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Neuro Block 2 > The Cranial Nerves > Flashcards

The Cranial Nerves Flashcards

1
Q

what is the only cranial nerve that doesnt go to the brainstem? (remains supratentorial)

what else is unique for that CN?

how is the axon for this CN?

A

CN 1

it doesnt go to the thalamus first

it is bipolar and unmyelinated

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2
Q

after the olfactory cranial nerve passes throught the cribriform plate, where do the nerves go?

what to bipolar olfactory nerves do that is peculiar?

why do olfactory nerves cross from 1 bulb to the other?

the crossing of olfactory nerves from 1 bulb to the other form what?

A

to the olfactory bulb

go to the olfactory nucleus bypassing the thalamus

they cross in other to inhibit other incorrect smells

the anterior commissure

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3
Q

besides olfactory nerves, what else goes through the anterior commissure?

what is the uncus?

what is its clinical relevance?

what is the anterior perforated substance?

A
  • spinothalamic tract (neospinothalamic) and the connection between the amygdalas
  • Part of the temporal lobe that has the primary olfactory area (34) found here.
  • this is the part that herniates in a transtentorial herniation
  • area where arteries penetrate into the brain
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4
Q

what is the most common cause of olfactory nerve damage?

how do you test CN1?

A

trauma to the frontal area

smell things..

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5
Q

determine where is the damage?

what is each symptom called?

A
  1. optic nerve - monocular blindness
  2. lateral optic chiasm - binasal hemianopia
  3. central optic chiasm - bitemporal hemianopia
  4. optic tract - contralateral homonymous hemianopia
  5. parietal - lower quadant hemianopia
  6. temporal - upper quadrant hemianopia
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6
Q

what is 1 cause for bitemporal hemianopia?

what composes the optic tract?

what happens wi thte optic tract? what do you get if you damage these?

A

pituitary adenoma in adults, craniopharyngioma in children

the opposite part of each tract (left optic tract has the right side of each eye)/contralateral visual fields

it breaks down into a temporal and parietal tracts

damage to temporal you get superior quarter loss of vision

damage to parietal you get inferior quarter loss of vision

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7
Q

Is CN 3 GVE, GVA, GSE, GSA?

A

GVE and GSE

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8
Q

what is the CN III eye muscle innervation?

A

Superior, middle and inferior rectus, inferior oblique.

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9
Q

what CN’s are involved in the pupillary reflex?

what is the direct response?

what is the Consensual response?

A

CN 2 and 3 together

pupil constricts to light shone in same eye.

pupil constricts when light is shone in other eye.

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10
Q

what are the CN 3 deficits?

A

Ptosis Levator palpabrae

Mydriasis Sphincter pupillae

Diplopia Horizontal and vertical

Eye ‘down and out’ 4 eye muscles

(Strabismus)

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11
Q

what is the nerve colored?

A

trochlear

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12
Q

the trochlear nerve has what type of innervation?

how do individuals with trochlear nerve damage walk around?

A

GVE

with a dejected look (they are looking down)

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13
Q

what are the CN 4 deficits?

A

Vertical diplopia: Head tilts down to accommodate for loss of superior oblique.

Torsional diplopia: Head tilts to side, towards a nucleus lesion, away from a nerve lesion. (Always away from the affected eye).

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14
Q

what is this nerve? (the one the box is written)

A

abducens

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15
Q

CN 6 receives what type of innervation?

What does the Abducent nucleus contain?

A

GSE

motor neurons innervating the lateral rectus, and interneurons which connect VI to the MLF

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16
Q

what are the deficits of CN VI?

A
  1. Medial deviation of the affected eye.
  2. Inability to abduct the eye across the midline (assuming complete lesion to CN VI; limited damage may simply reduce abduction).
  3. Horizontal diplopia.
  4. Strabismus: misalignment of the eyes which causes diplopia, and loss of depth perception.
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17
Q

identify

A
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18
Q

What are the 2 types of function of the trigeminal nerve?

what does each do?

A
  1. motor: chewing and tensor tympani
  2. sensory: V1, V2, V3
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19
Q

what are the trigeminal nuclei and where are they located?

A
  1. Mesencephalic nucleus: Starts in midbrain, extends into the pons. Stops where main sensory nucleus begins.
  2. Main Sensory nucleus: Starts in pons and becomes continuous with the spinal nucleus in the medulla.
  3. Spinal nucleus: Extends inferiorly into the spinal cord as far as C2.
  4. Motor nucleus: Localized to pons, medial to main sensory nucleus (masseter, temporalis, tensor tympani).
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20
Q

what do each trigeminal nuclei do?

A
  1. Mesencephalic nucleus: Propioception from the jaw, mechanoreceptors from the teeth.
  2. Main Sensory nucleus: Touch/position sensation from face (sorta like dorsal column info).
  3. Spinal nucleus: Pain/temperature from the face (sorta like spinothalamic).
  4. Motor nucleus: Localized to pons, medial to main sensory nucleus (masseter, temporalis, tensor tympani).
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21
Q

identify

A
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22
Q

damage to the 1st order neurons of the trigeminal tract will result in symptoms on which side?

what symptoms would you see?

if there is damage to a trigeminal lemniscus, symptoms are on what side of the face?

A

ipsilateral

facial sensory deficit

contralateral

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23
Q

identify

A
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24
Q

identify

A
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25
Q

where does CN V exits/enters?

Where does Opthalmic nerve exits skull ?

Where does Mandibular nerve exits skull?

Where does Maxillary nerve exits skull?

A

anterolateral surface of pons.

via superior orbital fissure, and enters the orbital cavity

via the foramen ovale

via foramen rotundum.

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26
Q

Damage to CN 5 in the brainstem, ganglion, peripheral portions, result in?

A
  1. Difficulty in chewing.
  2. Jaw deviates towards lesion upon opening.
  3. Loss of sensation from affected areas of face and head.
  4. Loss of corneal reflex.
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27
Q

What does damage to tensor tympani cause?

A

nothing or hypoacusis to low frequency sounds.

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28
Q

what are the two types of Trigeminal neuralgia?

what are the symptoms in each?

A

TN1: (Typical or Classic) Extreme, sporadic episodes of burning or ‘shock-like’ pain. Lasts a few seconds to minutes, can occur in succession.

TN2: (Atypical) Constant burning, aching or stabbing pain, of lower intensity that TN1.

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29
Q

what characterizes trigeminal neuralgia?

what division of the trigeminal nerve may it affect?

what can trigger it?

how long do episodes last?

A

Severe, burning pain in affected branch(es)

the opthalmic portion

mild stimulation

minutes - days

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30
Q

waht are the Surgical approaches for treatment of trigeminal neuralgia?

A

Microvascular decompression (a teflon insert is

placed between impinging artery and nerve).

Radiofrequency lesion.

Balloon compression rhizotomy.

Gamma knife = you end numb in 1 part of face

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31
Q

what treatment can result effective for treating TN1 but not TN2?

A

anticonvulsants

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32
Q

identify

A
33
Q

what innervation does Facial nerve have?

identify which areas each of these innervations go to

A

Motor Component (SVE):

  • Muscles of face and scalp
  • Stapedius muscle
  • Posterior belly of digastric, and stylohyoid muscles

Sensory Component (SVA):

  • Taste sensation from anterior 2/3 of tongue
  • Also taste from floor of mouth and palate

Parasympathetic Component (GVE):

  • Submandibular + sublingual salivatory glands
  • Lacrimal gland
  • Glands of nose and palate
34
Q

what is the course the main motor nucleus takes?

A

Main Motor Nucleus

  1. Axons pass around nucleus of CN VI, exit at the cerebellopontine angle.
  2. Motor nerve passes through the internal auditory meatus (canal), then the facial canal, and exits the skull through the stylomastoid foramen.
  3. Motor fibers pass through parotid gland en route to facial muscles
  4. Axons to the stapedius muscle exit at the facial canal
35
Q

what inputs does the motor nucleus have?

A

Inputs from cortex via corticobulbar tracts are for Voluntary control of facial muscles. (An involuntary pathway exists which controls emotional or mimetic facial changes; pathway is poorly understood).

36
Q

What inputs does the Superior Salivatory Nucleus contain?

A

Descending autonomic inputs from hypothalamus, taste information from nucleus solitarius.

37
Q

what inputs does the Lacrimal Nucleus?

A

Hypothalamic inputs (emotional responses), also inputs from sensory nucleus of V for reflex lacrimation (during corneal reflex).

38
Q

How is Reticular Formation Involved in the Corneal Reflex?

A
  • Sensory information (ie. wisp of cotton) are transmitted via CN V to reticular formation (RF).
  • RF fibers bilaterally innervate motor nucleus of CN VII.
  • CN VII axons innervate orbicularis oculi, which closes the eyelids.
39
Q

what structure gives off taste information?

this structure is connected to what 3 structures?

A

Geniculate ganglion:

  1. Intermediate nerve (which also does GVE component of CN VII)
  2. Chorda tympani
  3. Lingual nerve (a branch of V3 but also conveys taste information).
40
Q

what is bell’s palsy?

may be caused by what?

when the nerve regenerates, it may lead to what condition?

A

Swelling of the nerve within the facial canal, resulting in LMN facial paralysis.

post-viral infection

‘Crocodile Tears’ syndrome.

41
Q

CN 7 symptoms are all on which side?

what are the CN 7 symptoms?

A

ipsilateral

  1. Facial paralysis (upper and lower)
  2. Loss of lacrimation
  3. Decreased salivation
  4. Loss of taste sensation, anterior 2/3 of tongue
  5. Hyperacusis (stapedius muscle paralysis)
42
Q

what type of damage is this?

A

UMN damage

43
Q

what type of damage is this?

A

Facial nerve damage

44
Q

identify the squares

A
45
Q

if there is bilateral hearing loss, the damage is whre?

what about unilateral hearing loss?

A

in the CNS

the ear itself

46
Q

what type of CNS condition will lead to bilateral hearing loss?

A

wallenberg

47
Q

Fibers from both cochlear nuclei (anterior/posterior) synapse bilaterally where?

A

on the olivary nuclei

48
Q

once axons synapse bilaterally on the olivary nuclei form the cochlear nuclei, what will they do?

A

they ascend to inferior colliculus and medial geniculate body of the thalamus as the lateral lemniscus.

49
Q

what is Optokinetic reflex (Optokinetic nystagmus)?

A

CN VIII is involved in smooth tracking and saccadic

eye movements (saccadic meaning jumping).

(like when you track stationary poles while in a moving car)

50
Q

what pathway is involved in Nausea, vertigo, vomiting nystagmus, dizziness, disequilibrium?

what pathway is involved with hearing loss?

A

Vestibular portion/pathway

cochlear portion/pathway

51
Q

identify the squares

A
52
Q

what CN takes care of sensation and motor of the posterior part of the throat?

what takes care of taste of anterior 2/3 of the tongue?

what takes care of sensation of 2/3 of the tongue?

A

CN 9

CN 12

CN 5

53
Q

what is the motor nuclei for CN’s IX, X and XI?

What is the sensory nuclei for CN’s VII, IX and X where they terminate?

A

nucleus ambiguus

nucleus solitarius

54
Q

axons for CN 9 have 2 components?

A

GVA, GSA, SVA, SVE, GVE

55
Q

the GSA component of CN 9 will do what?

what will this part connect with?

A

Sensation from external auditory canal (via auricular branch of vagus).

Connects with spinal tract and nucleus of CN V.

56
Q

The GVA component of CN 9 does what?

A

Sensation from posterior 1/3 of tongue, pharynx, tonsils, auditory tube. Also carotid sinus (baroreceptors) and carotid body (chemoreceptors).

57
Q

what does the SVA component of CN 9 do? using what?

A

Taste from posterior 1/3 of tongue using as well petrosal ganglion to nucleus solitarius

58
Q

what will the GVE component of CN 9 do? uses what components?

A

Parasympathetic. Parotid and otic glands.

59
Q

what is the SVE component of CN 9 involved with?

A

Innervation of stylopharyngeus muscle.

60
Q

A CN 9 lesion will result in what symptoms?

A
  • Loss of gag reflex (afferent limb).
  • Loss of sensation from posterior 1/3 of tongue, tonsils, pharynx, and loss of taste from posterior 1/3 of tongue.
  • Bilateral lesions can affect carotid sinus reflex.
61
Q

what are the compnents of CN 10?

A

GSA, GVA, SVA, SVE, GVE

62
Q

what does the GSA component of CN 10 do?

what does it connect with?

A

sensation of Infratentorial dura, external ear, tympanic membrane.

Connects with spinal tract and nucleus of CN V.

63
Q

what does the GVA component of CN 10 do?

A

Sensation from throat areas, nodose ganglion.

64
Q

CN 9 would be affected in what condition?

A

in a medial medullary syndrome

65
Q

what does the SVA component of CN 10 do?

what structure does it involve?

A

Taste buds in epiglottis.

Nodose ganglion.

66
Q

what does the SVE component of CN 10 do?

A

contraction of Pharyngeal arch muscles of pharynx and

larynx, striated muscle of upper esophagus, uvula, levator palatini and palatoglossus muscles.

67
Q

what does the GVE component of CN 10 do?

A

innervates viscera of neck and thoracic (heart) and abdominal cavities. Dorsal motor nucleus of vagus contributes here.

68
Q

a lesion of CN 10 will result in what symptoms?

A
  1. Paralysis of the pharynx, larynx, soft palate = Dysphonia, Dysphagia, Dysarthria, Dsypnea
  2. Loss of gag reflex (efferent limb).
  3. Loss of cough reflex due to sensory loss from the
  4. pharynx and larynx.
  5. Bilateral laryngeal paralysis can result in asphyxia.
  6. Bilateral lesions can affect carotid sinus reflex.
69
Q

name at least 4 places i could damage to get decreased salivation?

A

CN 7 and CN9 on both sides = superior salivatory nucleus

nucleus solitarius on either side

70
Q

what are the 2 divisions of CN 11?

A

Cranial and Spinal

71
Q

what will the cranial division of CN 11 do?

A

motor nuclei in nucleus ambiguus, mediates swallowing (larynx). Also some proprioceptive feedback.

72
Q

Where is the spinal divison of CN 11?

what does the spinal division of CN 11?

A

The accessory nucleus of CN XI is located in the ventral horns of the spinal cord (C1 to C6).

These axons leave the anterior horns laterally, enter the foramen magnum, and exit the skull again via the jugular foramen, innervating the sternocleidomastoid and trapezius muscles.

73
Q

lesion of spinal division of CN 11 will result in what?

A

difficulty in shoulder shrugging and head turning movements.

74
Q

what does CN 12 do?

lesion of CN 12 will result in what?

A

movement and propioception of the tongue

Lesion results in deviation of the tongue to the affected side, atrophy and paralysis.

75
Q

what type of innervation does CN 12 receive?

what type of innervation does the genioglossus muscle receive?

A

receives bilateral corticobulbar innervation

contralateral corticobulbar fibers

76
Q

damage to CN XII nuclei results in what symptoms?

A

atrophy of tongue muscles, and deviation towards the affected side on protrusion.

77
Q

Corticobulbar damage results in what CN 12 symptoms?

A

contralateral deviation of the tongue without atrophy.

78
Q

name the exit points and say what goes through them

A

Neuro Block 2 (7 decks)

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