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Nervous System > Disorders of Special Sensory Function: The Cranial Nerves > Flashcards

Disorders of Special Sensory Function: The Cranial Nerves Flashcards

1
Q

CN 1?

A

olfactory N

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2
Q

CN 2?

A

optic N

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3
Q

CN 3?

A

occulomotor N

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4
Q

CN4?

A

trochlear N

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5
Q

CN 5?

A

trigeminal N

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6
Q

CN 6?

A

abducens N

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7
Q

CN 7?

A

facial N

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8
Q

CN 8?

A

vestibulocochlear N

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9
Q

CN 9?

A

glossopharyngeal N

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10
Q

CN 10?

A

vagus N?

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11
Q

CN 11?

A

accessory N

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12
Q

CN 12?

A

hypoglossal

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13
Q

what are 4 different functions of cranial nerves?

A

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

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14
Q

which cranial nerves supply special senses?

A

Olfaction (I)
Vision (II) (seeing)
Taste (VII, IX and X)
Hearing - and balance (VIII)

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15
Q

which cranial nerve is in control of olfaction?

A

CN 1

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16
Q

which cranial nerve is in control of vision?

A

CN 2

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17
Q

which cranial nerves are in control of taste?

A

VII, IX and X

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18
Q

which cranial nerves are in control of hearing and balance?

A

VIII

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19
Q

which cranial nerves are in control of ordinary sensation?

A

Mainly the Vth (trigeminal nerve)

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

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20
Q

what are the eye muscles innervated by?

A

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

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21
Q

what pneumonic is a reminder of innervation of eye muscles?

A

(LR6,SO4, rest 3)

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22
Q

what are the muscles of mastication innervated by?

A

V (trigeminal)

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23
Q

what are the muscles of facial expression innervated by?

A

VII (facial)

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24
Q

what are the muscles of larynx and pharynx innervated by?

A

mainly X (vagus)

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25
Q

what are the muscles of sternomastoid and trapezius muscle innervated by?

A

XI (accessory)

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26
Q

what is the autonomic function of occulomotor (CN III)?

A

Pupillary constriction

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27
Q

what is the autonomic function of facial (CN VII)?

A

Lacrimation – VII (facial)

Salivation – submandibular and sublingual glands – VII (facial)

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28
Q

what is the autonomic function of glossopharyngeal (CN IX)?

A

Salivation – parotid gland

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29
Q

what is the autonomic function of vagal (CN X)?

A

Vagal (X) input to organs in thorax and abdomen

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30
Q

what is tested for in affected olfactory (CN I)?

A

smell – unilateral or bilateral loss
use of a smell kit

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31
Q

what is tested for in affected optic (CN II)?

A

visual acuity
visual fields
pupillary reactions
fundoscopy
colour vision

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32
Q

what is tested for in affected 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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33
Q

what is tested for in affected trigeminal N?

A

sensation in the ophthalmic, maxillary and mandibular divisions
{light touch/pin prick}

power in the muscles of mastication (clench teeth and open mouth - feel for muscle bulk either side)

corneal reflex

jaw jerk

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34
Q

how do you test corneal reflex?

A

tiny piece cotton wool touch cornea - patient experiences blinking sensation

35
Q

how do you test for jaw jerk?

A

light tap on jaw on finger

36
Q

what is tested for in affected facial N?

A

Muscles of facial expression
run through cartoon, ask patient to do each one looking at symmetry and assymmetry

Corneal reflex
efferent pathway of corneal reflex

Taste
loss of sense of taste

37
Q

what is tested for in affected vestibulocochlear N?

A

Hearing using Rinne’s and Weber’s tests

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

38
Q

what is tested for in affected IX (glossopharyngeal) and X (vagal)?

A

movement of the palate

gag reflex

quality of speech

quality of cough
39
Q

what is tested for in affected IX XI – Accessory nerve?

A

Head turning and shoulder shrugging

sternomastoid and trapezius function

40
Q

what is tested for in affected XII – Hypoglossal nerve?

A

Appearance, movement and power of tongue

41
Q

what cranial nerves are responsible for Pupillary light reaction?

A

afferent – II ; efferent – III

42
Q

what cranial nerves are responsible for Corneal reflex?

A

afferent – V ; efferent – VII

43
Q

what cranial nerves are responsible for jaw jerk?

A

afferent and efferent – V

44
Q

what cranial nerves are responsible for gag reflex?

A

afferent – IX ; efferent - X

45
Q

what is the location of III and IV (Oculomotor and Trochlear) nuclei ?

A

MID-BRAIN

46
Q

what is the location of V, VI AND VII (Trigeminal, Abducent and Facial) nuclei?

A

PONS

47
Q

what is the location of VIII (Vestibulocochlear) nuclei?

A

PONTOMEDULLARY

48
Q

what is the location of IX, X XI and XII (Glossopharyngeal, Vagus, Accessory and Hypoglossal) nuclei?

A

MEDULLA

49
Q

where would the lesion be affecting the occulomotor N?

A

midbrain

50
Q

where would the lesion be affecting the III +IV+VI?

A

superior orbital fissure

51
Q

where would the lesion be affecting the VI +VII?

A

pons

52
Q

where would the lesion be affecting the CN V + VIII?

A

cerebellopontine angle

53
Q

what would an example be of an unusual combination of CN disfunction?

A

chronic or malignant meningitis

54
Q

what is a pure motor sign affecting neuromuscular junction (causing weakness)?

A

myasthenia gravis

55
Q

Not all cranial nerve signs imply a cranial nerve lesion, give examples?

A

eye movement disorders, facial weakness, difficulty swallowing after a stroke

double vision in myasthenia or thyroid eye disease

56
Q

how can cranial nerves be damaged within the brain?

A

ischaemia, tumour

57
Q

how can cranial nerves be damaged crossing sub arachnoid space?

A

meningitis

58
Q

how can cranial nerves be damaged outside skull?

A

base of skull tumours arising in nasopharynx

59
Q

what is optic neuritis?

A

demyelination within the optic nerve

60
Q

what are symptoms of optic neuritis?

A

monocular visual loss
pain on eye movement
reduced visual acuity
reduced colour vision
optic disc may be swollen

61
Q

what condition is optic neuritis often associated with?

A

multiple sclerosis

62
Q

what are parasympathetic pupillary responses?

A

constriction of the pupil

63
Q

what does loss of parasympathetic input of pupil result in?

A

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

64
Q

what does loss of sympathetic input of pupil result in

A

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

65
Q

what is the sympathetic pupillary response?

A

pupillary dilatation

66
Q

what are causes of dilated pupils?

A

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

67
Q

what are causes of small pupils?

A

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

68
Q

give examples of eye movement disorders?

A

Isolated third nerve palsy
Isolated fourth nerve palsy
Isolated sixth nerve palsy
Combination of the above
Supranuclear gaze palsy (not cranial nerve issue)
Nystagmus

69
Q

what is microvacular third nerve palsy?

A

diabetes, hypertension
Painless, pupil spared

70
Q

what is compressive third nerve palsy?

A

posterior communicating
artery aneurysm, raised ICP
Painful, pupil affected

71
Q

what is Isolated sixth nerve palsy?

A

Numerous causes including
idiopathic
diabetes
meningitis
raised intracranial pressure

72
Q

what is nystagmus?

A

Congenital
Serious visual impairment
Peripheral vestibular problem
Central vestibular / brainstem disease
Cerebellar disease
Toxins (medication and alcohol) (most common)

73
Q

what is trigeminal neuralgia?

A

Paroxysmal attacks of lancinating pain
Triggers
Middle age and older
Caused by vascular loop
Compression fifth nerve in the posterior fossa

74
Q

what are treatment options of trigeminal neuralgia?

A

Treated medically with carbamazepine (not well tolerated in older patients)

Surgical options if medication resistant

75
Q

what is bells palsy?

A

Unilateral facial weakness
Lower motor neurone type
Often preceded by pain behind ear
Eye closure affected
Risk of corneal damage

76
Q

how is bells palsy treated?

A

Treated with steroids
Usually good recovery

77
Q

what causes upper motor neuronal facial paralysis?

A

stroke/tumour

78
Q

what causes lower motor neuronal facial paralysis?

A

Bell’s Palsy, Lyme, sarcoid

79
Q

what is vestibular neuronitis?

A

Sudden onset
Disabling vertigo
Vomiting
Gradual recovery
Cause uncertain ? viral

80
Q

what is dysarthria?

A

disordered articulation, slurring of speech

81
Q

what is dysphagia?

A

difficulty swallowing

82
Q

what occurs in bulbar- and pseudobulbar palsy?

A

dysarthria and dysphagia

83
Q

what causes bulbar palsy?

A

lower motor neurone

84
Q

what causes Pseudobulbar palsy?

A

upper motor neurone

Nervous System (40 decks)

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