Quiz 3 (C.N. V-VIII) Flashcards
Sensory areas for V1
Surface of the eye, tear glands, scalp, forehead, upper eyelids
Common dysfunction of V1
Neuralgia
Common causes of V1 neuralgia
-Vascular loop compressing nerve root or occasionally MS -Cavernous sinus lesions -Superior orbital fissure lesions
Sensory areas for V2 and V3
Teeth, gums, lips, palate, and skin of the face
Motor areas of V2 and V3
Motor to muscles of mastication
Common dysfunction of mastication of V2 and V3
Neuropathy
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)
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
Largest C.N. What divisions make up this nerve?
Trigeminal V1- Ophthalmic V2- Maxillary V3- Mandibular
Muscles of mastication
-Masseter -Temporalis -Pterygoid -Mylohyoid -Digastric
What movements of the jaw are accomplished by C.N. V?
All movements (elevation, depression, protrusion, retraction, and side-to-side movements)
The mandible upon opening deviates toward the ___________ side when there is unilateral paralysis of the masticatory muscles
Paralyzed side
Bilateral paralysis of the mandible indicates what type of lesion?
Bilateral corticobulbar lesion
Describe Jaw Jerk reflex
-Mouth begins partly open -Reflex hammer tapped on the chin just below the lips in a downward direction
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
Formed by the union of V1, V2 and V3
Trigeminal (semilunar, Gasserian) ganglion
The dura of the anterior cranial fossa is supplied by this nerve
V1
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
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
V2
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
V3
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
