11/3 Anatomy And Cranial Nerves!!!! Flashcards Preview

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Flashcards in 11/3 Anatomy And Cranial Nerves!!!! Deck (125)
1

what is the menu or outline of CN modalities?

Sensory Neurons (GS,SS,VS) to CNS (MB,P,M) to Motor Neurons (SM,BM,VM)

2

what are the three types of sensory neurons of the cranial nerve modalities?

general sensational (GS); Special Sensation (SS); Visceral Senses (VS).

3

what type of innervation is CN modality of general sensation (GS)?

Pain, temp. touch, vibrations, proprioception.

4

what type of innervation is the CN modality of special sensation (SS)?

hear, smell, see, taste.

5

what type of innervation is CN modality of visceral sensation (VS)?

barrel receptors, stretch receptors etc.

6

where is the primary center of interneurons processing?

the Brain stem:

7

what are the parts of the brain stem?

the midbrain, the Pons, and the Medulla.

8

what are the three types of motor neurons of the cranial nerve modalities?

Somatic Motor; Brachial Motor; Visceral Motor.

9

what type of innervation is CN modality Somatic Motor (SM)?

Voluntary Motor innervation to skeletal muscles derived from somites.

10

what type of innervation is CN modality of Brachial Motor (BM)?

Voluntary motor innervation to skeletal muscles derived from the brachial arches.

11

what type of innervation is CN modality Visceral Motor (VM)?

Involuntary motor innervation to salivary glands, tear glands, sweat glands, parasympathetics etc.

12

what are cranial nerves in the end?

they are a bundle of neurons that can choose from the menu of cranial nerve modalities to provide sensory or motor innervation to the head! One Nerve can provide multiple sensory or motor modalities from the "menu"

13

what are other terms for GS, SS, VS modalities of cranial nerve innervation?

GS = General Somatic Afferent; SS= Special Visceral Afferent; VS= General Visceral Afferent.

14

what are other terms for SM, BM, and VM modalities of cranial nerve innervation?

SM= General Somatic Efferent; BM= Special Visceral Efferent; VM= General Visceral Efferent.

15

Describe the segmental pattern to CN and spinal nerve origins including what nerves come from what part of the brain stem:

Midbrain (CNIII, IV); Pons (CN V, VI, VII, VIII); Medulla (CN IX, X, XI, XII); Then the spinal nerves arise segmentally down the spine from C1 to S5!

16

what are the names of the Cranial Nerves?

CN1-Olfactory, CNII-Optic, CNIII-Oculomotor, CNIV-Trochlear CNV-Trigeminal CNVI-Abducens CNVII-Facial CNVIII-Vestibulocochlear CNIX-glossopharyngeal CNX-Vegus CNXI-Spinal Accessory Nerve CNXII-Hypoglossal

17

What is the Name, Origin, Foramen, Function, and clinical complaint/test for CN 1

CNI

Name:  Olfactory Nerve

Origin:  the ofactory epithelium in the superior part of the lateral and septal walls of the nasal cavity to the primary and association  areas of the cerebral cortex

Foramen: Cribriform foramina

Function: Smell

Clinical Complaint/Test:  Change in taste, no desire for food, early finding in parkinsons, test each nostril seperate for smell of something smelly!

18

What is the Name, Origin, Foramen, Function, and clinical complaint/test for CN 2

CNII

Name:  Optic Nerve

Origin: The Optic chiasm

Foramen: The Optic Canal

Function: SS: Sight

SM: Levator palpebrae superioris m.; superior, media, ad inferior rectus mm.; inferior oblique mm.

Clinical complaint/test:  Monocular blindness, and the only CN affected by M.S. (myelinated by oligodendrocytes). Snellen test; confrontation; Pupillary reflexes (II in, III out); Funduscopy.

19

What is the Name, Origin, Foramen, Function, and clinical complaint/test for CN 3

CNIII

Name: Oculomotor Nerve

Origin: edinger-westphal nucleus in the forebrain 

Foramen: Superior orbital fissure

Function:  open eye, eye movement, pupil constrict, lens focus

SM:  four of the extraocular muscles (superior rectus, medial rectus, inferior rectus, and inferior oblique) and the levator palpebrae superioris muscle.  

VM: PARASYMPATHETIC innervate the ciliary body (lens accommodation) and sphincter pupillae muscle (pupil constriction)

Clinical Complaints/ Test:  Mydriasis (dilated pupil), ptosis (droopy eyelid), eyeball down and out, loss of pupillary reflex on the side of the lesion and loss of the accommodation reflex.  Use Pupillary response, confrontation

20

What is the Name, Origin, Foramen, Function, and clinical complaint/test for CN 4

Name: Trochlear Nerve

Origin: from the posterior aspect of the brainstem at the level of the pons

Foramen: Superior Orbital fissure

Function:  Innervates the Superior Oblique muscle

Clinical complaint/test

21

What is the Name, Origin, Foramen, Function, and clinical complaint/test for CN 5

Name: Trigeminal Nerve

CN V-1: opthalmic Division

CN V-2 Maxillary Division

CN V-3: Mandibular Division

Origin: the lateral surface of the Pons

Foramen: 

V-1: Superior Orbital Fissure

V-2: Foramen rotundum

V-3: Foramen Ovale

Function: Principal General Sensory supply to the head

V-1: GS to the orbit, cornea and skin of the bridge of the nose, scalp and forehead

V-2: GS to the maxillary face (between the lateral corners of the eye and the cornes of the mouth)

V-3: GS to the lower part of the face and teeth, anterior of tounge, and BM to the muscle of mastication

Clinical compaints/tests: Loss of sensory to any of the three fields of the face;  V-1: corneal reflex V-2: upper teeth and skin; V-3: toungue, lower teeth and weekness in chewing.  Do the swipe the skin test to check! and the corneal reflex.

22

What is the Name, Origin, Foramen, Function, and clinical complaint/test for CN 6

Name:  Abducens

Origin: Pons

Foramen: superior orbital fissure

Function:  

SM: lateral rectus muscle

GS: external acoustic meatus and auricle 

SS: anterior two thirds of toungue

Clinical complaints/Tests: CN VI palsy or the inability to move the eye laterally, resulting in diplopia on lateral gaze.  do the "H" test!

 

 

23

What is the Name, Origin, Foramen, Function, and clinical complaint/test for CN 7

Name: Facial nerve:

Origin: from the pons and lateral to the Abducens Nerve.  

Foramen: Internal acoustic Meatus

Function:  Motor innervation to the muscles of facial expression, lacrimal gland, and submandibular and sublingual salivary glands, taste, and anterior two thrids of the tongue.

BM:  2nd branchial arch muscles: facial expression, stapedius, posterior digastricus,a nd stylohoid

VM: glands of the head except parotid gland (CN IX)

SS: taste from anterior 2/3 of the tongue

GS: transmit general sensation from a portion of the external acoustic meatus and auricle.

PARASYMPATHETIC!  Saliavation, Lacrimation, Nasa/palatal glands.

Clinical:  Bell's palsy on one side of the face or paralysis on lower 1/3 of one side due to stroke.  Test with the smile and raise eyebrow test!

24

What is the Name, Origin, Foramen, Function, and clinical complaint/test for CN 8

Name: Vestibulocochlear Nerve

Origin: from the Pons and just barely lateral to the Facial nerve.

Foramen: Internal Acoustic meatus

Function:  Hearing and equilibrium

SS:  hearing/equilibrium

Clinical: Hearing loss on one side, and tinnitus and vertigo;  test with the finger rub test w/eyes closed.

25

What is the Name, Origin, Foramen, Function, and clinical complaint/test for CN 9

Name: Glossopharyngeal nerve

Origin: from the lateral aspect of Medulla and just lateral and caudal the vestibulocochlear nerve.

Foramen: Jugular foramen

Function:  motor innervation to the stylopharyngeus muscle and parotid glands and sensory innervation from the carotid body and sinus, posterior one-third of toungue and the auditory tube.

PARASYMPATHETIC!  Parotid gland.

it does: BM, VM, GS, SS, VS !

clinical:  Palate symmetry, swallow, and gag reflex, vasovagal reflex.

26

What is the Name, Origin, Foramen, Function, and clinical complaint/test for CN 10

Name: Vegus nerve

Origin: from the lateral aspect of the Medulla

Foramne: Jugular foramen

Function:  innervates muscles of the larnx, pharynx, palate in addition to the gut tube, heart and lungs.

VS: larynx, trachea, esophagus, thoracic and abdominal viscera, and aortic arch stretch, chemoreceptors of aortic and carotid bodies.

GS:  pinna, laryngopharynx, external acoustic meatus

BM: palatoglossus, laryngeal, and pharyngeal, palatal.

VM: PARASYMPATHETIC!  Thoracis/Abd Viscera parasympathetics down to the mid gut!

Clinic:  Hoarsness, dificulty swallowing, pallate drops, gag reflex.  test with open mouth inspection of hte palate when say ahhhh...

27

What is the Name, Origin, Foramen, Function, and clinical complaint/test for CN 11

Name: Spinal Accessory Nerve

Origin: from the Medulla

Foramen:  Jugular foramen

Function:  BM: innervates the trapezius and sterno-cleidomastoid muscles

Clinical:  Weakness in turning the head and shoulder drop:  test with shoulder shrug or head turn with resistence.

 

28

What is the Name, Origin, Foramen, Function, and clinical complaint/test for CN 12

Name: Hypoglossal nerve

Origin: from the Medulla from the groove between the pyrimid and the olive.

foramen: Hypoglossal canal

Function:  SM: innervates the toungue muscles (intrinsic and extrinsic muscles)

Clinical:  tounge deviation towards the lesion;  test by having them press tounge into cheek against resistence.  

29

what is intramemberous bone formation?

Bones that form from dense irregular connective tissue

30

what is non-communicating (obstructive) hydrocephalus?

Block of the CSF flow that blocks the flow to the arachnoid space.

31

What is Communicating (non-obstructive) hydrocephalus?

Block of the CSF flow that doesn't block the flow to the the arachnoid space.

32

FLAT PiG  (hormones of the pituitary)

An acronyme for the pituitary!

From the Anterior:

FSH (follicle stimulating hormone)

LH (lutinizing hormone)

AcH (Adrenal corticotropic hormone)

TH (Thyroid Stimulating Hormone)

PgH (prolactin growth hormone)

From the Posterior:

Anti-dieretic

Oxytocin

 

33

Brain vascular supply

ICA, Vertebral -- small arteries that go into the brain itself, arterioles, capilaries (blood, brain behavior). Then -- Venules, small veins, Dural venous sinuses (periosteal layer and manejial layer),

34

what are the three hemorrhages that can occur in teh head?

epidural hemorrhage, subdural hemorrhage, subarachnoid hemorrhage.

35

What are the two types of strokes that can occur?

hemorrhagic; clot

36

what is the pterion?

the smallest or thinnest part of the skull at the temple

37

why do we get a discoid shape hemmorage when we have a epideral hematoma?

because the periosteal dura mater will peal away from the skull until it reaches a suture in the skull!

38

what do the bridging (cerebral) vein bridge?

the cerebrum and dural venous sinus (accross the arachnoid space)

39

What is the source of a epideral hematoma

skull fracture or other trauma that will burst the artery in teh epidural space

40

HOW can we get a subdural hemorrhage?

have the bridging veins burst due to tension on the bridging veins. (bad for infants and elderly or alcoholics)

41

how do we get a hemorrhage that is crescent shape (same shape as the skull concavity)

have a subdural hemorrhage and pooling of the blood in the space between the e MORE!

42

why does the brain hate a hemorrhagic stroke

pressure, lacking nutrients

43

what is a hemorrhagic stroke compared to ischemic stroke?

Hemorrhagic stroke is a burst vessel and bleeding into the brain. Ischemic is a stroke that occurs because of a block in the vessels.

44

What are the two components of the Autonomic nervous system of the head?

Parasympathetics:  (CN's III,VII, IX, and X)

Sympathetics (T1 Spinal Cord level)

45

What is the spinal cord level that all head sympathetics come from?

The T1!

46

Describe the course of sympathetic nerves into the head!

From the T1 spinal cord lateral horn-

Ventral root-

Trunk-

ventral ramus-

white matter communicon-

sympathetic chain-

up to the Superior Cervical gangleon-

Synapse in the SCG-

Out the gray matter comunicon-

Onto the ICA like christmas lights!

47

what is the most clinically relavent action of the sympathetic nervous system in the head?

Eyeball-

Dilator Pupillae Muscles: Dialate the pupil!

Superior Tarsal Muscle:  Smooth muscle that keep the eyelid open!!!

48

what is the syndrome where you knock out all of the sympathethics to the head

Horner's Syndrome

49

What are the symptoms of a Horner's Syndrome?

Ptosis:  Eyelid is droopy!

Anhydrosis: The face is flush and dry (sweat glands innervation)

Miosis: Different sized pupils!

"PAM has HORNS"

50

What are the bones of the Skull?

51

what bones covers the front of the skull

The Frontal Bone

52

what bone means "wall" and forms a wall around the sides of the brain?

Parietal bone

53

What bone lies under the hair that would gray first and is therefore the "time" bone?

temporal bone

54

What is the bone that is at the "temples"

The sphenoid bone that goes from one side of the skull to the other, that forms the back of the orbit and is a key stone bone that alot of other bones attach to.

55

What is the bone that you lay on your pillow?

the Occipital bone.

56

what are the fibrous joints that knit the bones of the head together?

The Sutures!

57

Knits the frontal the the pariatel bones together along the top of the head.

The coronal suture.

58

the suture that articulates the parietal and temporal bones

The Squamosal suture.

59

The suture that articulates the occipital bone to a paratial and temporal bones.  makes a "triangle"

Lambdoid suture.

60

The tiny suture that connects the coronal and squamosal sutures.

The Pterion suture

61

why is the tiny little pterion suture clinically important?

Middle maningial artery courses right here where the bone is thinnest!

62

what are the layers of the protective seat-belt of the skull?

the Dura mater, the Arachnoid mater and the Pia mater

63

How is the dura mater of the head different than the dura matter of the spine?

the head has two layers that are fused together:  

Dura mater:

Periosteal layer:  hugs the skull

Meningeal layer: divides and goes towards the brain paranchima

 

64

what is between the Periosteal layer and the meningeal layer?

this layer isn't always seperated but when it is, it forms Dural Venous Sinuses!

65

what is and How is a dura venous sinus different than a vien in the rest of the body?

It is a space between the periosteal and meningeal layers of the the cranial meninges that is full of venous blood. 

It does not have a tunica media (smooth muscle layer)

It does not have valves!

66

the viens that travel in the diploid bone, and provide drainage to the skin of the skull!

Diploic viens! 

67

what are the Emissary viens of the head?

they are veins that transverse the skull and connect the skin to the dural venous sinuses!

could be a source of infection into the brain!

68

Veins that drain the parachama of the bain from the capillaries of the brain tissue to the dura venous sinuses!

Cerebral Veins

69

What are the divisions of the Dura mater?

the Falx cerebri

Tentorium 

Falx Cerebelli

70

Seperate the left and right cerebral hemisphere in a vertical plane

The Falx Cerebri

71

Seperates the cerebeli from the cerebellum in a horizontal plane.

The Tentorium cerebelli

72

Seperates both the cerebelli hemispheres

The Falx Cerebelli

73

Courses along the top of the Falx Cerebri from the anterior to the posterior ( a dura venous sinus)

the Superior sagittal sinus

74

Courses along the bottom of the falx cerebri from the fron to the back (dura venous sinus)

Inferior sagittal sinus

75

From the intersection of the superior and inferior sagital sinus and runs along the back of the tentorum cerebeli (dura venous sinus)

The thransverse sinus

76

Dura venous sinous that rises from the transverse sinus and curves down towards the IJV

The Sigmoid sinus

77

Dura venous sinus, paired and flanks the side of the sphenoid body

The Cavernous sinus

78

Important clinical considerations of the cavernous sinus

communicates with the facial vein and with the pterygoid plexus of veins (spread of infection!!!)

ICA courses through it ( in wraps around the front and comes out the top!!)

CN's going to orbit course through it. ( CN 6 goes through the middle and in the wall of the CS from the top to the bottom are CNs: 3,4,V-1,V-2)

And it also has the pituitary gland righ in the middle at the top!

79

what is the blood supply to the Meninges?

the anterior, middle (most clinically rellavent), and postier meningeal artery from the maxillary arter, through the foramen spinosum, on the internal surface of the pterion!

80

Protude into the superior sagital sinus to allow the CSF to flow from the subarachnoid space into the dura venous sinuses.

The arachnoid granulations.

81

space where the CSF flows, where arteries and viens are housed!

The subarachnoid space

82

Dives down the sulci and along the brain

the pia matter

83

the area of the brain that is along the top!!

the cerebrum

84

The hollow cavity in each cerebrum filled with CSF

Lateral ventricles

85

The ventricle between the dianchephelon that communicates with the lateral ventricles

the third ventricle

86

communicates with the 3rd ventricle and dives down through the midbrain, filled with CSF

The cerebral aqueduct

87

The part of the brain that is caudel to the midbrain! 

Pons (CN V, VI, VII, VIII)

88

The brain caudel to the pons

the medulla oblengauta (CN IX, X, Xi, XII)

89

The califlower looking bulb in the bottom back of the brain

The Cerebellum

90

The parts of the brain from the top to the bottom

Cerebrum

Midbrain

Pons                                

 Cerebellum

Medulla Oblengata      

 

91

Communicates with the cerebral aquiduct above and in the subarachnoid space with the apperatures

The 4th ventricle

92

Describe the flow of CSF

The Choroid Plexus makes it from the blood supply

goes to the lateral ventricles

to the third ventricle

to the cerebral aquiduct

to the fourth ventricle

to the aperatures

to the sub arachnoid space

to the arachnoid granulations/Sub arachnoid villi

into a dura venous sinus

back to the IJV!

93

The connecting tissue between the right and left sides of the brain

Corpus callosum

94

Inside the later, third, and fourth ventricles to provide CSF

The choriod plexus

95

Openings to the subarachnoid space from the fourht ventricle

Apertures

2 Lateral

1 Median

96

The blood supply to the brain!!!!!!! (overview!!)

97

Blood supply through the skull to the front of the brain

The internal carotid artery (ICA)

98

The source of blood through the skull to the back of the brain

The vertebral artery

99

the anastimosis of the ICA and the Vertebral artery at the bottom of the brain

The cerebral arterial circel of willis

100

The only place in the body where an artery resides in a vein (and it doubles back and does it agian...)

The ICA coursing the carotid canal and through the Cavernous sinus

101

Blood supply that courses right over the corpus collosum between the two hemispheres

The Anterior cerrebral artery.

102

blood supply that Course between the frontal and temproal lobes of the brain

The middle cerrebral artery

103

blood supply that Courses in the transverse foramena of the cervical vetebra, through the foraman magnum to the back of the brain

the vetebral artery.

104

the arteries that supply the cerebellum

The 

PICA

AICA

SCA

 

105

CN III seperates this artery from the SCA

The posterior cerebella arteries

106

Supply the base of the cerebellum

The anterior and posterior cerebella arteries.

107

Overview of the blood flow of the brain:

108

CNs that innervate almost all of te structures of the head and neck, the skin, mucous membranes, muscles and glands (and some targets in the trunk!)

CN V,VII,IX and X

109

CNs that innervate only structures in the orbit

CN III, IV, VI

110

CN that innervates only the tongue muslces

CN XII

111

Thr cranial nerves that carry parasympathetic neurons

CN III, VII, IX, and X

112

The top of the brain stem and what CNs come from here?

The Midbrain (CN II, III, IV)

113

summary of function CN 1

Transmits the sense of smell

114

summary of function CN 2

Transmits visual information to the brain

115

summary of function CN 3

Innervates eye muscles

116

summary of function CN IV

Innervates the superior oblique muscle

117

summary of function CN V

Recieves sinsation from the face and innervates the muscles of mastication

118

summary of function CN VI

Innervates the lateral rectus

119

summary of function CN VII

Provides motor innervation to the muscles of facial expression

120

summary of function CN VIII

Senses sound, gravity and rotation

121

summary of function CN IX

Motor: Phayrngeal Musculature

Sensory: posterior part of the toungue, tonsil, pharynx

122

summary of function CN X

Motor: heart, lungs, bronchi, GIT

Sensory: heart, lungs, bronchi, trachea GIT, external ear.

123

summary of function CN XI

controls sternocleidomastoid and trapezius muscles

124

summary of function CN XII

Provides motor innervation t the muscles of the tongue

125