polio, tumours, vascular lesions of the medulla and syphilis

73
Q

symptoms of bulbar palsy?

A

wasted, fasciculating tongue

  • dysarthria
  • dysphonia
  • dysphagia

systems- neuro- oc (51 decks)

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