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Structure And Function 2 Test 3 > Norden- Cranial Nerves > Flashcards

Norden- Cranial Nerves Flashcards

1
Q

Accomodation reflex / near triad

A

Controlled by cortex via connections w/ CN III

Increase in curvature of the lens (ciliary muscles)

Pupillary constriction (pupillary sphincter)

Convergence of eyes (medial rectus)

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2
Q

Frontal eye fields

A

Area 8

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3
Q

Frontal eye fields (area 8) provides innervation to which motor nuclei?

A

CN III, IV, VI

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4
Q

A lesion in the cortical area 8 will cause what?

A

Inability to voluntarily conjugately move eyes to the contralateral side of the lesion and there will be baseline bilateral eye deviation to the side of the lesion.

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5
Q

Direct the eyes to a new point of fixation

A

Gaze centers

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6
Q

Voluntary eye movements are initiated primarily in _

A

Areas 4 and 8

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7
Q

Where is the vertical gaze center located?

A

In the periaqueductal gray region of the midbrain reticular formation

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8
Q

Where is the horizontal gaze center?

A

Paramedian pontine reticular formation

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9
Q

The horizontal and vertical gaze centers have connections to CNs III, IV, and VI through ______

A

The medial longitudinal fasciculus

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10
Q

The medial longitudinal fasciculus major function is:

A

To coordinate eye movements

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11
Q

Involuntary jerking or oscillatory movement of the eyes: can be vertical, horizontal, or rotational

A

Nystagmus

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12
Q

Pathological nystagmus can be caused by lesions:

A

In medial longitudinal fasciculus, vestibular system, or cerebellum

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13
Q

Palsy

A

Weakness (paresis)

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14
Q

PERRLA

A

Pupils equal, round, reactive to both light and accomodation

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15
Q

Mydriasis

A

Sympathetic

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16
Q

Pupillary constriction (Miosis)

A

Parasympathetic

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17
Q

Interruption of parasympathetics in eye

A

Produces dilation bc of unnopposed sympathetic innervation

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18
Q

Interruption of sympathetic fibers of eye

A

Produces pupillary constriction (unopposed parasympathetic innervation)

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19
Q

The inability to move both eyes so that the image of an object falls on both foveas

A

Strabismus

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20
Q

Strabismus causes

A

Diplopia, bc each eye is seeing a slightly different image

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21
Q

What allows the retinal image to remain stationary when you turn your head?

A

Cycloduction done by inferior and superior oblique

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22
Q

LMN for Cranial nerves are where?

A

In the motor nuclei of CN’s throughout the brainstem

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23
Q

Projections of LMN to specific muscles (in Cranial nerves) can be ___

A

Ipsilateral or contralateral

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24
Q

What is the general rule for the laterality of the cranial nerve innervations?

A

from cortex (UMN ) to CN nucleus is typically bilateral with slightly more coming from contralateral than from ipsilateral.

From the LMN, innervation to specific muscles is ipsilateral

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25
Q

Action; medial rectus

A

Adduction

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26
Q

Action ; lateral rectus

A

Abduction

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27
Q

Action superior rectus

A

Elevation

Intorsion

Adduction

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28
Q

Action; inferior rectus

A

Depression

Extorsion

Adduction

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29
Q

Action: inferior rectus

A

Depression

Extorsion

Adduction

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30
Q

Action: superior oblique

A

Intorsion

Depression

Abduction

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31
Q

Action: inferior oblique

A

Extorsion

Elevation

Abduction

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32
Q

Edinger-estphal nuclues

A

CN III

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33
Q

Lacrimal and superior salivatory nuclei

A

CN VII

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34
Q

Nucleus for parasympathetics of CN III

A

Edinger-Westphal nucleus

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35
Q

Parasympathetic nuclei for CN VII

A

Lacrimal and superior salivatory nuclei

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36
Q

Parasympathetic nucleus for IX

A

Inferior salivatory nucleus

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37
Q

Parasympathetic nucleus for CN X

A

Dorsal motor nucleus

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38
Q

The alar plate of the closed neural tube differentiates into

A

Sensory components

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39
Q

The basal plate of the closed neural tube

A

Motor efferent components of cranial nerves

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40
Q

Motor nuclei lie ______ to sensory nuclei in the rhomboid fossa

A

Medial

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41
Q

Special sensory afferents are located most _____

A

Laterally

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42
Q

Spinal ganglia and nerves derived from

A

Neural crest

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43
Q

Autonomic ganglia, including parasympathetic ganglia in the head are derived from ?

A

Neural crest

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44
Q

Special sensory afferents are most ____ located

A

Laterally

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45
Q

General somatic efferents are most ____ located

A

Medially

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46
Q

Areas in the brain involved with olfaction

A

Rhinencephalon

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47
Q

The rhinencephalon is close in association with ______. Which causes certain smells to evoke memories and emotions

A

Limbic system

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48
Q

Lose sense of smell:

A

Anosmia

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49
Q

Anosmia can lead to what in elderly?

A

Weight loss, because food all tastes the same / bland

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50
Q

Olfactory neurons undergo ____ throughout life

A

Mitosis

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51
Q

Life span of olfactory neurons

A

2 months

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52
Q

Unusual characteristics in the olfactory system:

A

Olfactory neurons undergo mitosis throughout life. Regenerating olfactory neuron axons are able to grow into the hostile territory of the CNS.

Olfactory bulb axons are ensheathed in olfactory ensheathing cells (which are specialized glial cells).
[these have been used to promote nerve regen in spinal cord injury]

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53
Q

Input to the primary olfactory cortex, which is in the uncus and adjacent area of the parahippocampal gyrus (pyriform cortex) does what unique thing?

A

It does NOT relay through the thalamus

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54
Q

Pyriform cortex

A

Primary olfactory cortex

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55
Q

Temporal structures in olfaction:

A

Uncus and adjacent areas of the parahippocampal gyrus (pyriform cortex [primary olfactory cortex])

Entorhinal cortex (area 28)

Amygdaloid nuclear complex

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56
Q

Integrates information across multiple sensory modalities and projects to the hippocampus.

First cortical area to show degeneration in Alzheimer’s disease

A

Area 28 (entorhinal cortex)

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57
Q

Plays a critical role in both learned and unlearned (instictual) responses and memory

A

Amygdaloid nuclear complex

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58
Q

Medial olfactory area is where?

A

Frontal lobe

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59
Q

Why is important to not use ammonia when testing olfactory sense?

A

Ammonia stimulates pain fibers from CN V. So you wont’ actually test CN I

60
Q

What is important to keep in mind when testing olfactory sense?

A

Make sure changes arent from obstruction of nasal passages

Note that some decreased sense of smell is NORMAL in elderly.

Don’t use ammonia

61
Q

What is common in seizures induced by lesions in the uncus / amygdaloid?

A

Disagreeable odors
Stereotypic movements of the lips and tongue
Altered emotional state (anxiety / fear )

62
Q

Automatisms

A

Stereotypic movements of the lips and tongue

63
Q

Space occupying lesions where may cause unilateral anosmia?

A

The floor of the anterior cranial fossa

The frontal lobe

Near the optic chiasm/tract/nerve area

64
Q

What can happen from fractures of the cribiform plate / ethmoid sinus ?

A

Tear fibers of olfactory nerve —> anosmia

Leakage of CSF from nose

Risk of meningitis and/or encephalitis

65
Q

Is the nucleus for levator palpebrae superioris paired or unpaired?

A

Unpaired

66
Q

Paired nucleus
Parasympathetic input to ciliary ganglion.

Part of accomodation reflex and pupillary light reflex

A

Edinger-Westphal nucleus

67
Q

What can be used to independently evaluate the integrity of CN III?

A

Accommodation reflex, which projects directly to the Edinger-Westphal nucleus

68
Q

What cranial nerves does the pupillary light reflex test?

A

CN II

CN III

69
Q

What must you make sure to do when testing the pupillary light reflex for cranial nerves II (afferent) and III (efferent)

A

Separately test each eye for both direct and consensual response

70
Q

Constriction of the pupil the light is not shined in in the pupillary light reflex?

A

Consensual response

71
Q

Clinically, when testing the CN III (occulomotor) what should you most commonly focus on?

A

Ipsilateral changes involving medial rectus (for EOM damage), the eyelid, and the pupil (parasympathetic)

72
Q

What should you look for in CN III damage?

A

Lateral strabismus (unopposed action of lateral rectus bc medial rectus is gone)

Ptosis

Mydriasis (unopposed action of dilator pupillae (sympathetic))
[no constriction to light OR accomodation]

73
Q

Symptoms of oculomotor opthalmoplegia

A

Wrinkled forehead

Raised eyebrow

Lid droop

Downward abducted eye

Dilated pupil

74
Q

What causes oculomotor opthalmoplegia?

A

Unilateral LMN lesion of CN III

All signs/symptoms are ipsilateral to lesion

75
Q

Causes contralateral difficulty in depressing and intorting the eye

A

Unilateral lesions of trochlear nucleus and initial segment of the nerve in the midbrain

76
Q

Patient’s w/ lesions involving trochlear nucleus or nerve will have ____

A

Vertical diplopia

Compensate by tilting head

77
Q

Cell bodies of the primary sensory neurons of the trigeminal nerve are where?

A

Trigeminal (semilunar) ganglion

Mesencephalic nucleus

78
Q

Which branch of cranial nerve V contains peripheral processes with origin in BOTH trigeminal ganglion and mesencephalic nucleus?

A

Mandibular nerve (sensory portion)

79
Q

External ear sensory innervation:

A

VII, IX, X, V,

Second and third cervical nerves

80
Q

Chief sensory nucleus carries what type of information?

A

Discriminative touch, vibration, conscious proprioception

81
Q

The spinal trigeminal nucleus carries

A

Pain and temperature

82
Q

The spinal trigeminal nucleus starts in the pons and then descends into the brainstem to the medulla, where it is continuous with __

A

The dorsolateral fasciculus of lissauer and the nuclei of the dorsal gray matter of the spinal cord

83
Q

Projection to the reticular formation is important for _____ in response to pain

A

Arousal

84
Q

Mesencephalic nucleus has neurons that are the only ______ primary sensory neurons found w/in the CNS

A

Pseudounipolar

85
Q

Mesencephalic nucleus has proprioceptive receptors where?

A

Adjacent to teeth of the lower jaw and in neuromuscular spindles in the muscles of mastication, hard palate, adjacent to teeth of upper jaw

86
Q

What does the mesencephalic nucleus sense?

A

Unconscious proprioceptive information

87
Q

Information for the reflex control of bite comes from what nucleus?

A

Mesencephalic nucleus

88
Q

What does the jaw jerk reflex test?

A

Sensory V (mesencephalic nucleus)

Motor V

89
Q

What does the corneal reflex test?

A

Sensory (V1)

Motor (VII)

90
Q

The trigeminal thalamic tract is a combination of the chief sensory neurons and the spinal trigeminal tract that starts at the thalamus. What senses does it carry?

A

Fine touch, proprioception, vibration, pain, and temperature for the face

91
Q

What symptoms do you get in a lesion of the TTT above the level of the chief sensory nucleus?

A

In face
Contralateral
Loss of pain and temperature and fine touch, cons proprioception, vibration

92
Q

Nucleus that receives synapse from VIII and then projects to the part of motor nucleus of V that innervates tensor tympani

A

Superior olivary nucleus (SON)

93
Q

Characterized by excruciating paroxysms of sharp, stabbing pain in the area of distribution of one of the branches of CN V. Usually unilateral. May have remissions and exacerbations

A

Tic douloureux

Trigeminal neuralgia

94
Q

What complication of shingles involving CN V must you worry about?

A

Ulcerations on the cornea which can cause blindness

95
Q

The abducens nerve contains a subnucleus which is involved in what?

A

Conjugate horizontal eye movement

96
Q

Fibers of the ___ nerve course medially and then dorsally over the abducens nucleus in the dorsal pons, forming a bulge

A

VII

97
Q

VI palsy due to ICP / meningitis is a _____ because the primary lesion is not due to VI nerve or nucleus damage.

A

False localizing sign

98
Q

What kind of diplopia is there in VI palsy?

A

Horizontal?

99
Q

Why is it important to try to tell if a VI palsy is a real VI nerve palsy or a false localizing sign?

A

If it is a real VI nerve palsy, it can be life-threatening, bc that means there is a space-occupying lesion or vascular accident in the pons.

100
Q

Cranial Nerve VII sensory components innervate what?

A

Cutaneous fibers to part of the external ear

Taste

101
Q

Where are the cell bodies of origin for sensory Cranial nerve VII’s taste omponent

A

Geniculate ganglion

102
Q

Area 43

A

Tast

103
Q

Where is the motor Nucleus of VII?

A

Caudal part of pons

104
Q

Cells for the parasympathetic part of CN VII are ???

A

The superior salivatory nucleus

Located in the pons

105
Q

Lesions of the lower motor neurons of CN VII cause ?

A

Ipsilateral paralysis of all facial muscles

106
Q

UMN lesion in area of CN VII what is symptom?

A

Contralateral paralysis of LOWER muscles of facial expression

107
Q

Efferent components of CNs IX and X for innervation of muscles arise from

A

The nucleus ambigus

108
Q

The nucleus ambiguus is a column of motor neurons situated _____

A

Dorsal to the inferior olivary nucleus in the medulla

109
Q

Nucleus responsible for coughing, gagging and vomiting reflex?

A

Nucleus ambiguus

110
Q

Stimulus for reflexes for coughing, gagging, and vomiting?

A

Stimuli arising in the mucosa of the respiratory and alimentary passages

111
Q

Motor components of CNs IX and X arise from ?

A

Nucleus ambiguus

112
Q

Gag reflex tests?

A

Sensory IX (from soft palate, pharynx, posterior aspect of tongue)

Motor efferents - from neurons of nucleus ambiguus

113
Q

Uvula reflex test?

A

Say ahh
Observe uvula
Unilateral lesion of nucleus ambiguus will cause deviation of uvula towards contralateral side

114
Q

A unilateral lesion of the nucleus ambiguus (LMN) causes

A

Ipsilateral paralysis of the soft palate, pharynx, and larynx

Pt will be hoarse, difficulty breathing, and swallowing. Gag reflex diminished/absent

115
Q

Where is the spinal accessory nucleus (for CN XI)

A

Upper 5-6 cervical segments

116
Q

Hypoglossal nucleus lies where?

A

Mostly medially in the medulla

117
Q

The hypoglossal nucleus receives afferents from ?

A

Tractus solitarius (CN VII) [taste]

Sensory trigeminal nucleus (CN V)
[for reflex movements in swallowing and chewing]

118
Q

Which muscle innervated by CN XII is the only that is contralateral from UMN?

A

Genioglossus

119
Q

What are the other names for the chief sensory nucleus of V?

A

Principle, main, superior, pontine

120
Q

What are the other names for the spinal nucleus of V?

A

Nucleus caudalis

121
Q

LMN’s of CN III are where?

A

Midbrain

122
Q

LMNs of CN IV are where

A

Midbrain

123
Q

LMN’s of CN V are where?

A

Pons

124
Q

LMN of CN VI are where?

A

Pons

125
Q

LMN of CN VII are where?

A

Pons

126
Q

LMN of CN IX are where?

A

Rostral medulla

127
Q

LMN of CN X is where?

A

Rostral medulla

128
Q

LMN of CN XII is where?

A

Caudal medulla

129
Q

Where is the trochlear nucleus?

A

Medial midbrain at the level of the inferior colliculus

130
Q

Where is the spinal nucleus of V (pain and temperatrue

A

From the pons (at level of chief nucleus) to caudal limit of medulla

131
Q

Derived from neural crest. These are the only pseudounipolar cells found within the CNS

A

Mesencephalic nucleus

132
Q

Mesencphalic neurons project mainly to the motor nucleus of V. Where is This nucleus??

A

In the pons at the same level as the chief sensory nucleus

133
Q

By definition, the TTT (containing chief sensory nucleus of V and spinal trigemninal nucleus axons) is a ____ pathway

A

Crossed

134
Q

The TTT synapses where?

A

VPM

135
Q

At what level have all of the axons of the trigeminothalamic tract decussated?

A

Above the midpons

Above the chief sensory nucleus

136
Q

The motor nucleus of V receives synapses from what nucleus, that end up being sent to the tensor tympani?

A

CN VIII fibers synapse in the superior olivary nucleus and then to the motor nucleus of V

137
Q

Most frequently involved division in trigeminal neuralgia

A

Maxillary division

138
Q

Where is the abducens nucleus?

A

Dorsal pons

139
Q

Describe the course that is taken by fibers of CN VII for taste

A

Cell body of origin is in the geniculate ganglion. These take a long, peripheral course before synapsing in the rostral part of nucleus solitarius. Second order neurons then synapse in the thalamus at the VPM. From here, 3rd order neurons go to area 43 in the cortex (in postcentral gyrus)

140
Q

Where is the motor nucleus of VII?

A

Caudal pons

141
Q

Cells for the superior salivatory nucleus are where?

A

Scattered in the pons

142
Q

Where is nucleus ambiguus (motor CN IX and X)

A

Dorsal to the inferior olivary nucleus in the medulla (cannot be see)

143
Q

The dorsal motor nucleus of X does what?

A

Parasympathetic innervation

Majority end in adominal viscera

144
Q

Where does the hypoglossal nucleus lie?

A

Most medially in the medulla between the dorsal nucleus of the vagus and the midline of the brain

145
Q

The hypoglossal nucleus receives afferents from ?

A

Nucleus of tractus solitarius (CN VII)

Sensory Trigeminal Nuclei (CN V)

Structure And Function 2 Test 3 (21 decks)

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