Neurology 3 Flashcards
The 12 Cranial Nerves
- Olfactory 2. Optic 3. Oculomotor 4. Trochlear 5. Trigeminal 6. Abducens 7. Facial 8. Vestibulocochlear 9. Glossopharyngeal 10. Vagus 11. Accessory 12. Hypoglossal
Cranial Nerves: Sensory
CN 1, 2, 8
The exit point of CN V3
Mandibular Division: Foramen Ovale
Cranial Nerves: Motor
CN 3, 4, 6, 11, 12
The exit point of CN III-VI
Superior Orbital Fissure
Cranial Nerves: Vagal system
CN 10, 9, 7, 1 (1971)
Cranial Nerves: Midbrain
CN 3 and 4
The exit point of CN XII
Hypoglossal Canal
Cranial Nerves: Diencephalon
CN 2
The exit point of CN VII - VIII
Internal Acoustic Meatus (IAM)
Cranial Nerves: Telencephalon
CN 1
The exit point of CN I
Cribriform plate of Ethmoid
Cranial Nerves: Parasympathetic
CN 10, 9, 7, 3 (1973)
Cranial Nerves: Medulla Oblongata
CN 9, 10, 11, and 12
The exit point of CN V2
Maxillary Division: Foramen Rotundum
Cranial Nerves: Mixed
CN 10, 9, 7, 5 (1975)
Cranial Nerves: Pons
CN 5, 6, 7, and 8
The exit point of CN IX - XI
Jugular Foramen
The exit point of CN II
Optic Canal
Structures that exit Foramen Magnum
Spinal part of CN XII, Right & Left Vertebral Artery, Medulla Oblongata
Pathology of CN 1
Anosmia
Unilateral Anosmia is due to the affectation of what structures?
Olfactory bulb or tract
What causes Bilateral Anosmia?
Problems with mucus membrane (cold and allergy)
Two reflexes facilitated by Optic Nerve
Pupillary Light and Accommodation
Reflex based on the changes on the pupil in relation to the distance of the object
Accommodation Reflex
Reflex based on the constriction of pupil upon lighting the eye
Pupillary Light Reflex
Accommodation reflex: Near object
Lens Thicker, Converge, Pupil Constrict
In bright to dark light changes, how long before the eye adapts?
20 minutes
In dark to bright light changes, how long before the eye adapts?
5 minutes
5 refraction error pathology
Myopia, Hyperopia, Astigmatism, Presbyopia, Nyctalopia
Near-sightedness
Myopia
Hardened lens due to old age
Presbyopia
Far-sightedness
Hyperopia
Night blindness due to decrease Vit A
Nyctalopia
Lesions in refractory system
Astigmatism
2 intraocular pressure pathology
Glaucoma and Cataract
Peripheral dark spot
Glaucoma
Central dark spot
Cataract
Visual Pathway
BA 17 (Visual Cortex) > Optic Radiation > Optic Tract > Optic Chiasma > Optic Nerve
Lesion at Optic Radiation
(+) C/L Homonymous Quadrantinopisa
Lesion at Optic Nerve
(+) I/L Monocular Blindness
(+) C/L Homonymous Hemianopsia
Lesion at Optic Tract, Optic Radiation, and BA 17
Lesion at Optic Chiasma
(+) Bitemporal Hemianospia
2 fibers of Optic Radiation
Parietal and Temporal Fibers
Superior Fiber Lesion
Parietal = Inferior C/L Homonymous Quadrantinopisa
Inferior FIber Lesion
Temporal = Superior C/L Homonymous Quadrantinopisa
Assessment for Visual Acquity
Card (near) and Snellen Chart (far)
Distance for Snellen Chart assessment
20 ft or 6 m
Assessment for Visual Field
Confrontation test
Assessment for Color Vision
Ishihara’s
How to assess glaucoma and cataract
Intraocular Pressure = Tonometry
How to assess astigmatism and presbyopia
Refracting System = Retinoscopy
4 muscles supplied by the oculomotor nerve
EOM, Levator Palpabrae Superioris, Pupillary Muscle, and Cillary Muscle
Subjective Double Vision
Diplopia
The weakness of Medial Rectus
External Strabismus
Unequal Pupil Size
Argyll Robertson Pupil
Paralysis of the eye
Ophthalmoplegia
The weakness of constrictor pupillae
(-) Pupillary light and Accommodation Reflex
Reacting Affective Pupil Dilation
Marcus Gunn Pupil
Weakness of Levator Palpabrae
Ptosis
Ptosis is common in what type of condition?
Myasthenia Gravis
Internal Ophthalmoplegia
Spared EOM and Paralyzed Constrictor Papillae
Argyll Robertson Pupil Manifestation
ARP: Accommodation Reflex Present + Pupillary Light Reflex Absent
External Ophthalmoplegia
Paralyzed EOM and Spared Constrictor Papillae
What muscles are working when you look at the left side?
(R) MR and (L) LR
What muscles are working when you look at the right and upward?
(R) SR and (L) IO
What muscles are working when you look at the left and downward?
(R) SO and (L) IR
Pupillary Light Reflex: Afferent Nerve
CN II
Pupillary Light Reflex: Efferent Nerve
CN III
Light is shown in the (R) eye but the (R) pupil stayed dilated however the (L) pupil constricted
Lesion at (R) CN 3
Light is shown in the (R) eye but the (R) pupil stayed dilated and no consensual reflex happened. Then, light is shown in the (L) eye, the (L) pupil constricted and consensual reflex happened on the (R) eye.
Lesion and (R) CN 2
Light is shown in the (R) eye but the (R) pupil stayed dilated and no consensual reflex happened. Then, light is shown in the (L) eye but the (L) pupil stayed dilated and no consensual reflex happened.
Lesion at CN 3
Muscle supplied by Trochlear Nerve
SO4: Superior Oblique
Trochlear nerve pathology
Vertical Diplopia
Three divisions of Trigeminal Nerve
V1: Ophthalmic, V2: Maxillary, V3: Mandibular
Trigeminal Division: supplies Upper jaw
V2
Trigeminal Division: supplies Tip of the nose
V1
Trigeminal Division: supplies Mylohyoid
V3
Trigeminal Division: supplies Cornea and Eyelid
V1
Trigeminal Division: supplies Upper teeth
V2
Trigeminal Division: supplies Muscle of Mastication
V3
Muscles of Mastication
Masseter, Temporalis, Medial and Lateral Pterygoid
3 other muscles supplied by V3
Mylohyoid, Anterior Belly of Digastric, Tensor Tympani
Trigeminal Division: supplies Forehead and Scalp
V1
Trigeminal Neuralgia
Tic Douloreux
Involuntary blinking of the eyes elicited by stimulation of the cornea
Corneal Reflex (CN 5 lesion = negative reflex)
Lession due to affectation of tensor tympani
Hearing Loss
Muscle supplied by Abducens Nerve
Lateral Rectus
2 Abducens Nerve Pathology
Horizontal Diplopia and Internal Strabismus
Muscle for Distaste
Procerus
Muscle for Grimace
Risorius
Muscle for Smiling
Zygomaticus Major or Minor
Muscle for Pouting
Mentalis
Muscle for Egad
Platysma
Muscle for Frowning
Corregator Supercilli
Muscle for Blinking or Winking
Orbicularis Oculi
Muscle for Kissing
Orbicularis Oris
Muscle for Sneering
Levator Anguli Oris
Muscle for Sucking or Blowing
Buccinator
3 Nucleus of Facial Nerve
Mesencephalic, Chief or Main Sensory and Spinal
CN 7 Nucleus: Pain and Temp
Spinal Nucleus
CN 7 Nucleus: Proprioception
Mesencephalic Nucleus
CN 7 Nucleus: Discriminative sensation and Light Touch
Chief or Main Sensory Nucleus
A general sensation of anterior 2/3 tongue
CN V3: Mandibular Division
A general sensation and taste of posterior 1/3 tongue
CN 9
A general taste of anterior 2/3 tongue
CN 7
(+) Horizontal Diplopia
CN 6
(+) External Strabismus
CN 3
(+) Vertical Diplopia
CN 4
(+) Internal Strabismus
CN 6
5 glands innervated by Facial Nerve
Lacrimal, Nasal, Palatine, Sublingual, Submandibular
4 other muscles innervated by Facial Nerve
PASS: Posterior belly of digastric, Auricular, Stylohyoid, Stapedius
Bell’s Palsy 6 Site of Lesion
“Sharon Cuneta Says Gaby Is Pangit”
Stylohyoid, Chorda Tympani, Stapedius, Geniculate Body, IAM, Pons
Bell’s Palsy: Lesion at Stylohyoid
Facial Paralysis
Bell’s Palsy: (+) Hyperacusis
Stapedius
Bell’s Palsy: Lesion at IAM
Facial Paralysis + Hearing Problem
Bell’s Palsy: (+) Loss of Taste
Chorda Tympani
Bell’s Palsy: Lesion at Geniculate Body
Facial Paralysis + Loss of Taste + Hyperacusis
Bell’s Palsy: Lesion at Pons
Facial Paralysis + Loss of Taste + Hyperacusis + Hearing Problem
Stimulus for Marcus Gunn and Marin Amat
Jaw Opening
Facial nerve assessment using tapping of parotid gland
Chvostek
(+) Bell’s Phenomenon
Rolling of the eye upward and outward
(+) Marcus Gunn
Eye Opening
(+) Chvostek
Twitching of facial muscle
(+) Marin Amat
Eye closure
Auditory muscles supplied by CN 8
Organ of Corti
3 sensory feedback of balance
Visual, Vestibular and Somatosensory (Proprio)
How to identify if the balance problem is associated with the vestibular system
(+) Romberg’s and occlusion of hearing
Romberg’s: (+) Eye Closing
Dorsal Column Affectation
Romberg’s: (+) Eye Opening
Nervous System
Hearing loss due to the lesion of the inner ear and CN 8
Sensorineural deafness
Nystagmus seen in patients with CN 8 problem
Peripheral Nystagmus
How long does peripheral nystagmus lasts?
1 week
Hearing loss due to the lesion of the outer ear and middle ear
Conduction deafness
Bilateral affectation of CN 8
(+) Dysequilibrium
Hearing loss due to the lesion of the BA 41 & 41
Cortical Deafness
Ringing of ear
Tinnitus
Common s/sx seen in patients with BPPV
Vertigo
3 Auditory Ossicles
Malleus, Incus and Stapes
Auditory Ossicles: Hammer
Malleus
Auditory Ossicles: Stirrup
Stapes
Auditory Ossicles: Anvil
Incus
CN 8 Assessment: Rotation of head to 45 degrees
Dix Hallpike
CN 8 Assessment: Tuning fork at the vertex
Weber
CN 8 Assessment: Tuning for at the Mastoid Process
Rinne’s
Normal Rinne’s
Air is louder and longer than Bone Conduction
Both air ad bone conduction is diminished
Sensorineural deafness
Bone conduction is louder and longer than air
Conduction deafness
Caloric Testing
COWS: Cold - Opposite side nystagmus; Warm - Same side Nystagmis
Muscle innervated by CN 9
Stylopharyngeus muscle
2 autonomic glands innervated by CN 9
Parotid Gland and Carotid Sinus
2 Glossopharyngeal nerve pathology
Difficulty in swallowing (dysphagia) and speaking (dysarthria)
Decrease saliva production
Aptyalia
Loss of taste
Ageusia
CN in Nucleus Ambiguous
CN 9 and 10
CN in Nucleus Salivatory
CN 7 and 9
CN in Nucleus Solitarius
CN 7, 9, 10
6 Autonomic Functions of Vagus Nerve
Cardio, Pulmo, GIT, Kidneys, Epiglottis, Uvula
Hoarseness of Voice
Dysphonia
4 Vagal Pathology
Dysphonia, Speech & Swallow, Autonomic Dysfunction and Uvula Deviation
Afferent of Gag Reflex
CN 9
Efferent of Gag Reflex
CN 10
Muscles innervated by CN 10
Palatoglossus muscle
Structures innervated by Accessory nerve - Cranial division
Soft palate, Pharynx, Larynx
Two muscles innervated by the Accessory nerve - Spinal division
SCM and Trapezius
Three tongue muscles innervated by CN 12
Genioglossus, Hyoglossus and Styloglossus
Tongue muscle: Elevate
Palatoglossus
Tongue muscle: Retract
Styloglossus
Tongue muscle: Protract
Genioglossus
Tongue muscle: Depress
Hyoglossus
2 Hypoglossal Nerve Pathology
Dysarthria and Tongue Deviation
(+) Jaw Deviation
CN 5
Ipsilateral Deviation d/t CN affectation
Jaw and Tongue
Contralateral Deviation d/t CN affectation
Uvula
(+) Tongue Deviation
CN 12
(+) Uvula Deviation
CN 10
How many thoracic spinal nerves we have?
12
How many lumbar spinal nerves we have?
5
How many cervical spinal nerves we have?
8
How many coccygeal spinal nerves we have?
1
How many sacral spinal nerves we have?
5
The largest nerve in Cervical Plexus
Phrenic Nerve (C3-5)
The largest nerve in Sacral Plexus
Sciatic Nerve
The term that describes the spinal nerve branch and its branches
Ramus
The largest nerve in Lumbar Plexus
Femoral Nerve(anterior crural)
The largest nerve in Brachial Plexus
Radial Nerve (musculospiral)
3 layers of the nerve
Epineurium (outer), Perineurium (middle), Endoneurium (inner)
A layer of the nerve composed of a dense network of collagen fibers
Epineurium
Brachial Plexus: Roots
C5-T1
Brachial Plexus: Upper Trunk Roots
C5-6
Brachial Plexus: Lower Trunk Roots
C8-T1
Brachial Plexus: Middle Trunk Roots
C1
Brachial Plexus: Lateral Cord branches
LML: Lateral Portion of Median Nerve, Musculocutaneous Nerve, and Lateral Pectoral Nerve
Brachial Plexus: Upper Trunk Branches
Nerve to subclavius and suprascapular nerve
Brachial Plexus: Medial Cord Branches
UMMM: Ulnar Nerve, Medial Portion of Median Nerve, Medial Pectoral Nerve and Medial Cutaneous of Arm & FA
Brachial Plexus: C5 branch
Dorsal Scapular Nerve
Brachial Plexus: Posterior Cord Branches
ULTRA: Upper and Lower Subscapular Nerve, Thoracodorsal Nerve, Radial Nerve and Axillary Nerve
Brachial Plexus: C5, C6, C7 branch
Long Thoracic Nerve
Lumbar Plexus: Roots
T12 - L4
Lumbar Plexus: Anterior L2-4
Obturator
Lumbar Plexus: Anterior L1-2
Genitofemoral
Lumbar Plexus: Posterior L2-4
Femoral
Lumbar Plexus: Posterior L2-3
Lateral Femoral Cutaneous Nerve
Lumbar Plexus: Anterior T12-L1
Iliohypogastric
Lumbar Plexus: Anterior L1
Ilioinguinal
Sacral Plexus: Roots
L4 - S3
Sacral Plexus: Posterior L4-S2
Superior Gluteal
Sacral Plexus: Anterior L5-S3
Nerve to Obturator Internus
Sacral Plexus: Anterior L4-S2
Nerve to Quadratus Femoris
Sacral Plexus: Posterior S1 - S3
Posterior Femoral Cutaneous Nerve
Sacral Plexus: Posterior L5-S3
Inferior Gluteal
Sacral Plexus: Anterior L4- S3
Tibial
Sacral Plexus: Posterior L4- S2
Common Peroneal
Outflow of SNS
Thoracolumbar
Outflow of PSNS
Craniosacral
Ganglionic NT of PSNS
Ach
Post-Ganglionic NT of SNS
NE / Epi
Ganglionic NT of SNS
Ach
Post-Ganglionic NT of PSNS
Ach
SNS Manifestation: Sweat, Cardiac Muscle force, and BP
Increase
PSNS Manifestation: Liver
NR
PSNS: Pupil and Bronchi
Constrict
SNS: Systemic Artery
Constrict
SNS: Pupil and Bronchi
Dilate
PSNS: Male Reproduction System
Erection
SNS: Bladder Detrussor
Relax
PSNS: GIT Peristalsis
Increase
SNS: Male Reproduction System
Ejaculate
SNS Manifestation: Liver
Increase
PSNS: Bladder Detrussor
Constrict
SNS: Bladder Sphincter
Contract
Pathway of nerve impulses to produce voluntary movements
Somatic Nervous System
Reflex Arc
Receptor > Afferent Fibers > SC > Efferent Fibers > Effectors
2 reflexes under Monosynaptic Reflex
DTR and Superficial Reflex
2 reflexes under Polysynaptic Reflex
Flexor Withdrawal and Crossed Extension
Motor Response to certain stimuli
Reflex
6 Mechanoreceptors
Cutaneous Sensory Receptors, Merkel’s, Meissner’s Ruffini’s, Krause End Bulb, Pacinian
6 Deep Joint Receptors
Muscle Spindle, GTO, Thermoreceptor, Nociceptors, Chemoreceptors, Electromagnetic
Electromagnetic receptor for dark
Rod
Electromagnetic receptor for light
Cones
3 main division of reflexes
Spinal, Brainstem and Autonomic
7 Spinal Reflexes
Flexor Withdrawal, Crossed Extension, Moro, Startle, Traction, Palmar Grasp and Plantar Grasp
5 Brainstem Reflexes
ATNR, STNR, TLR, Positive Supporting and Associated Reaction
The smallest muscle in the body
Stapedius
“Trumpeteer” muscle
Buccinator
The smallest and stupid cranial nerve
Trochlear
The longest cranial nerve
Vagus
The largest cranial nerve
Trigeminal
The longest intracranial course
Abducens
Only sensory input that does not synapse in the thalamus
Olfactory
