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Neurology > Lecture 35 Disorders of the Cranial Nerve > Flashcards

Lecture 35 Disorders of the Cranial Nerve Flashcards

1
Q

Name the cranial nerves involved in special sensory function

A
  • Olfaction (I)
  • Vision (II)
  • Taste (VII, IX and X)
  • Hearing - and balance (VIII)
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2
Q

Name the cranial nerves involved in general sensation

A
  • Trigeminal Nerve V3
  • The ear from the VII (facial)
  • IX (glossopharyngeal)
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3
Q

Name the cranial nerves involved in control of muscle activity

A
  • Eye muscles – III (oculomotor), IV (trochlear) and VI (abducence) (LR6,SO4, rest 3)
  • Muscles of mastication – V3 (trigeminal)
  • Muscles of facial expression – VII (facial)
  • Muscles of larynx and pharynx – mainly X (vagus)
  • Sternomastoid and trapezius muscles - XI (accessory)
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4
Q

Name the cranial nerves that are parasympathetic and involved with autonomic functions

A
  • Pupillary constriction – III (oculomotor)
  • Lacrimation – VII (facial)
  • Salivation – submandibular and sublingual glands – VII (facial)
  • Salivation – parotid gland - IX (glossopharyngeal)
  • Vagal (X) input to organs in thorax and abdomen
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5
Q

How would you test Olfactory nerve

A

Smell-unilateral or bilateral loss

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6
Q

How would you test Optic nerve

A

visual acuity, visual fields, pupillary reactions, fundoscopy, colour vision

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7
Q

How would you test the oculomotor, trochlear and abducens nerve

A

ptosis, pupil of equal size, pupillary reactions, eye movements

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8
Q

How would you test the trigeminal nerve

A

power in the muscles of mastication, corneal reflex, jaw jerk

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9
Q

How would you test the facial nerve

A

muscle of fascial expression, corneal reflex, taste

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10
Q

How would you test the vetsibulochlear nerve

A

hearing using Rinne’s and Weber’s tests, Vestibular function using Dix-Hallpike manoeuvre and Untenberger’s test

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11
Q

How would you test the glossopharyngeal nerve

A

movement of palate, gag reflex, quality of speech, quality of cough

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12
Q

How would you test the accessory nerve

A
  • head turning and shoulder shrugging
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13
Q

How would you test the hypoglossal nerve

A

appearance, movement and power of tongue

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14
Q

Name the afferent and efferent nerves involved in pupillary reflex

A

afferent – II ; efferent – III

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15
Q

Name the afferent and efferent nerves involved in corneal reflex

A

afferent – V ; efferent – VII

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16
Q

Name the afferent and efferent nerves involved in Jaw jerk

A

V

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17
Q

Name the afferent and efferent nerves involved in gag reflex

A
  • afferent – IX ; efferent - X
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18
Q

Where is the oculomotor and trochlear located

A

Midbrain

19
Q

Where is the Trigeminal, abducent and facial nerve located

A

Pons

20
Q

Where is the Vestibulochlear nerve located

A

Pontomedullary Junction

21
Q

Where is the Glossopharyngeal, Vagus, Accessory and Hypoglossal located

A

Medulla

22
Q

Bilateral III signs

A

Midbrain

23
Q

III +IV+VI signs

A

Superior orbital fissure

24
Q

V + VIII signs

A

cerebellopontine angle

25
Q

How can cranial nerves be damaged

A
  • Within brain- ischaemia, tumour
  • Crossing the sub-arachnoid space- meningitis
  • Outside the skull- by base of skull tumours arising in nasopharynx
26
Q

Name some features of Optic Neuritis

A
  • Demyelination within the optic nerve
  • Monocular visual loss
  • Pain on eye movement
  • Reduced visual acuity
  • Reduced colour vision
  • Optic disc may be swollen
  • Often associated with MS
27
Q

Describe Parasympathetic control of the the pupillary response

A
  • constriction of the pupil
  • loss of parasympathetic input results in a fixed, dilated pupil
  • e.g. complete third nerve palsy
28
Q

Describe sympathetic pupillary response

A
  • pupillary dilatation

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

29
Q

Name some causes of dilated pupils

A
  • Youth
  • Dim lighting
  • Anxiety, excitement
  • “Mydriatic” eye drops
  • Amphetamine, cocaine overdose
  • Third nerve palsy
  • Brain death
30
Q

Name some causes of small pupils

A
  • Old age
  • Bright light
  • “Miotic” eye drops
  • Opiate overdose
  • Horner’s Syndrome
31
Q

Name causes of isolated third nerve palsy

A

o Microvascular- diabetes, hypertension- painless, pupils spared
o Compressive- posterior communicating artery aneurysm, raised ICP- painful, pupil affected
• Isolated fourth nerve palsy- Trochlear

32
Q

Name causes of isolated sixth nerve palsy

A

o Idiopathic
o Diabetes
o Meningitis
o Raised ICP

33
Q

Name features and causes of Nystagmus

A 
o	Congenital
o	Serious visual impairment
o	Peripheral vestibular problem
o	Central vestibular / brainstem disease
o	Cerebellar disease
o	Toxins (medication and alcohol)
34
Q

Describe Bell’s Palsy

A 
LMN type
Unilateral weakness
•	Often preceded by pain behind ear
•	Eye closure affected
•	Risk of corneal damage
•	Treated with steroids
•	Usually good recovery
35
Q

Describe Supranuclear lesion

A

Lesion in the cortex
UMN type
Forehead unaffected due to bilateral nerve supply to the upper part of the face

36
Q

What is Dysarthria

A

– disordered articulation, slurring of speech

37
Q

What is Dysphagia

A

– difficulty swallowing

38
Q

When does Dysarthria and Dysphagia occur together

A

Bulbar abd pseudobulbar palsy

39
Q

Describe Bulbar palsy

A

 Bilateral LMN lesion affecting IX-XII

40
Q

Name causes of Bulbar palsy

A

 MND
 Polio
 Tumours
 Vascular lesions of the medulla and syphilis

41
Q

What are the clinical features of bulbar palsy

A 
	Wasted, fasciculating tongue
	Dysarthria
	Dysphonia
	Dysphagia
	Beware of feeding these patients
42
Q

Describe Pseudobulbar palsy

A

Bilateral UMN lesion

In vascular lesions of both internal capsules

43
Q

Name clinical symptoms of Pseudobulbar palsy

A 
	Dysarthria
	Dysphonia
	Dysphagia
	Spastic immobile tongue
	Brisk jaw jerk
	Brisk ag reflex

Neurology (44 decks)

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