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BMS100 Neuroanatomy > Lecture 6 > Flashcards

Lecture 6 Flashcards

1
Q

Cranial Nerve Rule #1: Parasympathetic GVE fibers reside ONLY in?

A
  • CN III: Oculomotor
  • CN VII: Facial
  • CN IX: Glossopharyngeal
  • CN X: Vagus
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2
Q

What is the associated ganglion of CN III?

A

ciliary ganglion

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3
Q

What is the associated ganglion with CN VII?

A

Pterygopalatine & Submandibular Ganglion

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4
Q

What is the associated ganglion with CN IX?

A

Otic Ganglion

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5
Q

What is the associated ganglion with CN X?

A

Various ganglia near visceral organs

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6
Q

Cranial Nerve Rule #2: Branchial Motor (BE/SVE) fibers reside ONLY in nerves associated with pharyngeal (branchial) arches, which cranial nerves are these?

A
  • CN V3
  • CN VII
  • CN IX
  • CN X
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7
Q

Major sensory nerve of the face

A

CN V - trigeminal

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8
Q

What is the pathway of the CN V?

A
  • Begins at pons and travels superiorly/anteriorly towards face
  • Splits into three terminal divisions at “trigeminal ganglion” in middle cranial fossa
    V1 = Ophthalmic
    V2 = Maxillary
    V3 = Mandibular
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9
Q

What is CN V1?

A

opthalmic

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10
Q

What is CN V2?

A

maxillary

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11
Q

What is CN V3?

A

mandibular

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12
Q

Each terminal branch exits the skull via a different foramen and innervates a different region of the face for which cranial nerve?

A

CN V

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13
Q

What code is CN V1? What does it innervate?

A

GSA
- upper face

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14
Q

What code is CN V2? What does it innervate?

A

GSA
- mid face

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15
Q

What code is CN V3? What does it innervate?

A

GSA
- lower face

BE/SVE
- arch 1
- muscles of mastication

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16
Q

What sensation is the spinal nucleus of the trigeminal nerve associated with?

A

Pain the Tem & light touch

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17
Q

What is the pathway, foramina, and function of CN V1?

A
  • Pathway: originates at trigeminal ganglion, ophthalmic division passes through the cavernous sinus, exits via superior orbital fissure, & has many additional branches from there
  • Foramina: Superior orbital fissure
  • Function: GSA Modality
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18
Q

What are the general sensory areas of CN V1?

A
  • forehead
  • anterior scalp
  • upper eyelid
  • tip of the nose
  • anterior nasal cavity
  • frontal & ethmoidal sinuses
  • dura mater of anterior cranial fossa
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19
Q

How do you test for CN V1?

A
  • Test sensation of forehead
  • CN V1 – corneal reflex
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20
Q

What is the pathway, foramina, and function of CN V2?

A
  • Pathway: passes through the cavernous sinus, exits skull via foramen rotundum to innervate face
  • Foramina: Rotundum
  • Function: GSA Modality
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21
Q

What are the general sensory area of CN V2?

A
  • the sides of the nose
  • lower eyelids
  • upper lip
  • posterior nasal cavity
  • teeth of the upper jaw
  • maxillary sinus
  • nasopharynx
  • palate
  • dura of the middle cranial fossa
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22
Q

How do you test for CN V2?

A

Test sensation of lateral nose, cheek and upper jaw

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23
Q

What is the pathway, foramina, and functions of CN V3?

A
  • Pathway: not associated with cavernous sinus, exits skull via foramen ovale to innervate lower face
  • Foramina: Ovale
  • Function: GSA Modality & BS/SVE
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24
Q

What are the general sensory areas of CN V3?

A
  • lower lip
  • chin
  • lower face & cheek
  • anterior external ear
  • teeth of mandible
  • mucous membranes of cheek
  • anterior 2/3 of tongue
  • dura in the middle cranial fossa
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25
Q

The CN V extensively innervates the __ __

A

dura mater

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26
Q

What are muscles does CN V3 innervate/control?

A

Arch 1

Voluntary motor control to muscles of mastication
- Temporalis
- Masseter
- Medial pterygoid
- Lateral pterygoid

Collectively these muscles open/close the mandible for chewing action

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27
Q

The __ __ muscle, innervated by the mandibular branch of CN V, connects the auditory tube to the malleus handle.

A

tensor tympani

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28
Q

What is the role of tensor tympani?

A

Increases the tension in the tympanic membrane, thus protecting it from excessive vibration in response to loud sounds –> dampens noise produced by chewing in own ear

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29
Q

sensation of pain elicited without presence of noxious stimuli

A

neuralgia

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30
Q

What happens during trigeminal neuralgia?

A

trigeminal nerve perceives sensations as pain - Intermittent attacks of severe, sharp, stabbing pain “electric shock”

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31
Q

What branches does trigeminal neuralgia often affect?

A

CN V2 & V3
- GSA code ONLY (no motor)

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32
Q

T/F: Trigeminal neuralgia shows bilateral distribution

A

False, unliateral

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33
Q

What is trigeminal neuralgia aggravated by?

A
  • Exposure to cold
  • Chewing
  • Brushing teeth
  • Talking
  • Touching face
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34
Q

Where do you test for sensation of CN V1?

A

forehead

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35
Q

Where do you test for sensation of CN V2?

A

cheek

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36
Q

Where do you test for sensation of CN V3?

A

jaw

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37
Q

How do you test for CN V3 motor?

A

ask pt to move muscles of mastication

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38
Q

What are the codes associated with CN VII? What areas of the body are they associated with?

A
  • BE/SVE axons to muscles of facial expression (arch II)
  • SVA axons (taste) from the anterior 2/3rds of the tongue
  • GVE axons to the submandibular, sublingual and lacrimal glands
  • GSA axons for the “patch” of skin behind the ear
39
Q

What is the pathway of CN VII?

A
  • Facial nerve originates from the pons and first exits skull through the internal acoustic (auditory) meatus winding through the petrous portion of the temporal bone (facial canal) - Infection in the middle/inner ear can impact CN VII
  • Within temporal bone, nerve gives off several intracranial branches
  • Remaining nerve will exit the cranial base via the stylomastoid foramen
40
Q

Which nerve is impacted by middle/inner ear infections?

A

CN VII

41
Q

Which foramen does CN VII pass through?

A

Internal Acoustic Meatus AND Stylomastoid Foramen

42
Q

Once CN VII exits the skull, it gives rise to 6 __ __?

A

extracranial branches

43
Q

The __ attaches to the stapes and helps to dampen intense/loud sounds

A

Stapedius

44
Q

Which cranial nerve innervates stapedius?

A

CN VII

45
Q

results from trauma to the facial nerve, such as a viral meningitis infection

A

Bell’s palsy

46
Q

What are the symptoms of Bell’s Palsy?

A
  • Weakness, twitching, or flaccid paralysis of facial muscles, including drooping of the eyelid and corner of the mouth. These symptoms would result from damage to the SVE portion of the facial nerve.
  • Dry eye or mouth. These symptoms would result from damage to the GVE component of the nerve.
  • Impairment of taste resulting from damage to the SVA component of the nerve
47
Q

protects eyes from foreign bodies

A

corneal reflex

48
Q

What 2 cranial nerves can be tested with corneal reflex?

A

Sensory arc: CN V1 (touch to surface of cornea)
Motor arc: CN VII (orbicularis oculi)

49
Q

What is the desired response of corneal reflex test?

A

BILATERAL regardless of input side

50
Q

How do you test the corneal reflex?

A

Cotton gauze touched to cornea of R eye should result in blink/closure of BOTH eyes

51
Q

What could dull the corneal reflex, giving a false positive?

A

contact lenses

52
Q

Cotton gauze touched to L eye, only R eye blinks –>

A

means sensory signal worked, but L motor did not work

53
Q

Cotton gauze touched to L eye, and no eyes blink –>

A

means sensory input did not work

54
Q

How do you test for CN VII?

A
  • corneal reflex
  • test muscles of facial expression
  • test taste
55
Q

What is different about the vestibulocochlear nerve?

A

two separate nerves that travel together

56
Q

What is the pathways of the vestibulocochlear nerve?

A

Begins at base of pons and exits cranium via internal acoustic meatus. Terminates as separate nerves in inner ear

57
Q

What is the foramina of vestibulocochlear nerve?

A

internal acoustic meatus

58
Q

What is the function of vestibulocochlear nerve?

A

Special Somatic Afferent (SSA) for two senses:
- Hearing (Cochlear)
- Balance & equilibrium (Vestibular)

59
Q

What is the pathway of CN IX?

A
  • Nerve emerges from the brainstem in the lateral medulla and exits the posterior cranial fossa through the jugular foramen.
  • Majority of nerve remains extracranial to innervate structures of face and throat
60
Q

What is the foramina of CN IX?

A

jugular foramen

61
Q

What are the functions (codes) of CN IX?

A
  • BE/SVE – voluntary motor: axons innervate stylopharyngeus (swallowing muscle)
  • SVA – special visceral afferent: axons carry taste perception from the posterior 1/3 of the tongue
  • GVE – general visceral efferent: axons innervate the parotid gland via otic ganglion (secretomotor function)
  • GVA – general visceral afferent: axons from the carotid body (visceral sensation from carotid body for chemoreception – maintaining BP)
  • GSA – general somatic afferent: sensory from skin posterior to the ear, posterior 1/3 of tongue, and the afferent part of the gag reflex
62
Q

What is the pathway of CN X?

A

Nerve emerges from the brainstem in the lateral medulla and exits the posterior cranial fossa through the jugular foramen

63
Q

What foramina does CN X exit?

A

jugular foramen

64
Q

What are the functions (codes) of CN X?

A
  • BE/SVE – voluntary motor: axons innervate the majority of the muscles of the pharynx, larynx and soft palate (moving food towards esophagus during swallowing)
  • SVA – special visceral afferent: axons from skin posterior to ear, dura in posterior cranial fossa, mucous membranes of pharynx & larynx
  • GVE – general visceral efferent: axons from thoracic & abdominal viscera & aortic body - Chemoreceptors – blood content & Baroreceptors – blood pressure
  • GVA – general visceral afferent: axons (taste) from the root of tongue and epiglottis region (throat)
  • GSA – general somatic afferent: to thoracic and abdominal viscera up to left colic flexure. Synapse is in or around target organ.
65
Q

The gag reflex is initiated in response to stroking the back of the throat and is mediated by the __ nerve

A

vagus

66
Q

helps prevent choking (Protective response that prevents oral contents from entering the throat except as part of normal swallowing)

A

gag reflex

67
Q

What nerves can be tested by gag reflex?

A
  • Sensory arc: CN IX (touch to base of throat)
  • Motor arc: CN X (motor response of pharynx)
68
Q

What is the desired response of the gag reflex?

A

BILATERAL regardless of input side (contraction of soft palate muscles of BOTH sides)

69
Q

uvula will deviate to the intact side (away from side of injury) - gag reflex

A

CN X motor problem

70
Q

NO RESPONSE (soft palate muscles do not contract at all) - gag reflex

A

CN IX sensory problems

71
Q

What is the pathway of CN XI?

A

Nerve begins at medulla and exits cranium via jugular foramen

72
Q

What is the foramina of CN XI?

A

jugular foramen

73
Q

What is the function of CN XI?

A

voluntary motor to Sternocleidomastoid and Trapezius muscles
- SCM – contralateral rotation of head
- Traps – shoulder “raises”
General Somatic Efferent (GSE)

74
Q

What is the pathway of CN XI?

A

Nerve begins at medulla and exits cranium via hypoglossal canal

75
Q

What is the foramina of CN XII?

A

Hypoglossal canal

76
Q

What is the function of CN XII?

A

voluntary motor to muscles of the tongue
General Somatic Efferent (GSE)

77
Q

The cortex normally send bilateral innervation to cranial nerve motor nuclei. The one exception is innervation of the __ muscle, which is contralateral

A

genioglossus

78
Q

What is injured if the tongue deviates to left?

A

left CN XII or right motor cortex

79
Q

What is injured if the tongue deviates to right?

A

right CN XII or left motor cortex

80
Q

What are common causes of hypoglossal nerve injury?

A

-Injuries are fairly rare
- Posterior neck dissection
- Fracture of atlanto-occipital joint

81
Q

How does the patient present with CN XII injury?

A
  • Tongue deviated to same side as injury due to atrophy of muscle muscles
  • “lick your wounds” presentation
  • Dysphagia (difficulty swallowing)
  • Slurred speech
  • Fasciculation on the tongue – “bag of worms” appearance
82
Q

How do you test for CN XII?

A
  • “stick out tongue”
  • ask pt to open mouth and see how it looks inside the mouth
83
Q

What sensation is the chief or principal nucleus or main sensory nucleus of the trigeminal sensory nuclei associated with?

A

discriminative sensation and light touch as well as conscious proprioception

84
Q

What sensation is the mesencephalic nucleus of the trigeminal sensory nuclei associated with?

A

unconscious proprioception

85
Q

What are the intracranial branches of the facial nerve?

A
  • chorda tympani carries GVE & SVA
  • greater petrosal nerve carries GVE
86
Q

What is the pathway of the chorda tympani nerve of the facial nerve? What does it carry?

A
  • Branches off main nerve in the facial canal (inside skull)
  • SVA = Special visceral afferent carrying taste perception from the anterior 2/3rds of the tongue
  • GVE = General visceral efferent secretomotor of the submandibular and sublingual glands
  • Via submandibular ganglion = Saliva production
87
Q

What is the pathway of the greater petrosal nerve of the facial nerve? What does it carry?

A
  • Exits the petrous portion of the temporal bone where parasympathetic axons synapse in the pterygopalatine ganglion.
  • GVE = General visceral efferent
  • Secretomotor to lacrimal gland of eye (tear production)
88
Q

The primary gustatory region of the cortex is found in: the?

A

insula

89
Q

What are the extracranial branches of the facial nerve?

A
  • BE/SVE Modality = Voluntary motor control to muscles of facial expression
  • GSA Modality = GAS to skin behind the ear (posterior auricular branch)
90
Q

What are the branches of the BE/SVE modality extracranial branch of the facial nerve?

A
  • Temporal
  • Zygomatic
  • Buccal
  • Mandibular
  • Cervical
91
Q

The BE/SVE branch of the vagus nerve travels posterior to the thyroid, what are common causes of injury to this nerve?

A
  • tumor or after surgical intervention of the thyroid
  • Bronchial carcinoma
  • Aortic arch aneurysm
92
Q

How would the patient present with injury to the BE/SVE branch of the vagus nerve?

A
  • Hoarse voice
  • Vocal changes (dysphonia)
  • Difficulty producing speech
93
Q

What is the job of the GVE branch of the vagus nerve?

A

to promote rest & digest (decrease HR, respiratory rate, stimulate digestion & secretion of enzymes)

BMS100 Neuroanatomy (6 decks)

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