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HNN > Session 4 > Flashcards

Session 4 Flashcards

1
Q

The structures of the head face and neck are innervated by

A

Cranial nerves (12 Pairs)

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2
Q

Majority of cranial nerves arise from the

A

Brainstem (unlike spinal nerves which arise from spina cord)

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3
Q

Similarity between cranial and spinal nerves

A

Both considered part of the peripheral nervous system

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4
Q

Which nerves are mixed

A

4 cranial nerves and all spinal nerves

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5
Q

What does a mixed nerve mean

A

Carry both motor and sensory

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6
Q

What are the other 8 cranial nerves that aren’t mixed

A

3 are purely sensory, 5 are purely motor

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7
Q

What is special about the 3 purely sensory cranial nerves

A

Carry special sensory function, such as hearing and balance, vision, and smell

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8
Q

Which nerve is for hearing and balance

A

CN VIII (8)

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9
Q

Which nerve is for vision

A

CN II (2)

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10
Q

Which nerve is for smell

A

CN I (1)

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11
Q

Examples of general sensation

A

Temperature, cold, proprioception

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12
Q

Special sense taste is carried where

A

within two of the mixed cranial nerves CN VII (7) and CN IX (9)

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13
Q

Cranial nerves have an important association with

A

Parasympathetic nervous system - account for the cranial outflow of this arm of the autonomic nervous system

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14
Q

Which cranial nerves carry parasympathetic function

A

Only 4- CN III, VII, IX and X
3,7,9,10

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15
Q

Explain numbering of cranial nerves

A

Generally follows the order in which they arise (or enter) the brainstem from rostral to caudal (cranial nerve I (olfactory) is most rostral)

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16
Q

Where does the cerebellum sit

A

Behind brain stem

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17
Q

Brain stem is made up of

A

Midbrain, pons, medulla

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18
Q

Frontal and parietal lobes separated by the

A

Central sulcus

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19
Q

What is corpus calosum

A

White matter that connects 2 hemispheres

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20
Q

What is septum pellucidum

A

Thin membrane covering cavity

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21
Q

Towards nostril is

A

Rostral (front of brain)

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22
Q

Medulla is continuous through

A

Foramen Magnum to become Spinal cord

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23
Q

Why does a problem in the brain stem have a large impact

A

Lots packed into small space

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24
Q

What nerve nuclei functions are found in midbrain

A

Eye movement, reflexes of pupils

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25
Q

What nerve nuclei functions are found in pons

A

Feeding, trigeminal (motor muscles for mastication), sleep

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26
Q

What nerve nuclei functions are found in medulla

A

Cardiovascular and respiratory

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27
Q

Pre central gyrus responsible for

A

Primary motor cortex

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28
Q

Post central gyrus responsible for

A

Primary somatosensory cortex

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29
Q

Frontal lobe controls

A

Voluntary motor control
Speech production
Social behaviour
Impulse control
Higher cognition (planning, thinking)

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30
Q

Temporal lobe controls

A

Language, emotion, long-term memory, sense of smell, hearing and taste

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31
Q

Parietal lobe controls

A

Somatosensory perception
Spatial awareness

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32
Q

Occipital lobe controls

A

Visual perception

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33
Q

Cerebellum controls

A

Co-ordination and motor learning

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34
Q

What is uncal herniation

A

Herniation of uncus of temporal lobe through the tentorium notch due to rise in pressure

Due to geographical proximity will push against 3rd cranial nerve III occulomotor

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35
Q

Describe homunculus

A

Legs dangle into central sulcus, face tongue and fingertips largest

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36
Q

Motor pathways cortex to peripheral nervous system cross where

A

Level of medulla on opposite side of brain

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37
Q

Spinal nerves decussate/cross to the opposite side at the level of the

A

Lower medulla

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38
Q

Cortical control of limb movement is from one primary motor cortex, which is

A

Contralateral

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39
Q

Where do pathways connecting the primary motor cortex with cranial nerves cross

A

Level of nuclei onto which they communicate

40
Q

Cortical control of muscles is from one primary motor cortex which is

A

Contralateral

BUT

Most cranial nerves also have cortical input from the ipsilateral cortex ( a back- up)

41
Q

What is sparing of forehead

A

Difference to tell if a problem with the cranial nerves or with stroke rather than Bell’s palsy or something different

42
Q

Neurological signs of cranial nerve dysfunction can arise due to an injury or lesion involving

A
  • The cranial nerve during its route outside of the CNS
  • The brainstem where CN nuclei are located
  • The neurones within forebrain/brainstem which connect other parts of brain to cranial nerves
43
Q

Cranial nerves topography

A

2 CNs from forebrain - I olfactory and II optic
2 CNs from midbrain- III occulomotor and IV trochlear
4 CNs from pons- V trigeminal, VI abducens, VII , VIII
4 CNs from medulla- 9-12

44
Q

2 CNs from forebrain

A

I olfactory II optic

45
Q

CNs from midbrain

A

occulomotor III and trochlear IV

46
Q

4 CNs from pons

A

V trigeminal, VI abducens and 7 and 8

47
Q

Absence or reduced sense of smell

A

Anosmia/hyposmia

48
Q

What can impact olfactory nerve

A

Head/facial impact: shearing olfactory neurones during passage through cribiform foramina

Anterior cranial fossa tumours: compression of olfactory bulb or olfactory tract

Associations with Parkinson’s disease, Alzheimer’s disease

49
Q

Commonest cause for anosmia

A

Common cold / upper respiratory tract infection

50
Q

Where is olfactory mucosa with olfactory receptors found

A

Within epithelium in superior part of nasal cavity either side of nasal septum

51
Q

Route of olfactory nerve

A
  • Olfactory mucosa
  • Up through base of skull through cribiform foramina
  • Olfactory bulb
  • Olfactory tract
  • temporal lobe
52
Q

Importance of optic nerve being extension of forebrain

A

Carries extension of meninges, CN can be affected by raised ICP

53
Q

How would you test optic nerve

A

Pupillary size and response to light (CN II forms sensory/afferent limb of pupillary light reflex)

Visual acuity (Shelley chart) and visual fields

Ophthalmoscopy (can directly visualise part of optic nerve)

54
Q

What will patients with optic nerve lesions report

A

Blurred vision or complete absence of vision in eye supplied by affected CN

55
Q

Clinical examination findings with optic nerve lesions

A

Poor visual acuity (Snellen chart)
Abnormalities in pupil size and response to light
Evidence of pathology involving the optic nerbe may be visible on opthalmoscopy

56
Q

Optic nerve is part of the

A

Visual pathway - vision can be affected by diseases/lesions involving other parts of the visual pathway

57
Q

What will you see in a vision problem caused by optic nerve due to raised ICP

A

Swollen optic disc= papilloedema

58
Q

Example of diseases involving optic nerve

A

Optic neuritis- swelling damages optic nerve

Anterior ischeamic optic neuropathy (AION)- blood supply to front of optic nerve at back of eye affected by disease

59
Q

What does pale optic disc mean

A

May have had an episode of optic neuritis

60
Q

Optic nerve route

A
  • Retinal ganglion cells axons
  • Axons form optic nerve
  • Exits back of orbit via optic canal
  • Fibres from left and right optic nerve merge at optic chiasm (close to pituitary gland)
  • Continue as right and left optic tracts
  • Some fibres communicate from tract to brainstem, some continue visual pathway
61
Q

What do fibres communicate from optic tract to brainstem

A

Information about light intensity- control pupil size

62
Q

Pathology affecting a retina or an optic nerve on one side will cause

A

Blurring/visual symptoms in that one eye affected

63
Q

Lesions involving visual pathway from optic chiasm or onwards will cause

A

Visual disturbance involving both eyes e.g. pituitary tumours compress optic chiasm causing bilateral symptoms (bitemporal hemianopia)

64
Q

Lesions within different parts of the visual pathway give

A

Different patterns of visual loss e.g. retinal detachment, optic neuritis, pituitary tumour, strokes

65
Q

Occulomotor, Trochlea and Abucens nerves all

A

Supply muscles within the orbital cavity responsible for moving the eye ball

66
Q

Occulomotor, trochlea and Abducens nerves all have commonality in route after exiting brainstem at different levels, reach orbital cavity passing through

A

Cavernous sinus, superior orbital fissure, into orbital cavity

67
Q

How do you test CN III, IV, VI

A

Observation of resting position of patient’s gaze

Asking patient to perform a series of eye movements

68
Q

Oculomotor CN III target tissues

A

Somatic efferent fibres (motor to skeletal muscle)- all extra ocular muscles except 2, muscle in eyelid (levator palpebrae superioris)

Visceral efferent fibres (parasympathetic)- muscles inside eyeball (ciliary (thickness of lens), sphincter pupillae muscle). Not under voluntary control

69
Q

Inspection of resting gaze

A

For CN III Oculomotor

Eyelid position (supplies LPS muscle that keeps eye lid retracted)

Eye movements

Pupils and pupillary light reflexes (via parasympathetic fibres, muscle controlling pupillary contraction)

70
Q

Signs of oculomotor nerve lesion arise due to

A

Involvement of somatic fibres and or parasympathetic fibres

71
Q

Classic signs of oculomotor nerve lesion

A

Double vision (Dipoplia)
Ptosis (eye drooping)
Abnormal eye position (down and out)
Pupil may or may not be dilated

72
Q

Oculomotor nerve route has close relationship to

A

Tentorium cerebelli edge

73
Q

2 causes for CN III lesion

A

Micro vascular ischeamia

Compressive

74
Q

Features of micro vascular ischeamia causing CN III lesion

A

Risk factors over 50, diabetes or hypertension

Pupil sparing

75
Q

Features of compressive occulomotor nerve lesion

A

Lesion compresses onto outside of CN III

Pupil involving

E.g. aneurysmal (PCA): associated with headache/retroorbital pain

Head injury

Tentorial (uncul) herniation e.g. secondary to increased ICP

76
Q

Not all ptosis is due to

A

CN III lesion

77
Q

What does the CN IV Trochlear do

A

Motor- supplies 1 muscle (superior oblique muscle)

78
Q

Examination to investigate Trochlear CN IV

A

Inspection of resting gaze ,testing eye movements

Report double vision, abnormal eye position and difficulty moving eye downwards (Depression) when eye positioned inwards (adducted)

79
Q

Trochlear nerve router

A

Arises from dorsal midbrain, runs via cavernous sinus, enters orbital cavity

Only cranial nerve to come off back of mid brain

80
Q

Features of trochlear nerve lesions

A

Congenital or acquired

Acquired- micro vascular ischeamia, trauma (even minor), intracranial tumour

81
Q

CN VI Abducens comes from

A

Pons

82
Q

CN VI Abducens nerve supplies

A

Lateral rectus

83
Q

Signs of Abducens CN VI problems

A

Report double vision- Dipoplia (worse in lateral gaze on side of lesion)

Abnormal eye position at rest

Difficulty/unable to move affected eye laterally

84
Q

Abducens nerve lesions causes

A

Micro vascular ischeamia, head injury, tumour

Raised ICP (of any cause) —> false localising sign

Most likely nerve to be affected by raised ICP

85
Q

Why is abducens nerve route susceptible to stretch

A

Due to vertical route and fixed at point of brainstem exit and entry to cavernous sinus

Raised ICP causing downward displacement of brain can stretch CN VI causing CN VI signs (false localising)

86
Q

Trigeminal ganglion divisions

A
87
Q

CN V Trigeminal nerve supplies

A

Skin and tissues of face, portion of scalp and deep facial structures

Anterior 2/3rds of tongue general sensation (not taste) via branch of Vc

Muscles of mastication (via branches of Vc)

88
Q

Cranial nerve examination

A

Light touch Va,Vb and Vc dermatomes

Muscles of mastication action

Corneal reflex (lightly touch cornea with cotton wool and should see both eyes blink)

89
Q

Potential clinical examination findings

A

Sensory deficits within dermatome regions (on affected side)

Weakness in muscles of mastication (on affected side if Vc involved)

Absent corneal reflex (CN Va is sensory part of this reflex)

90
Q

Trigeminal nerve lesions cause

A

Trigeminal herpes zoster (shingles reactivation of VZ in trigeminal ganglion)

Trigeminal neuralgia (compression from an aberrant blood vessel)

Orbital and mandibular fractures (distal branches of CN V divisions)

Posterior cranial fossa tumours

91
Q

What is this

A

Trigeminal herpes zoster

92
Q

Sharp shooting pain in face suggestive of

A

trigeminal neuralgia

93
Q

Ophthalmic division of trigeminal nerve pathway

A
94
Q

Maxillary division of trigeminal nerve pathway

A
95
Q

Mandibular division of trigeminal nerve pathway

A

HNN (19 decks)

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