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Pathophys-Derm > Herniation and Cranial Nerves > Flashcards

Herniation and Cranial Nerves Flashcards

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1
Q

In LD position what is normal ICP in mmH2O? in mmHg?

A

<15 mmHg

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2
Q

What is the definition of herniation?

A

shifting of brain tissue from area of high pressure to area of lower pressure

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3
Q

2 ways to get an uncal herniation?

A
  1. hemorrhagic stroke involving middle cerebral artery, and 2. meninioma in same area pushing downward
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4
Q

Is an uncal herniation supra or infratentorial?

A

supra

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5
Q

What will an uncal herniation cause first?

A

ipsilateral CN III palsy

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6
Q

Ipsilateral CN III palsy will result in?

A
  1. pupillary dilation 2. paresis/weakness of EOMs (except LR and SO), so eye will be looking DOWN and OUT, also eyelid will be droopy (ptosis) d/t lack of innervation of the levator muscle
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7
Q

What will happen with a slow growing lesion like a tumor causing uncal herniation as opposed to a traumatic/hermorrhagic bleed?

A

You will start with ipsilateral CN III palsy and then it will go to bilateral CN III palsy

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8
Q

How often do you do neuro checks in critical care unit?

A

every 15 mins

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9
Q

When someone has hyperosmia, what conditions should you consider?

A

migraines, temporal lobe seizures or hallucinations

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10
Q

If someone has hyposmia, what can this be associated with?

A

Degenerative diseases, AD, aging, PD, HD

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11
Q

If someone has anosmia, what conditions should you consider?

A

nasal or paranasal disease/infection/trauma

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12
Q

What nerve is the AFFERENT limb of the pupillary reflex?

A

CN II (Optic)

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13
Q

What nucleus in the thalamus does CN II go to?

A

Lateral geniculate

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14
Q

A collateral from CN II after it goes to the Lateral geniculate in the thalamus goes where? Why?

A

Goes to the brainstem, not for interpretation but for pupillary response

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15
Q

Parietal is Baum’s loop = ?

A

contralateral homonymous inferior quadrantanopia “pie in floor”

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16
Q

Temporal is Meyer’s loop = ?

A

contralateral homonomyous superior quadrantanopia “pie in sky”

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17
Q

What nerve innervates the levator muscle? What does this muscle do?

A

CN III, it raises the eyelid

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18
Q

PNS from CN III to sphincter of iris changes what?

A

pupil size

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19
Q

PNS from CN III to ciliary muscle changes what?

A

lens shape

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20
Q

3 ways to get CN III palsy?

A

trauma, DM, atherosclerosis

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21
Q

What is EFFERENT limb of pupillary reflex?

A

CN III (Oculomotor)

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22
Q

When you shine a light in the eye, what all are you testing?

A

CN II, III, and the brain stem (@ level of the midbrain)

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23
Q

Where does CN III’s visceral efferents originate?

A

Edinger-Westphal Nucleus

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24
Q

If you shine a light in someone’s LEFT eye and they have no direct or consensual response but when you shine it in their RIGHT eye they have both direct and consensual, what two places could you have a lesion?

A

The LEFT CN II or in the LEFT PRE-TECTAL NUCLEUS in the midbrain. Both would give the same response.

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25
Q

If you shine a light in someone’s RIGHT eye and they have a response in that eye but not consensually and then shine in the left eye which yields no response in that eye but response consentually, where is the problem? There are 2 possible answers

A

They either have lesioned their LEFT EWN or their LEFT ciliary ganglion.

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26
Q

What way does the superior oblique muscle move the eye?

A

inward and down

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27
Q

What CN is responsible for facial sensations?

A

CN V, trigeminal

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28
Q

What CN is responsible for proprioception of the muscles of mastication?

A

CN V, trigeminal

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29
Q

What CN is the AFFERENT limb of the corneal reflex?

A

CN V, trigeminal

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30
Q

What CN provides motor to mm of mastication?

A

CN V, trigeminal

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31
Q

If you have a problem with CN VI, what will happen?

A

medial strabismus and double vision

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32
Q

What CN provides sensory info from the anterior 2/3rds of the tongue?

A

CN VII, facial

33
Q

What CN provides pain and temp info from the external auditory meatus and skin of the ear?

A

CN VII, facial

34
Q

If a pt comes in with swimmer’s ear and is in a lot of pain, what CN is responsible for that pain sensation?

A

CN VII, facial

35
Q

Does CN VII have visceral efferents? If so, where to?

A

Yes, to lacrimal and salivary glands (except parotid)

36
Q

What nerve is the EFFERENT limb of the corneal reflex?

A

CN VII, facial

37
Q

If someone has Bell’s palsy, what treatment should you focus on?

A

The eye, keeping it moist due to the ptosis

38
Q

With the corneal reflex, what level of the brainstem are you also testing?

A

The pons

39
Q

If you are testing the corneal reflex and touch the right cornea and you see blinking on the left and then when you touch the left there is also only blinking on the left, where is your lesion?

A

Right motor nucleus of CN VII or in the R facial nerve itself

40
Q

If you have a lesion in the R trigeminal ganglion, not only will you lose pain temp and touch of the ipsilateral side of the face, but what else will happen?

A

You will lose the corneal reflex on the R side, so if you touch the right cornea, neither eye will blink.

41
Q

If you can raise your left eyebrow but can’t smile on your left, what should you think of?

A

A stroke on the RIGHT side of your cortex

42
Q

Organ of corti = ?

A

Hearing

43
Q

Crista ampullae of vestibular apparatus = ?

A

equilibrium

44
Q

Conductive hearing loss will give what kind of results with Weber/Rinne?

A

Decrease Rinne in affected ear, Increase Weber in affected ear

45
Q

Sensorineural hearing loss will give what results with Weber?

A

Decrease Weber in affected ear

46
Q

A “normal” dolls eyes response is what, if the person’s brain stem is still intact?

A

That when you turn their head to one side their eyes will eventually turn and stay forward

47
Q

What does it mean if both eyes follow the head with turning and don’t return looking forward with the Doll’s eye test?

A

This means there is no connection happening in the brainstem

48
Q

What reflex is the Doll’s eyes test testing?

A

Oculocephalic

49
Q

What all are you testing with Doll’s eyes?

A

CN VIII, upper medullary region, pons (because this is where CN VIII comes in), and the midbrain (bc it has to go all the way up to CN III to respond)

50
Q

What does “COWS”? stand for/used for?

A

Cold Opposite Warm Same Side, this is to help remember the NORMAL (subsequent) response to the test with squirting water in the ear.

51
Q

What are the two different phases to the water in the ear test?

A 
Initial response w/ cold water: eyes go toward the water, 
Subsequent response (COWS), with cold water eyes will have nystagmus toward the  opposite side of the water.
52
Q

Besides looking for eyes responding to the water in the water squirting test, what else should you be looking for?

A

Both eyes to be doing the same thing

53
Q

What all are you testing with the water squirting into the ear test?

A

CN VII, VIII, III, IV, VI

54
Q

If one eye responds how it should to the water squirting test and one eye doesn’t what does this mean? What if both eyes are abnormal?

A

One eye: brain stem disfunction

Both eyes: No brain stem function at all

55
Q

Brain death = ?

A

Body cannot maintain internal homeostasis

56
Q

Irreversible coma = ?

A

Cerebral Death

57
Q

What responses are lost with cerebral death?

A

behavioral and environmental

58
Q

What are the potential outcomes for pts who survive cerebral death?

A

Remain in coma, emerge into a “vegetative state” or a “wakeful unconscious state”, or progress into a minimally conscious state such as akinetic mutism or “locked-in syndrome”

59
Q

What part of the brainstem are you testing with the gag reflex?

A

medulla

60
Q

Which nerve is responsible for the AFFERENT limb of the gag reflex?

A

CN IX: glossopharyngeal

61
Q

Taste from the posterior 1/3rd of the tongue is through what CN?

A

IX: glossopharyngeal

62
Q

Visceral efferents to the parotid gland are through which CN?

A

IX, glossopharyngeal

63
Q

Motor to muscles necessary for swallowing and the gag reflex are through which CN?

A

IX, glossopharyngeal

64
Q

Taste buds in epiglottis and sensory from pharynx and larynx is what CN?

A

X, vagus

65
Q

Which CN is the EFFERENT limb of the gag reflex?

A

X, vagus

66
Q

Muscles for soft palate and pharynx and larynx are innervated by what CN?

A

X, vagus

67
Q

What is afferent portion of CN XI?

A

propioception from muscles in the neck

68
Q

Which muscles are innervated by CN XI?

A

Trapezius and SCM

69
Q

If you have damage to your CN XI? Can you still use the muscles it innervates?

A

Yes because they are also innervated partially by spinal nerves, but you will have diminished strength.

70
Q

What is a “false localizing manifestation”?

A

When you have a tumor on the R you would expect that it would compress the IC on the same side of the tumor and cause contralateral motor paresis, but a “False localizing sign” is when you would have paresis or paralysis on the SAME side as the tumor due to the compression of the opposite IC. (from the brain pushing over)

71
Q

What is Kernahan’s notch?

A

a cerebral peduncle indentation as a result of a tumor or hemorrhage on the opposite side of the brain. It will result in hemiparesis on the OPPOSITE side of the notch which would be the same side of the body as the tumor or bleed.

72
Q

What happens if an uncal herniation continues?

A

Downward and medial displacement of the hemisphere may also compress one or both POSTERIOR CEREBRAL ARTERIES causing impairment of blood flow to the occipital lobes (another false localizing sign)

73
Q

What do you have to worry about with a cingulate herniation?

A

The anterior cerebral artery could become compressed

74
Q

If a cingulate herniation causes the anterior cerebral artery to be displaced beneath the falx how will an infarction manifest?

A

As contralateral lower extremity weakness+/ confusion and drowsiness

75
Q

herniation of both hemispheres transtentorially =?

A

central herniation

76
Q

How does a “central” herniation manifest?

A

bilateral dilated and fixed pupils, flaccidity (no motor control), coma

77
Q

What are Duret hemorrhages?

A

When the brainstem is displaced with a central herniation, it can wretch the surrounding vessels causing linear (duret) hemorrhages

78
Q

Describe a cerebellar tonsillar herniation

A

cerebellar tonsils get compressed which may compress medullary centers; can result in sudden death

79
Q

Who do you see cerebellar tonsillar herniations in?

A

Kids, because 80% of adult tumors are supratentorial when most of the kids’ tumors are below.

Pathophys-Derm (3 decks)

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