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MBChB - Y2 - Systems - Nervous System > Disorders of The Cranial Nerves > Flashcards

Disorders of The Cranial Nerves Flashcards

1
Q

Which cranial nerves contain special senses?

A

Olfaction - 1

Vision - 2

Taste (7,9 and 10)

Hearing and balance (8)

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2
Q

Which cranial nerves carry ordinary sensation?

A

Trigeminal

Ear - facial nerve and the glossopharyngeal

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3
Q

What controls the muscles of the larynx and the pharynx?

A

Mainly the vagus

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4
Q

What cranial nerves have autonomic function? and what is the autonomic function?

A

3,7,9 and 10

3 - pupillary constriction

7- Lacrimation, salivation (sublingual and submandibular glands)

9 - Salivation (parotid gland) - glossopharyngeal

10 - inout to organs in thorax and abdomen

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5
Q

How do we test olfaction?

A
  • Olfactory –smell – unilateral or bilateral loss
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6
Q

Investigations for 2nd cranial nerve when testing it?

A

Visual acuity

Visual fields

Pupillary reactions

Fundoscopy

Colour vision

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7
Q

What do you look for when testing the nerves responsible for eye movement?

A

Ptosis?

Equal sized pupils?

Pupillary reactions?

Eye movements - both vertical and horizontal

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8
Q

Tests for trigeminal?

A

Sensations in the ophthalmic, maxillary and mandibular divisions

Power in the muscles of mastication

Corneal reflex

Jaw jerk

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9
Q

What do we test for with facial nerve?

A

Muscles of facial expression

Corneal reflex

Taste

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10
Q

How do we test the vestibulocochlear nerve?

A

Hearing - rhinnes and webers test

Vestibular function using the dix - hallpike manouvre

and untenbergers test (step test)

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11
Q

How do we test the glossopharyngeal nerve?

A

Movement of the palate

Gag reflex

Quality of speech

Quality of cough

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12
Q

How do we test the accessory nerve?

A

Head turning and shoulder shruging

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13
Q

How do we test the hypoglossal nerve?

A

Appearance, movement and power of the tongue

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14
Q

What are the cranial nerve relfexes and what nerves do they use?

A

• Pupillary light reaction

afferent – II ; efferent – III

• Corneal reflex

afferent – V ; efferent – VII

• Jaw jerk

afferent and efferent – V

• Gag reflex

afferent – IX ; efferent - X

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15
Q

Which cranial nerve nuclei like in the MIDBRAIN?

A

3 and 4

(occulomotor and trochlear)

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16
Q

Which cranial nerve nucle lie in the PONS?

A

5,6,7

Trigeminal, abducent and facial nerve

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17
Q

Which nerve lies in thge pontomedullary junction?

A

8

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18
Q

Which cranial nerve nuclei lie in the medulla?

A

9,10,11 and 12

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19
Q

Which nerves are associated with the cerebellopontine angle?

A

7 and 8

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20
Q

Which nerves are assocaited with the pons?

A

5 and 7

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21
Q

What may result in bilateral 3rd cranial nerve signs?

A

Issue with the midbrain

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22
Q

What may cause unusual combinations of cranial nerve problems?

A

Chronic or malignant meningitis

23
Q

What may cause pure motor signs with cranial nerve issues?

A

Myasthenia gravis

24
Q

What may cause double vision that isn’t a cranial nerve disorder?

A

Myasthenia gravis or thyroid disease

25
Q

What are the ways cranial nerves can be damaged?

A

Ischaemia tumour

Meningitis

26
Q

What is optic neuritis?

A

Demyelinating inflammatory condition of the optic nerve

Inflammation also occurs int he muscles of the eye, they are sore to move

27
Q

What are the signs 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
28
Q

What is a useful test for optic neuritis?

A

Visual evoked repsonse - shows a delay in nerve conduction as a result of optic neuritis

29
Q

What is the result of loss of parasympathetic input from the third cranial nerve?

A

Fixed dilated pupil

30
Q

What causes a constricted pupil?

A

Damage anywhere wihtin the sympathetic pathway can lead to a constricted pupil

31
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
32
Q

What are the causes of small pupils?

A
  • Old age
  • Bright light
  • “Miotic” eye drops
  • Opiate overdose
  • Horner’s Syndrome
33
Q

What are eyemovement disorders?

A
  • Isolated third nerve palsy
  • Isolated fourth nerve palsy
  • Isolated sixth nerve palsy
  • Combination of the above
  • Supranuclear gaze palsy - inability to look in a particular direction as a result of cerebral impairment (nothiung to do with the cranial nerves)
  • Nystagmus
34
Q

What can cause isolated third nerve palsy?

A

Microvascular - diabetes, hypertension

Compressive - posterior communicating artery aneurysm, raised ICP

35
Q

What is the difference in clinical features between microvascular and compressive third nerve palsy?

A

Microvascular - painless, pupil spared

Compressive - painful, pupil affected

36
Q

What can cause isolated 6th nerve palsy?

A

Idiopathic

Diabetes

Meningitis

Raisd intracranial pressure

37
Q

What causes nystagmus?

A
  • Congenital
  • Serious visual impairment (e.g. macular degeneration)
  • Peripheral vestibular problem
  • Central vestibular / brainstem disease
  • Cerebellar disease
  • Toxins (medication and alcohol) medication - phenytoin and carbamezapine
38
Q

What causes trigeminal neuralgia?

A

Triggered by temperature / touching the face

Caused by a vascular loop causing compression of the fifth nerve in the poeterior fossa

39
Q

What is the presentation of trigeminal neuralgia?

A

Paroxysmal attacks of lancinating pain

40
Q

How is trigeminal neuralgia treated?

A

Treated medically with carbamazepine

41
Q

What type of motor neurone type palsy is bells palsy?

A

Lower motor neurone

42
Q

What are the features of bells palsy?

A

Unilateral facial weakness

Often preceeded with pain behind the ear

Eye closure is affected (risk of corneal damage)

43
Q

How is bells palsy treated?

A

Steroids

Usually good recovery

Not all patients recover fully

plastics - re-establish facial symmetry

44
Q

What is the difference between UMN and LMN facial paralysis?

A

UMN - stroke and tumour

LMN - bells palsy, lyme and sarcoid

UMN - forehead movement is still possible on affected side because innervation is bilateral

LMN - No forehead movement on affected side

45
Q

What are the features of vestibular neuronitis?

A

Sudden onset

Disabling vertigo

Vomiting

Gradual recovery

Cause is uncertain (viral?)

46
Q

What is the treatment for vestibular neuronitis?

A

Anti-emitics and bed rest

Tends to recover fully

Very often MS can present with something like thid

47
Q

What is dysarthria and dysphagia?

A

Dysarthria - disordered articulation, slurring of speech

Dysphagia - difficulty swallowing

•Both occur in bulbar- and pseudobulbar palsy

–Bulbar – lower motor neurone

–Pseudobulbar palsy – upper motor neurone

Myasthenia gravis also presents with slurring although this is usually towards the end of the day

48
Q

What causes pseudobulbar palsy?

A

Bilateral UMN lesion - Vascular lesions of both internal capsules (MND)

49
Q

What are the features of pseudobulbar palsy?

A

dysarthria

  • dysphonia
  • dysphagia
  • spastic, immobile tongue
  • brisk jaw jerk
  • brisk gag reflex
50
Q

What is bulbar palsy?

A

Bilateral LMN lesion affecting 9 - 12

51
Q

What causes bulbar palsy?

A

MND

Polio

Tumours

Vascular lesions of the medula and syphilis

52
Q

What are the clinical features of bulbar palsy?

A
  • wasted, fasciculating tongue
  • dysarthria
  • dysphonia
  • dysphagia

BEWARE OF FEEDING THESE PATIENTS - may aspirate

53
Q
A

MBChB - Y2 - Systems - Nervous System (48 decks)

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