lecture 15: CN III, IV, VI Flashcards
true or false and explain: all visual information entering the right eye will end up on the left primary visual cortex
false, it is all information from th right visual field
true or false: the right temporal optic radiations carry info from the upper left visual quadrants
true
true or false and explain: the temporal aspects of the retina always receive information from the right visual field
false, receive info from medial visual fields
true or false and : all neurons carrying information from the fovea (bilateral) will decussate at the optic chaise
false
following a head injury, friend says they can barely smell and nose seems runnier than usual (but not congested) what part of olfactory pathway is affected
olfactory n (if runny, CSF)
cribirome plate can be broken and damage olfactory nerves
what are the orbits
paired pyramidal osseous cavities
what are the 7 bones that contribute to each orgbit
frontal
sphenoid
ehhmoid
palatine
lacrimal
maxilla
zygomatic
what fissure is located between the greater and lesser wings of sphenoid
superior orbital fissure
explain the oblique orientation of the orbit
each apex points in a posteromedial direction, creating an oblique orientation
each apex of orbit points in a BLANK direction, creating an oblique orientation
POSTERMOEDIAL
the orbital axis points in what direction
posteromedial
true or false, the orbital axis does not equal the optic axis
true
explain how the axis of eyeball (optical axis) does not equal the axis of orbit (or=bital axis)
orbital axis points posteromedially while optic axis is a straight vertical line
what is at the apex od the orbit
optic canal
what n passes thru the optic canal
optic n
how many extraocculator muscles are there
7
true or false: all 7 extraoccualtor muscles attach to the eye
false, only 6
what are the 7 extraoccualar muscles
superior obloqie
inferior oblique
medial rectus
lateral rectus
inferior rectus
superior rectus
levator palpeerde superioris
what is the one extraoccular muscle that does not attach to the eyeball
levator palpebrae superioris
what are the 3 rotation axes of the extraoccular muscles
horizontal (transverse)
vertical
anteroposterior
vertical axis of the eye allows what movements
abduction and adduction
anteroposterior axis of the eye allows what movements
lateral and medial rotation
aka intorsion and extorsion
tranverse axis of the eye allows what movements
evlevation and depression
true or false; eyes usually move along a single plane/single axis
false, rarely
extraoccular muscles work in various combos to facilitate muscles
do the rectus muscles attach on the anterior or posterior part of the eyeball
anterior
do the oblique muscles attach on the anterior or posterior part of the eyeball
posterior
know the locations of the extraocculato eye moments
the medial and lateral rectus attach where
to common tendinous ring and anterior sclera on medial and lateral sides respective
the medial and lateral rectus only contribute to movement about what axis (and what movements)
about the vertical axis (adduction and abduction)
true or false:the medial and lateral rectus only contribute to movement about transverse axis (ie: elevation and depression)
false, only vertical axis (adduction and abduction)
what are the only two types of movement possible for the medial and lateral rectus and why
only adduction and abduction because they can only contribute to movement about the vertical axis
what os the action of the medial rectus
adduction
adduction is medial or lateral erctus
medial
what os the action of the lateral rectus
abduction
abduction is medial or lateral rectus
lateral
is adduction of eye getting closer to further from nose
closer
where do the superior and inferior rectus attach
to the common tendinous ring and to the anterior sclera on the superior and inferior aspects respectively
the primary action for the superior and inferior rectus is along what axis
about the horizontal axis (elevation and depression)
explain the primary, secondary and tertiary actions (along what axes) of the superior and inferior rectus
primary action about horizontal axis
secondary action about AP axis
tertiary action about the vertical axis
the secondary action for the superior and inferior rectus is along what axis
AP axis (intorsion/extorsion_
the tertiary action for the superior and inferior rectus is along what axis
vertical axis (adduction/abduction)
what is the primary action of the superior rectus
elevation
what is the secondary action of the superior rectus
intersion
what is the tertiary action of the superior rectus
adduction
what is the primary action of the inferior rectus
depression
what is the secondary action of the inferior rectus
extorsion
what is the tertiary action of the inferior rectus
adduction
true or false: both thes superior and inferior rectus do adduction
true
explain how there is multiracial actions of the superior and inferior rectus muscles
can be attributed to the lack of alignment between the optical and orbital axes
true or false: both superior oblique and rectus are abductiors
false
superior oblique = abductor
superior rectus=adduction
explain why adduction is a tertiary action for superior and inferior rectus
since the medial and lateral rectus are always the primary adductors and abductors
explain attachment of the superior obliqeu
attaches to the sphenoid and passes thru a fibrous ring (trochlea) resulting in a change of direction (redirects line of pull)
explain why there is a redirection of line of pull in the superior oblique
attaches to the sphenoid and passes thru a fibrous ring (trochlea) resulting in a change of direction (redirects line of pull)
explain the attachment of the inferior oblique
attaches to the maxilla on the anterior medial floor of orbit
explain the primary, secondary and tertiary actions (along what axes) of the superior and inferior oblique
primary action about the AP axis (torsion)
secondary about the horizontal axis (dep elevation)
tertiary about the vertical axis (adduction/abduction)
the primary action for the superior and inferior oblique is along what axis
AP axis (torsion)
the secondary action for the superior and inferior oblique is along what axis
horizontal axis (dep and elevation)
the tertiary action for the superior and inferior oblique is along what axis
vertical axis (abduction)
what is the primary action of the superior oblique
intorsion
what is the secondary action of the superior oblique
depression
what is the tertiary action of the superior oblique
abduction
what is the primary action of the inferior oblique
extorsion
what is the secondary action of the inferior oblique
elevation
what is the tertiary action of the inferior oblique
abduction
both the superior and inferior obliques are adductors or abducors
abductors
both the superior and inferior rectus are adductors or abducors
adductors
which extraocculatr muscles do adduction
MAIN: medial rectus
side: superior and inferior rectus
which extraocculatr muscles do abduction
main: lateral rectus
side: superior and inferrer oblique
which extraocculatr muscles do elevation
MAIN: superior rectus
side: inferior oblique
which extraocculatr muscles do depression
main: inferior rectus
side: superior oblique
which extraocculatr muscles do intorsion
main: superior oblique
side; superior rectus
which extraocculatr muscles do extorsion
main: inferior oblique
side: inferior rectus
explain the seemingly inverted actions of the obqlieu muscles about the horizontal axis (ie: superior oblique=depression)
can be attributed to how the oblique muscles run anterior to posterior
true or false: the oblique muscles run posterior to anterior
false
anterior or posterior
what is the test for extraoccualtor muscles
H test
how do you assess the extraoccular muscles (and aosciatdd cranial n)
H test
requires isoalated each muscle individually (most movements require multiple muscles)
accomplished by aligning the optical axis with the line of pull for the SR/IF and SO/IO
how can you test the medial and lateral rectus
just have them abduct and adduct (since they are the primary movers) and if intact and symmetrical on both sides its good
how can you test the superior and inferior rectus muscles
put eye into 23 degrees abduction (produced by lateral rectus) which aligns the optical axis with the line of pull for the superior and inferior rectus muscles
=ask patient to elevate and depression (is only being done by rectus muscles and not obliques)
by putting the eye intoput eye into 23 degrees abduction (produced by lateral rectus), what does this allign
which aligns the optical axis with the line of pull for the superior and inferior rectus muscles
if the eye is in 23 degrees abduction, what are the only muscles working for elevation and depression
SR and IF
do test SR and IR, does the eye need to be in adduction or abduction
abduction
do test SO and IO, does the eye need to be in adduction or abduction
adduction
how can you test the superior and inferior oblique muscles
put eye into 51 degrees adduction (produced by medial rectus) which aligns the optical axis with the line of pull for the superior and inferior oblique muscles
=ask patient to elevate and depression (is only being done by oblique muscles and not rectus)
by putting the eye intoput eye into 51 degrees adduction (produced by medial rectus), what does this allign
aligns the optical axis with the line of pull for the superior and inferior oblique muscles
if the eye is in 51 degrees adduction, what are the only muscles working for elevation and depression
inferior and superior oblique
be able to do h test
which cranial n is the king of the eyeball
oculomotor n (CN III)
what are the 3 cranial n involved in extra occular muscles
CN III (oculomotor0
CN IV (trochlear)
CN VI (abducens)
is oculomotor a sensory, motor, or both nerve
motor
is trochlear a sensory, motor, or both nerve
motor
is abducents a sensory, motor, or both nerve
motor
where do all 3 cranial nerves of extra occular muscle innervation (III, IV, VI) exit the skull
via the superior orbital fissure
true or false: cranial n III, IV and VI only carry motor info
true
what is the only n out of these (trochlear, oculomotor and abducens) that carries visceral motor info
oculomotor
what does the superior branch of the oculomotor n innervat
SR, levator palp superioris
SR, levator palp superioris are innervated by what
superior branch of occulmotor
what does the inferior branch of the oculomotor n innervate
IR , MR, IO (preganglionic parasymp fibers)
IR , MR, IO (preganglionic parasymp fibers) is innervated by what
inferior branch of oculomotor
what carries preganglionic parasymp fibers for the eye
inferior branch of oculomotor n
what carries postganglionic parasymp fibers for the eye
short cilliary n
what is the parasympathetic ganglion near the eye
ciliary ganglion
what are the small nerves coming from the ciliary ganglion and what is their function
short ciliary nerves
carry post ganglionic parasympathetic fibers (go to our ciliear muscles and scphinter muscles)
which nerves carry the postganglionic parasymp fibers for the eye
short ciliary n
what is the target tissue for the post ganglionic parasympathetic fibers of the eye
to ciliary muscles (change the shape of the lens) and sphincter papillae (change the size of the pupil)
what does the trochlear n innervate in the eye
superior oblique m
superior oblique m is innervated by what
trochlear n
what does the abducens n innervate
lateral rectus muscle
lateral rectus muscle is innervated by what
abducens
lesion to abducens n will cause probelms with what movement
abduction
what is the location of the oculomotor n at the brainstem level
interpenduncular fossa (level of superior colliculi)
what is the location of the trochlear n
dorsal aspect of midbrain (level on inf colliculi)
true or false, the trochlear n emerges from ventral brainstem
false, dorsal aspect
what is the location of the abducens n
pontomedullary junco ventrally (most medial)
true or false: abducens n carries both somatic and visceral motor info
false, oculomotor does
oculomotor, abducens and tracheal all emerge from foramina in what skull bone
sphenoid
true or false: CN III, IV have brainstem nuclei while CN VI does not
false, they all are associated with brainstem nuclei
why does the oculomotor n have two brainstem nuclei
since it carries both visceral and somatic motor info
where is the locations of the oculomotor nuclei
in rostral midbrain (superior colliculi)
=ventral to cerebral aqueduct near midline)
in rostral midbrain (superior colliculi)
=ventral to cerebral aqueduct near midline)
is associated with what brainstem nuclei
oculomotor
what is the oculomotor nuclei that carries main somatic motor info
nucleus of CN III (oculomotor n)
what is the oculomotor nuclei that carries visceral motor info
accessory oculomotor n
true or false: it is almost impossible to damage one oculomotor nucleus without the other
true, they are so close
what is the location of the trochlear n nucleu
caudal midbrain (at inf colliculi)
ventral to cerebral aqueduct
caudal midbrain (at inf colliculi)
ventral to cerebral aqueduct
is what brainstem nuclei
trochlear
true or false: trochlear n comes from the dorsal brainstem
true
where is the location of the abducens nuclei in the brainstem
caudal pons
true or false: trochlear n brainstem nuclei is located at caudal pons
false, thats abducens
what is the somatic motor brainstem nuclei of the trochlear n called
nucleus of CN IV/ trochlear nucleus
where does the abducens exit the brainstem
at the pontomedullary junction
true or false: the oculomotor n has the longest intracranial route
false, the abducens does
in the caudal pons, are the abducens nuclei located more ventral or dorsal
dorsal
in the caudal pons, are the abducens nuclei located more lateral or medial
medial
what is the name of the brainstem nuclei for abducens n
nucleic of CN VI / abducens nucleus
true or false, the right trochlear nucleus gives rise to left trochlear n
true
are the somatic motor nuclei of CN III, IV, VI located more medial or lateral
medial
explain the course of the extraoccular muscle n
all three n (3,4,6) pass through (or along the wall of) the cavernous sinus en route to the orbit
what 3 nerves pass through or along the wall of the cavernous sinus
CN III, IV, VI
what cranial n passes THROUGH the cavernous sinus out of III, IV, VI
abducens (VI)
what are some additional structures that pass thru the cavernous sinus (besides CN III, IV, VI)
CN V1 and V2, internal carotid a and carotid plexus
what sits at the centre of cavernous sinus (but not actually in it)
pituitary gland
if you have a cavernous sinus hemmorange, what cranial n are affected
III, IV, VI
V1 and V2
true or false: CN III, IV and VI exit the skull via the inferior orbital fissure of the sphenoid bone
false, superior
where are the cavernous sinus located
lateral to the sella turcica
infection of the cavernous sinus that infects cranial n III, IV and VI can lead to what
a situation where you no longer have voluntary movement of your eyes
true or false: the oculomotor nucleus carries visceral motor
false, somatic motor
located in the midbrain at the level of the superior colliculi which brainstem nuclei
oculomotor n
what are the 3 subnuclei of the on=culomotor nucleus
lateral
medial
centra
what does the lateral sub nucleus or oculomotor supply
IPSILATERAL IR, IO, MR
IPSILATERAL IR, IO, MR is supplies by what oculomotor sibnucleus
lateral
what does the medial subnucleus of oculomotor supply
CONTRALATERAL SR
CONTRALATERAL SR is supplied by what oculomotor subneir
medial
what does the central sub nucleus of oculomotor supply
supplies lev palp superioris bilaterally
supplies lev palp superioris bilaterally is done by what oculomotor subnucleus
central subnucleus
true or false: the central subnucleus of oculomotor supplies lev palp superioris unilaterally
false, bilaterally
true or false: the right SR will actually be receiving innervation form the right medial subnucleis
false, receiving from the left medial subnucleus (since contralateral projections)
which is located more dorsal, the oculomotor nucleus or the accessory oculomotor
accessory
the accessory oculomotor n carries somatic or visceral motor
visceral
what does the accessory occulomotor nucleus supply
ciliary muscles (change in lens shape) and sphincter pupil (constrict pupils) via ciliary ganglion
ciliarymuscles (change in lens shape) and sphincter pupil (constrict pupils) via ciliary ganglion is supplied by what brainstem nucelsi
accessory occulomotor
ciliary muscles (change in lens shape) and sphincter pupil (constrict pupils) are supplied via what ganglio
via ciliary ganglion
contraction of ciliary muscles increases or decreases internal diameter of the lens
decreases (lens becomes fatter)
contraction of sphincter pupil constricts or dilates pupil
contacts
construction of pupil is done by para or sympathetic fibers
parasympathetic (via ciliary ganglia)
explain sympathetic innervation of dilator pupils
comes from thoracic level horns and synapse in superior cervical ganglionsu
superior cervical ganglion is for dilating or constricting pupil
dilating (sympa)
ciliary ganglion is for dilating or constricting pupil
constricting (parasympathetic)
what are the 3 symptoms of horners syndrome
miosis (constricted pupil)
anhidrosis (reduced sweat)
slight ptosis (droopy eyelids)
what is miosis
constricted pupil
what is anhidrosis
reduced sweat
what is ptosis
eyelid drooping
miosis, anhydrous and slight ptosis is associated with what condtion
horners syndrome
horners syndrome is associated with damage to sympathetic or parasympatethic neurons inneravting face and neck
sympatethic
explain the pathway for horners syndrome
higher order, downstream signalling from subcortical structures (eg. hypo)
communicate with preganglionic sympathetic neurons with cell bodies in upper thoracic lateral horns (t1-t2)
preganglionic synapse with posterior ganglionic sympathetic neurons in superior cervical ganglion)
fibers move thru carotid plexus
=innervate the dilator papillae, superior tarsal muscles and eccrine sweat glands
in innervation to dilator pupillae, where are the preganglionic sympathetic neurons located
cell bodies in lateral horns of upper thoracic area
in innervation to dilator pupillae, where do the preganglionic sympathetic neurons synapse with post
in superior cervical ganglion (highest region of sympa g=chain)
true or false: you can get a droopy eyelid from both parasympathetic and sympathetic damage
true just with parasympthieic the affects will be more severe
where will the symptoms present in oculomotor n plays
all symptoms will present ipsilateral to lesion if the NERVE is affected
what are the symptoms of an oclumotor n palsy
strabismus (down and out position)
ptosis (droop eyelid)
dilated pupil (decrease sphincter pupil tone)
unresponsive to light and unable to accommodate (loss of ciliary muscle innervation)
true or false: all lesions to nerves affected the extraoccualr muscles will result in strabismus
true
explain why you have ptosis in oculomotor n palsy
since the oculomotor n (specifically the central subnucleus) innervated the levator palp superioisis
explain why the eye will present in an down and out position for oculomotor n palsy
only left with lateral rectors and superior oblique muscles (since they are innervated by trochlear
explain why you have a dilated pupil in oculomotor n plasy
because there is a decrease sphincter pupilae tone (since innervated by accessory nucleus of oculomotor)
explain why you have unresponsiveness to light and unable to accommodate in oculomotor n palsy
loss of ciliary n muscle innervation (innervated by accessory oculomotor nucleus)
the pupillary light reflex involves what cranial nerves
cranial nerves II and II (optic and oculomotor)
explain the pathway of the pupillary light reflex
stimulus=light
afferent limb (sensory)
=visual info carried by optic n (CN II)
=fibersbypass lateral geniculate nuclei and project to pretectal nuclei in midbrain
interneurons
=pretectal nuclei sends signals to accessory oculomotor nuclei bilaterally (axons decussate in posterior cominssure)
efferent limb (visceral motor)
=preganglionic parasymp fibers from accessory oculomotor nuclei project to the ciliary ganglia (synapse)
=post ganglionic fibers (short ciliary n) innervate sphincter pupillae muscles
response=contrisction of pupils
explain the afferent limb aspect of the pupillary light reflex
afferent limb (sensory)
=visual info carried by optic n (CN II)
=fibersbypass lateral geniculate nuclei and project to pretectal nuclei in midbrain
true or false, in the pupillary light reflex, sensory information carried by optic n will synapse like normal in the lateral genicualte nucleis
=fibersbypass lateral geniculate nuclei and project to pretectal nuclei in midbrain
where do optic n fibers project to in the pupillary light reflex
pretectal nuclei in midbrain
explain the interneuron aspect of the pupialry light reflex
interneurons
=pretectal nuclei sends signals to accessory oculomotor nuclei bilaterally (axons decussate in posterior cominssure)
where do the pretectal nuclei send their signals
interneurons
=pretectal nuclei sends signals to accessory oculomotor nuclei bilaterally (axons decussate in posterior cominssure)
do pretectal nuclei sends signals to accessory oculomotor nuclei bilaterally or unilaterally
bilaterally (axons decussate in posterior cominssure)
explain the efferent limb of the pupillary light reflex
efferent limb (visceral motor)
=preganglionic parasymp fibers from accessory oculomotor nuclei project to the ciliary ganglia (synapse)
=post ganglionic fibers (short ciliary n) innervate sphincter pupillae muscles
where do preganglionic parasymp fibers from accessory oculomotor nuclei project to in the efferent limb of the pupillary light reflex
the ciliary ganglia
after preganglionic parasymp fibers from accessory oculomotor nuclei project to the ciliary ganglia (synapse), what do the post ganglionic fibers inneravtes in the pupilary light reflex
=post ganglionic fibers (short ciliary n) innervate sphincter pupillae muscles
what is the response of the pupillary light reflex
cosntriction of pupil
is there only direct response for the pupilary light reflex and explain
no there is direct (eye getting the light) and consensual (other eye not getting light should also constrict)
think of a lesion in the pupillary light reflex that would lead to only direct loss, consentual loss or both
visual accommodation reflex is carried out by what CN
CN II and III
when does visual accommodation happen
when we look at something close and need to keep it in focus on the fovea
the visual accommodation response is coordinated by whaat area
supraoculomotor area (in upper midbrain at the junction between dienceptaon)
what are the 3 main things that happen for viausla accomodation
1) convergence of gaze
2) increase in reactive power
3) increase of depth of field
explain convergence of gaze in visual accomodation
adduction thru activation of medial rectus muscles bilaterallyis
is convergence done by medial or lateral rectus
medial (it is adduction)
explain increase of refractive power in the visual accomodation
increase curvature of the lens (get fatter) thru activation of ciliary muscles bilaterally
=to properly land of fovea
explain increase depth of field in visual accomodate
constriction of pupil through activation of spincther pupilae bilatearlly
be able to know visual accomodation pathway
be able to know the pupillary light reflex plathway
in trochlear n palsy, will symptoms appear ipsialtearl or contralateral to lesion
ipsilateral
the trochlear nucleus is somatic motor or visceral motor
somatic motor
true or false: the trochlear nucleus is locared in the midbrain at the level of the inferior colliculi
true
what does the trochlear nucleus supply (extraoccular muscle)
supplies the superior oblique muscle contra laterally
right trochlear nucleus gives rise to the right or left trochelear n
left (therefore right trochlear nucleus will supply the left superior oblique)
trueor false: lesion to trochlear nerve or trochlear nucleus will result in same symptoms and ipsilateral
false, same symptoms but they will be contralateral for the nucleus lesion (since it gives rise so the contralateral n)
what are the symptoms of a trochlear n palsy
vertical or torsional diplopia (double vision) =torsional axes do not line up
hypertropia (eye deviated upwards)
=compensatory posture is tilting head away from affected side
vertical or torsional diplopia (double vision) =torsional axes do not line up
hypertropia (eye deviated upwards)
=compensatory posture is tilting head away from affected side
is associated with what cranial n palsy
troclear
explain why the eye would be deviated upwards in trochlear n palsy
because the superior oblique muscle is damaged (eye cannot go downwards)
is the abducens nucleus somatic motor or visceral motor
somatic motor
true or false: the abducens nucleus supplies the lateral rectus ipsialteral
true
which nerve has a length intranial course and explain
abducens
=travels rostrally in posterior cranial fossa
=sharp right angled bend over apex of petrous temporal bone before enteiring cavernous
in abducens n palsy, will the eye be slightly adducted or abducted and why
slightly adducted (damaging the innervation to lateral rectus, eye cannot abduct properly)
explain what would happen with a left abducens n plays (look right, forward and left)
look right: all good
look centre: left eye would be slightly adducted
look left: right eye will look left but left eye (affected) will not move and you will get nystagmus
ADD SLIDES ON COORDINATION OF GAZE
where are the frontal eye fields located
in and rostral to supplementary motor area
what are the projections of the frontal eye fields in coordination of gaze
directly to PPRF (voluntary) and indirectly to PPRF via superior colliculi (reflexive)
what are the frontal fields best described as
cortical area controlling saccadic eye movements
cortical area controlling saccadic eye movements ??
frontal eye fields
what is blood supply to frontal eye fields
middle cerebral
what areas are primary associated with smooth pursuit
parieto-temporo-occipito areas
parieto-temporo-occipito areas are assocaited with smooth pursuit or saccadic
smooth
explain saccades
rapid, coordinated eye movements that redirect gaze to different fixaation points
rapid, coordinated eye movements that redirect gaze to different fixaation points
=saccadic or smooth
saccadic
is saccadic voluntary, reflexive or both
both
find the target would be saccades or smooth prusit
saccades
explain smooth pursuit
coordinated eye movements that stabilize the image of a moving visual stimuli on the retina
coordinated eye movements that stabilize the image of a moving visual stimuli on the retina
is saccades or smooth
smooth
true or false: smooth pursuit is under voluntary control
false, it is not
follow teh target is associated with smooth or saccases
smooth
what is the general somatic function of the oculomotor n
innervaties 4/6 extraoccular muscles (not lateral rectus or superior oblique) and lev palp superior
what is the general visceral function of the oculomotor n
inneravtes ciliary and sphincter pupillae muscles
true or false: trochlear n innervates superior rectus m
false, superior oblique
true or false: abducens n inneravtes the medial rectus muscle
false, lateral rectus q