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Neuro Pathology > Disorders of the Cranial Nerves > Flashcards

Disorders of the Cranial Nerves Flashcards

1
Q

Functions of the cranial nerves

A

Special senses
Ordinary senses
Control of muscle activity
Autonomic functions

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2
Q

What special senses do cranial nerves provide?

A

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

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3
Q

What cranial nerves provide ordinary sensations?

A

V (trigeminal)

Ear from VII (facial) and IXth (glossopharyngeal)

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4
Q

What control of muscle activity do cranial nerves provide?

A 
Eye muscles
- III, IV, VI
Muscles of mastication 
- V
Muscles of facial expression 
- VII
Muscles of larynx and pharynx 
- X
Sternocleidomastoid and trapezius muscles - XI
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5
Q

What autonomic functions do cranial nerves provide?

A

Pupillary constriction - III
Lacrimation - VII
Salvation of submandibular and sublingual glands - VII
Salvation of parotid glands - IX
Input to organs in thorax and abdomen - X

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6
Q

How do we test CN I?

A

Unilateral or bilateral smell loss

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7
Q

How do we test CN II?

A 
Visual acuity
Visual fields
Pupillary reactions
Fundoscopy 
Colour vision
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8
Q

How do we test CN III, IV and VI?

A

Any ptosis
Pupils of equal size
Pupillary reaction
Vertical and horizontal eye movements

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9
Q

How do we test CN V?

A

Sensation in opthalmic, maxillary and mandibular divisions
Power in muscles of mastication
Corneal reflex
Jaw jerk

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10
Q

How do we test CN VII?

A

Muscles of facial expression
Corneal reflex
Taste

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11
Q

How do we test CN VIII?

A

Hearing - rhinnes and webers
Vestibular function
- dix hallpike manouvre
- weinbergers test

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12
Q

How do we test CN IX and X?

A

Movement of palate
Gag reflex
Quality of speech
Quality of cough

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13
Q

How do we test CN XI?

A

Head turning and shoulder shrugging

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14
Q

How do we test CN XII?

A

Appearance, movement and power of the tongue

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15
Q

Which CNs are responsible for the pupillary light reactions? (both afferent and efferent)

A

Afferent - II

Efferent - III

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16
Q

Which CNs are responsible for the CN reflexes of the corneal reflex? (afferent and efferent)

A

Afferent - V

Efferent - VII

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17
Q

Which CNs are responsible for the jaw jerk? (Afferent and efferent)

A

Both V

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18
Q

Which CNs are responsible for the gag reflex? (afferent and efferent)

A

Afferent - IX

Efferent - X

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19
Q

Causes of dilated pupils

A 
Youth 
Dim lighting 
Anxiety
Excitement
"Mydriatic eye drops"
Amphetamine
Cocaine overdose 
Third nerve palsy
Brain death
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20
Q

Causes of small pupils

A 
Old age
Bright light 
"Miotic" eye drops
Opiate overdose
Horner's syndrome
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21
Q

Examples of eye movement disorders

A 
Isolated 3rd nerve palsy 
Isolated 4th nerve palsy 
Isolated 6th nerve palsy 
Combination of above
Supranuclear gaze palsy 
Nystagmus
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22
Q

Causes of isolated third nerve palsy

A 
Microvascular 
- DM
- HTN 
Compressive
- posterior communicating artery aneurysm 
- rasied ICP
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23
Q

What helps to distinguish between micro vascular and compressive causes of isolated 3rd nerve palsy?

A

Microvascular - painless, pupil spared

Compressive - painful, pupil affected

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24
Q

Causes of isolated 6th nerve palsy

A

Idiopathic
DM
Meningitis
Raised ICP

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25
Q

Causes of nystagmus

A 
Congenital 
Serious visual impairment
Peripheral vestibular problem 
Central vestibular/brainstem disease
Cerebellar disease
Toxins (medication and alcohol)
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26
Q

What is trigeminal neuralgia?

A

Paroxysmal attacks of lacinating (stabbing/piercing) pain

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27
Q

Who gets trigeminal neuralgia?

A

> middle aged patients

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28
Q

Pathology of trigeminal neuralgia

A

Vascular loop - compression fifth nerve in the posterior fossa

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29
Q

Treatment of trigeminal neuralgia

A

Carbamazepine

Surgery if medication resistant

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30
Q

Another name for bells palsy

A

Idiopathic facial nerve palsy

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31
Q

Presentation of bells palsy

A 
Unilateral facial weakness 
Preceded by pain behind ear 
Eye closure affected
May also have
- altered taste
- dry eyes
- hyperacusis
32
Q

Which of CNS or PNS is affected in bells palsy?

A

PNS

33
Q

What is there a risk of in bells palsy?

A

Corneal damage

34
Q

Treatment of bells palsy

A

Prednisolone (within 72 hours of onset)
Eye care
- artificial tears
- eye lubricants

35
Q

What would cause an UMN facial palsy?

A

Stroke

Tumour

36
Q

What would cause a LMN facial palsy?

A

Bells palsy
Lyme
Sarcoid

37
Q

What is vestibular neuritis?

A

Infection of the vestibular nerve in the inner ear

38
Q

Presentation of vestibular neuritis

A

Sudden onset
Disabling vertigo
Vomiting
Gradual recovery

39
Q

Definition of dysarthria

A

Disordered articulation, slurring of speech

40
Q

Definition of dysphagia

A

Difficulty swallowing

41
Q

Which of UMN or LMN is affected in bulbar palsy?

A

LMN

42
Q

Which of UMN or LMN is affected in pseudobulbar palsy?

A

UMN

43
Q

Which of bulbar and pseudobulbar palsy has both dysarthria and dysphagia?

A

Both

44
Q

Pathology of pseudobulbar palsy

A

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

45
Q

Presentation of pseudobulbar palsy

A 
Dysarthria
Dysphonia
Dysphagia 
Spastic, immobile tongue 
Brisk jaw jerk 
Brisk gag reflex
46
Q

Pathology of bulbar palsy

A

Bilateral LMN lesions affecting IX-XII e.g. MND, polio, tumours, vascular lesions of medulla, syphillis

47
Q

Presentation of bulbar palsy

A

Wasted, fasculating tongue
Dysarthria
Dysphonia
Dysphagia

48
Q

Where are CNs III and IV found?

A

Midbrain

49
Q

Where are CNs V, VI and VIII found?

A

Pons

50
Q

Where is the CN VIII found?

A

Pontomedullary junction

51
Q

Where are CNs IX, X, XI and XII found?

A

Medulla

52
Q

Where can CNs be damaged?

A

In the brain e.g. by ischaemia, tumour
Crossing the subarachnoid space by e.g. meningitis
Outside of the skull e.g. by base of skull tumour in nasopharynx

53
Q

What is optic neuritis?

A

Demyelination within the optic nerve

54
Q

Presentation of optic neurtis

A 
Monocular visual loss
Pain on eye movement
Reduced visual acuity
Reduced colour vision 
Optic disc may be swollen
55
Q

What is optic neuritis usually associated with?

A

MS

56
Q

Bilateral CN III signs would indicate a problem where?

A

Midbrain

57
Q

A combination of CN II, IV and VI signs would indicate a problem where?

A

Superior orbital fissure

58
Q

A combination of CN VI and VII signs would indicate a problem where?

A

Pons

59
Q

A combination of CN V and VIII signs would indicate a problem where?

A

Cerebellopontine angle

60
Q

Unsual combination of cranial nerve signs may indicate what?

A

Chronic or malignant meningitis

61
Q

Pure motor signs by CN may indicate what?

A

Myastenia gravis

62
Q

What does a parasympathetic response do to the pupil?

A

Constricts it

63
Q

What does loss of a parasympathetic input to the pupil result in?

A

A fixed dilated pupil

64
Q

What does a sympathetic response do to the pupil?

A

Dilates the pupil

65
Q

What can damage anywhere in the sympathetic pathway to the pupil result in?

A

A constricted pupil

66
Q

What causes homonymous hemianopias?

A

Lesions of

  • optic tract OR
  • optic radiation OR
  • occipital cortex
67
Q

Homonymous hemianopia and WHAT would indicate damage to the occipital cortex?

A

Macula sparing

68
Q

What causes homonymous quadrantanopias?

A

Lesions of

  • temporal lobe (superior)
  • parietal lobe (inferior)
69
Q

What is the pneumonic to remember what homonymous quarantanopias are caused by which lobe?

A

PITS

  • parietal inferior
  • temporal superior
70
Q

What causes bitemporal hemianopia?

A

Lesion of optic chiasm

71
Q

Upper quadrant defect vs lower quadrant defect in bitemporal hemianopia

A

Upper > lower = inferior chiasmal compression, commonly a pituitary tumour
Lower > upper = superior chiasmal compression, commonly a craniopharyngioma

72
Q

What does a defect in CN VI result in?

A

Defective eye abduction

Horizontal diplopia

73
Q

What is facial nerve palsy the most common neurological manifestation of?

A

Sarcoidosis

74
Q

Who is bells palsy more common in?

A

Pregnant women

75
Q

What CN is susceptible to damage early in the course of raised ICP and why?

A

Abducens nerve

Long course of the nerve

Neuro Pathology (21 decks)

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