Quiz 3 (C.N. V-VIII) Flashcards by Joseph Heston

Sensory areas for V1

Surface of the eye, tear glands, scalp, forehead, upper eyelids

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Common dysfunction of V1

Neuralgia

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Common causes of V1 neuralgia

-Vascular loop compressing nerve root or occasionally MS -Cavernous sinus lesions -Superior orbital fissure lesions

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Sensory areas for V2 and V3

Teeth, gums, lips, palate, and skin of the face

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Motor areas of V2 and V3

Motor to muscles of mastication

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Common dysfunction of mastication of V2 and V3

Neuropathy

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Common causes of neuropathy for V2 and V3

-Lesions of cavernous sinus or superior orbital foramen -MS -Vascular loop -Carcinomatous or lymphomatus, meningitis -Connective tissue disorders -Meningiomas, schannomas or metastatic tumors at the skill base (like NF2)

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Tests for C.N. V

-Corneal blink reflex -Sharp sensation on the face -Light touch sensation on the face -Inspect muscles of mastication for tone and strength -Jaw jerk reflex -General sensation to the anterior 2/3 of the tongue

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Largest C.N. What divisions make up this nerve?

Trigeminal V1- Ophthalmic V2- Maxillary V3- Mandibular

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Muscles of mastication

-Masseter -Temporalis -Pterygoid -Mylohyoid -Digastric

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What movements of the jaw are accomplished by C.N. V?

All movements (elevation, depression, protrusion, retraction, and side-to-side movements)

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The mandible upon opening deviates toward the ___________ side when there is unilateral paralysis of the masticatory muscles

Paralyzed side

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Bilateral paralysis of the mandible indicates what type of lesion?

Bilateral corticobulbar lesion

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Describe Jaw Jerk reflex

-Mouth begins partly open -Reflex hammer tapped on the chin just below the lips in a downward direction

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Normal and abnormal findings of the Jaw Jerk reflex. What would an abnormal finding indicate?

Normal- little to no jaw movement Abnormal- quick snapping of the mouth Abnormal finding indicates upper motor neuron lesion

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Formed by the union of V1, V2 and V3

Trigeminal (semilunar, Gasserian) ganglion

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The dura of the anterior cranial fossa is supplied by this nerve

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V1 leaves the orbit through the ____________ and proceeds through the lateral wall of the _____________ in close relation to C.N.’s _________

Superior Orbital Fissure Cavernous sinus C.N. III, IV, VI

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Supplies upper lip, lateral and posterior portions of nose, upper cheek, anterior temple, mucosa of nose, upper jaw, upper teeth, roof of mouth, and dura of part of the middle cranial fossa

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V2 leaves the ____________ fossa, passes thorough the ____________ and travels the inferior part of the _________ and enters the trigeminal ganglion

Pterygopalatine fossa Foramen rotundum Cavernous sinus

Supplies lower lip, chin, posterior cheek, temple, external ear, mucosa of lower part of mouth, anterior 2/3 of the tongue, and portions of the dura of anterior and middle cranial fossae

Proprioceptive impulses of V3 are largely carried in the ______ nerve, which is incorporated into the V3

Motor

V3 enters the cranium through the __________ and goes to the trigeminal ganglion

Foramen ovale

How to test sensory of C.N. V

Light touch- can use fingertips or wisp of cotton. Pinprick- alternate pin and blunt sensation (go through all 3 divisions)

How to do the corneal reflex of C.N. V

Wipe a clean wisp of cotton on the cornea

Idiopathic, recurrent, sharp painful sensation in the V1, V2, V3 distribution

Trigeminal Neuralgia

Follows dermatomes/divisions. Virus associated with chickenpox. Break outs occur with disease, medications, stress, aging, or stresses on the immune system

Herpes Zoster

Lesion of the Cavernous sinus will affect what nerves?

III IV V VI

Motor innervation to the muscles of expression and taste for the anterior 2/3 of the tongue

C.N. VII

Muscles supplied by VII

All the facial muscles (frontalis, orbicularis oculi, orbicularis oris, platysma, posterior belly of digastric, and the stapdius muscle)

Partial to complete facial paralysis with smoothing of the brow, open eye, flat nasolabial fold, and drooping of the mouth ipsilateral to the lesion.

Nuclear or infranuclear (peripheral) lesions (Bell's Palsy)

Spare the brow and eyelid musculature; there is flattening of the nasolabial fold and drooping of the mouth contralateral to the lesion.

Supranuclear (central) lesions (Stroke)

Name the pathology

Right sided Bell's Palsy

Name the pathology

Stroke

75 year old female reports problems with her hearing since her last visit. Your initial assest saw Webers test lateralize to the right ear. Rinne showed: Right ear 15 mastoid/ 35 EAM Left ear 12 mastoid/12 EAM What do your findings suggest?

Left ear has Neurosensory loss

How to assess motor component of C.N. VII

- Instruct patient to look up and check symmetry - Hame patient smile and check nasolabial folds - Puff out cheeks, don't let me squeeze the air out - Note drooling, dysarthria, dysphagia

How to assess sensory component of C.N. VII

- Taste - With patients eyes close and tongue protruded, wipe a salt or sugar tip on lateral surface and side of the tongue and ask the patient to identify the taste without sticking their tongue in their mouth. - Rinse the mouth therely and repeat the test on the other side, using a different substance

4 primary tastes

Bitter Sweet Sour Salty

Loss of taste. What other nerve should be assessed due to the rareness of C.N. VII affecting taste dysfunction?

Aguesia Olfactory nerve should be assessed (C.N. VII causing aguesia is rare)

Causes of Aguesia (C.N. VII)

Viral infection Aging Toxic Metabolic disease

A peripheral lesion of C.N. VII must be proximal to the __________ to affect taste.

Stylomastoid foramen

Complete hemifacial paralysis without loss of taste in ipsilateral 2/3 anterior tongue confirms diagnosis of \_\_\_\_\_\_\_\_\_\_\_

Bell's Palsy

How to assess C.N. VIII

Observation of the external ear Observationof the internal ear Rinne test Weber test Finger Rustle test Schwabach test Watch Tic test

C.N. VIII has 2 components. The ______ nerve that detects head and body motion, and the _____ nerve that detects sound

Vestibular nerve = head and body motion Cochlear nerve = sound

Primary receptors of the vestibular portion of C.N. VIII are _________________ that detect _____________ and the ______________ that detect \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Semicircular canals Angular acceleration Otolithic organs Linear acceleration

The _____________ receives auditory signals and conveys its information via the cochlear portion

Organ of Corti

Processes that affect the receptors or C.N. VIII will cause these symptoms

- Hearing loss - Tinnitus (ringing ears) - Otalgia (ear pain) - Vertigo (dizziness) - Oscillopsia (images in visual field jump to vestibular mechanism) - Disequilibrium

How to assess Cochlear portion of C.N. VIII

Finger rustle Watch tic Rinne Weber Schwabach