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neuromuscular pt 1 > Cranial Nerves > Flashcards

Cranial Nerves Flashcards

1
Q

What are the Cranial Nerves

A
  1. Olfactory
  2. optic
  3. oculumotor
  4. trochlear
  5. trigeminal
  6. Abducens
  7. fascial
  8. Vestibulocochlear
  9. Glossalpharyngeal
  10. vagus
  11. accessory
  12. hypoglosssa
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2
Q

What nerves are sensory and what nerves are motor?

A
  1. Olfactory - S
  2. optic - S
  3. oculumotor -M
  4. trochlear-M
  5. trigeminal-B
  6. Abducens -M
  7. fascial-B
  8. Vestibulocochlear - S
  9. Glossalpharyngeal - B
  10. vagus -B
  11. accessory - M
  12. hypoglosssa - M
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3
Q

Olfactory Nerve

A
  • sensory only
  • olfaction/smell
  • only sensory input that can reach cortex without synapses in cortex
  • olfactory bulb => medial temporal lobe of cerebrum and olfactory cortex in insule => amygdala and parahippocampal gyrus
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4
Q

Optic nerve

A
  • sensory only
  • vision
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5
Q

oculomotor

A
  • motor
  • serves muscles of the eye
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6
Q

trochlear

A

Motor
serves superior oblique eye muscle

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7
Q

trigeminal

A
  • Motor and sensory
  • sensory from face and mouth
  • motor to muscles of mastication
  • function in chewing, fascial sensation, sensation from TMJ and teeth, afferent limb of corneal reflex
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8
Q

Abducens

A
  • motor
  • serves the lateral rectus eye muscle

CN6

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9
Q

fascial

A
  • motor and sensory
  • serves the muscles of fascial expression, lacrimal glands and salivary glands
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10
Q

Vestibulocochlear

A
  • Sensory
  • equilibrium and hearing
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11
Q

Glossopharyngeal

A
  • motor and sensory
  • serves the pharynx for swallowing
  • posterior third of tongue, parotid salivary gland
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12
Q

vagus

A
  • motor and sensory
  • sensation from visceral (internal organs)
  • parasympathetic motor regulation of visceral organs
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13
Q

accessory

A
  • motor
  • serves muscles the move head, neck and shoudle
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14
Q

hypoglosssa

A
  • motor
  • serves muscles of the tongue
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15
Q

What occurs with damage to Olfactory and how to test it

A
  • loss of sense of smell = Aanosmia
  • test = pungent smells such as coffee, vanila
  • close one nostril to test each nerve
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16
Q

What are the three divisions of the trigeminal nerve

A

V1 = opthalmic branch
V2 = maxillary branch
V3 = mandibular branch

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17
Q

What are the motor connections of the trigeminal nerve

A
  • trigeminal motor nucleus is in pons
  • receives bilateral connections from corticobrainstem tract (upper)
  • innervates muscles for mastication
  • motor axons travel in mandibular branch
  • also innervate: tensor tympani, mylohyoid, tensor palatini, diagastric ms
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18
Q

What are the three trigeminal sensory nuclei

A

Primary/main sensory:

  • first order neurons synapse here, light touch and pressure

Mesencephalic nucleus (midbrain)

  • proprioceptive info from mm’s of mastication
  • transmitted ipsilaterally by axons of CN-V to here
  • reticular formation in midbrain

Spinal trigeminal nucleus

  • neurons for pain and temperature synapse here (pons/medullar)
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19
Q

How to test the trigeminal nerve

A
  • light tough and pressure for face and head, forehead, cheeks, chin as well as pain and temp
  • to test muscular innervation, palpate the temporal/masseter muscles
  • have patient clench teeth while observing for jaw deviation or symmetry in muscle contration
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20
Q

Testing trigeminal nerve: masseter reflex

A
  • proprioceptive sensory information from mesencephalic nucleus neurons
  • synapse with trigeminal motor nucleus
  • normal mandible jerks slightly upward with an UMN lesion this will be exaggerated
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21
Q

testing trigeminal nerve: corneal reflex

A
  • pain information from cornea travels via spinal trigeminal tract to spinal trigeminal nucleus
  • internuerons synapse on bilateral fascial nerve nuclei
  • motor neurons in fasical nerve innervate obicularis oculi which closes eyelids
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22
Q

What will be seen clinically with deficits with trigeminal nerve lesions

A

Ipsilateral:

  • loss of sensation, paresthesia or numbness of face
  • trigeminal neuralgia/tic douloureux
  • flaccid paralysis of muscles of mastication
  • loss of corneal reflex
  • deviation of jaw to ipsilateral side
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23
Q

what might accompany damage to the trigeminal nerve

A
  • ataxia (middle cerebellar peduncle)
  • nystagmus (cerebellum)
  • vertigo
  • tinnitus
  • fascial palsy
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24
Q

Trigeminal neuralgia

A
  • severe sharp stabbing pain in area of distribution
  • begins and ends abruptly
  • primary cause is pressure of blood vessel compressing the nerve
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25
Q

Corticobrainstem tract damage vs trigeminal nerve damage

A
  • due to Bilateral connection, UMN lesions does not usually produce weakness in upper fasical muscles
  • but if you damage the trigeminal nerve then there will be ipsilateral muscle weakness on the full 1/2 of face
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26
Q

Fasical motor functions

A
  • fasical nucleus: located in the caudal pons
  • muscles of the fascial expression, close the eye, move the lips
  • involved in motor portion of corneal reflex (with CN V)
  • dampens vibration of stapes
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27
Q

Fasical nerve sensation

A
  • Touch, nocioceptive, and pressure info from pharynx, and skin near the ear canal
  • Taste from the anterior 2/3 of the tongue. (to solitary nucleus)
  • solitary tract - compact fiber bundle in the posterolateral medulla
28
Q

fascial nerve visceral functions

A
  • innervates the superior Salivatory Nucleus - in the medulla
  • parasympathetic neurons innervate the salivary, nasal, and lacrimal glands
29
Q

What occurs with fascial nerve damage

A
  • Lesion of the corticobrainstem tract will result in weakness of the lower facial muscles contralateral to the lesion, without affecting the upper face
  • Lesion of the facial nerve or motor nucleus: - paralysis of the entire half of the face –Bell’s Palsy
  • Motor neurons innervating the upper portion of the face receive bilateral innervation (eyebrows and forehead).
  • Motor neurons innervating the lower face receive only contralateral innervation
  • ramsay hunt syndrome
  • hyperascusis: over sensitivity to certain frequencies
  • dry mouth
  • corneal dryness
30
Q

How to examine the fascial nerve

A
  • observe face at rest then have patient raise eyebrows, wrinkle forehead, show teeth, puff out cheeks, close eyes tightly (while examiner attempts to open eyes)
31
Q

differentiate between bells palsy and CVA

A

Bell’s Palsy

  • inability to wrinkle brow
  • dropping eyelid; inability to close eyes
  • inability to puff cheecks
  • dropping of mouth with inability to smile

CVA

  • lower fascial muscles are involved
32
Q

Ramsay hunt syndrome

A
  • shingles
  • fascial paralysis
  • ear pain
  • blisters on external ear
  • occas- mouth blisters
  • problems with balance
  • vertigo
  • hearing
  • tinnitus
33
Q

Glossopharyngeal IX

sensory function

A
  • taste from the posterior third of the tongue
  • tactile information from the soft palate pharynx (Gag reflex afferent limb)
34
Q

Glossopharyngeal IX

Autonomic functions

A
  • Baroreceptors in the carotid sinuses and chemoreceptors in the carotid bodies
35
Q

Glossopharyngeal IX

Motor functions

A
  • stylopharyngeus muscle (muscle of the soft palate)
  • involved in swallow & speech
  • motor nucleus is close to motor nuclei for X and IX = nucleus ambiguus
36
Q

Glossopharyngeal IX

Nerve damage

A
  • Gag reflex and swallowing affected
  • Salivation decreased
37
Q

Vagus nerve X

functions

A
  • Mixed innervation of larynx, pharnx, and viscera
  • Regulation of visceral activity, swallowing, speech, taste
38
Q

Vagus nerve nuclei

A
  • Nucleus Ambiguus (CN IX and X)
  • bilateral innervation from the corticobrainstem tract
  • innervate the voluntary muscles of the larynx (laryngeal nerve)
  • Innervate constrictor muscle of the pharynx (closes to allow food to pass thru esophagus
39
Q

Vagus nerve

afferent functions

A
  • Touch, proprioceptive & nocioceptive information from the pharynx, larynx,
    and part of the external ear
40
Q

Vagus nerve Autonmic funtions

A
  • Afferent and Efferent axons
  • larynx, pharynx, trachea, lungs, heart, gastrointestinal tract (except the lower large intestine), pancreas, gallbladder, and liver
  • reduce the heart rate, constrict bronchi, affect speech production, and increase digestive activity.
41
Q

Vagus Nerve parasympathetic function

A
  • Efferents
  • Smooth muscles and glands
  • pharynx, larynx, thorax, abdomen
  • Reduction of heart rate, constrict the bronchi, and stimulate digestion
42
Q

Vagus nerve and Glossopharyngeal nerves damage

A
  • Damage to cranial nerve X and IX - commonly associated with each other
  • Deficits are usually coupled
  • Dysarthria, dysphagia, dysphonia
  • diminished or loss of gag reflex
  • uvular deviation
  • cardiac and GI abnormalities
  • dysarthria

Dysarthria-poor control of speech
Dysphagia-difficulty swallowing

43
Q

Accessory

A
  • Innervates the sternocleidomastoid and the trapezius muscles
  • Nuclei are found dorsally in the medulla and in the upper cervical region of the spinal cord
  • processes from the spinal cord ascend and enter the skull join with the rest of cranial nerve XI

enters the spinal cord from medulla

44
Q

Damage to accessory nerve

A
  • Complete lesion of the nerve itself paralyzes the ipsilateral sternocleidomastoid and trapezius muscles
  • UMN lesion=paresis—cortical innervation is bilateral; muscle hypertonic
45
Q

Hypoglossal Nerve

A
  • Innervates the intrinsic and extrinsic muscles of the tongue
  • Nucleus of the hypoglossal nerve receives connections from the contralateral corticobrainstem tract
  • Hypoglossal nerve innervates the ipsilateral half of the tongue
46
Q

Hypoglossal nerve: clinical deficits

A
  • paresis or paralysis of the ipsilateral tongue
  • fasciculations and atrophy
  • ipsilateral deviation with protrusion

Corticobrainstem tract lesion = paresis of the tongue contralateral to the lesion

47
Q

How to test hypoglossal nerve

A

stick tongue out and observe

48
Q

CN II: optic nerve

A
  • photosensitive cells in retina receives visual information from environment
  • synpase with retinal output cells
  • travels in optic nerve, through optic chiasm then through optic tract
  • travels from lateral geniculate body in thalamus to primary isual cortex in occiptial lobe
  • travels via optic radiation
49
Q

visual fields projections

A
  • information from left visual field travels to the right visual cortex
  • information from right viusal field travels to the left visual cortex
50
Q

optic nerve damage

A
  • ipsilateral blindness
  • loss of pupillary light reflex (must be able to see the light)
  • frequently affect in those with MS
51
Q

Cranial Nerve III

A
  • motor to levator palpebrae, superior, medial and inferiro rectus and inferiro oblique
  • parasymathetics to consonstrictor pupillae and cilary muscles via ciliary ganglion

when light is shown both pupils contrict

52
Q

CN III lesion

A
  • ptosis: droopy eye
  • eye aimed outward and down
  • diplophia: double vision
  • unable to move the eye medially, down and up
  • loss of pupillary light reflex/consensual reflex
  • loss of pupil constriction
53
Q

CN IV: trochlear

A
  • superior oblique muscles for eye rotation (eye rolling)
  • pathway: corticobrainstem tract to trochlear nucleus in midbrain, exits dorsally below inferiro colliculus
54
Q

CN VI: abducens

A
  • corticobrainstem tract neurons
  • synpase on abducens nucleus on pons
  • travel via abducens nerve to lateral rectus muscles
  • moves pupil laterally

test by using a point (like of finger) nad making an H

55
Q

Coordination of eye movement

A
  • 6 cranial nerves
  • 12 eye muscles
  • coordination occurs on medial longitudinal fasciculus
  • coordinates head and eye movements
  • connects bilaterally oculomotor nuceli with each other and with vestibular and spinal accessory nuclei
56
Q

eye reflexes

A
  • CN II optic (afferent)
  • CN III oculomotor) - efferent
  • pupillary
  • consensual
57
Q

eye reflex

  1. Pupillary
  2. consensual
A
  1. shine ligh in eye
    ipsilateral pupil constricts
  2. shine light in eye contralateral pupil constricts
58
Q

how does the consensual reflex work

A
  • Consensual reflex:
  • Axon of different neuron in pretectal nucleus crosses midline
  • Synapses on contralateral Edinger-Westphal nucleus
  • Axon synapses on contralateral ciliary ganglion
  • Activates contralateral pupillary sphincter
59
Q

Accomodation/convergence with eyes

A
  • adjustments to view a near object
  • pupils constrict
  • increase lens curvature
  • eyes converge (adduct)
60
Q

Sympathetic effects on eyes

A
  • dilate the pupil
  • assist on elevating eyelid
  • levator palpebrae superioris has dual innervation
  • skeletal muscle CN III
  • smooth muscle (superior tarsal muscle)
61
Q

CN VIII: vestibulocochlear

A
  • 2 branches
  • cochlear = hearing
  • vestibular = balance/where head is in space
62
Q

CN VIII: vestibulocochlear

cochlear portion

A
  • hearing
  • sounds converted from mechnical to neural signals in inner ear
  • vibration stimulates hair cells of cochlear nerve
  • travels to cochlear nuclei in pontomedullary junction
63
Q

use of sound information

A

signals travel from cochlear nuclei

  • retiular formation
  • inferior colliculus
  • primary auditory cortex
  • auditory assoication area
  • wernicke’s area
64
Q

How to test the cochlear portion of CN VIII: vestibulocochlear

A

ring test

  • tunning fork
  • can you hear it on the both sides the same
  • stick on top of head
65
Q

CN VIII: vestibulocochlear

vestibular branch

A
  • transmits information regarding head position with respect to gravity and head movement
  • balance

head impulse test to test this

neuromuscular pt 1 (32 decks)

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