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Finals Neurology > Cranial Nerves Lesions + Bell's palsy > Flashcards

Cranial Nerves Lesions + Bell's palsy Flashcards

1
Q

CN 2 - OPTIC

  • Function
  • Vision pathway
  • Light reflex
  • Accomodation
A

Function is vision

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2
Q

What is an Argyll-Robertson pupil?

Most common cause

A
  • No light reflex
  • Normal accomodation [to close object]

Cause; diabetes mellitus, neurosyphilis

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3
Q

What is Holmes-Adie pupil?

Wheres the lesion

Common presentation

A
  • Sluggish light reflex (large pupils)

Lesion: postganglionic fibers of ciliary gangion of parasympathetic innervation

Young women with limb areflexia

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4
Q

What is Horner’s syndrome?

  • Draw the relevent pathway
  • Common cause
  • Cardinal signs
A

Damage to sympathetic orbit supply

Pathway

  • Hypothalamus ⇒ Brainstem ⇒ T1 exit
  • ⇒ Stellate ganglion ⇒ Sup. cerical ganglion
  • ⇒ Plexus around int. carotid ⇒ ciliary ganglion
  • With CN5 to pupil

Cause

  • Pancoast (lung apex) tumour
  • Cerebral vasc. disease

Cardinal signs PEAM;

  • Ptosis (drooping up. eyelid)
  • Enapthalmos (eye shunk in socken)
  • Anhydrosis (no sweat ipsilaterally)
  • Miosis (constricted pupil)
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5
Q

What is pancoasts tumour

A

Tumour in lung apex ⇒ compresses ganglion causing Horner’s syndrome

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6
Q

Draw the vision pathway with its lesions & results

A
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7
Q

What nerves control eye movement

  • Names & full functions of each nerve
  • Draw H diagram detailing muscles
A
  1. Oculomotor 3
    • Motor - S, I & M Rectus, I oblique & upper eyelid
    • Parasympathetic - Spinchter pupillae
  2. Trochlear 4
    • Motor - S oblique
  3. Abducens 6
    • Motor - Lateral rectus
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8
Q

What is diplopia?

A

Double vision

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9
Q

What is 3rd nerve palsy?

How does it present?

Common cause

A

Oculomotor not working correctly

  • S, I & M rectus, I oblique not working
    • Unopposed L rectus & S oblique cause eye to go DOWN & OUT
  • Motor part of light reflex (from Edinger Westphal nucleus to ciliary ganglion)
    • LARGE pupil UNREACTIVE to light
  • Upper eyelid [levator palpebrae superioris]
    • Droopy eyelid
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10
Q

What is 4th nerve palsy

How does it present

A

Trochlear not working correct (rare in isolation)

  • Diplopia when looking down & away from affected side
  • ie When you use the Superior Oblique on the affected side you get diplopia!

Weakness in depression of the adducted eye

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11
Q

What is 6th nerve palsy

Common cause

A

Abducens not working correctly (L Rectus)

  • Vascular lesions or raised intracranial pressure
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12
Q

Outline the causes and presentation of pseudobulbar palsy

A

Bilateral damage to pyramidal tract system

  • Dysphagia
  • Dysarthria
  • Emotionalism
  • Small tongue stuck to floor of mouth
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13
Q

What is the fucntion of the 5th nerve?

  • Name
  • Branches
  • Corneal reflex
A

Trigeminal, 5th nerve

  • Sensory - face, scalp, cornea (sensory part of corneal reflex)
  • Motor - mastication (temporalis, masseter and pterygoids), tensor tympani

Branches

  1. Opthalmic (sensory)
  2. Maxillary (sensory)
  3. Mandibular (sensory & motor)

Corneal reflex

  • Cornea touches ⇒ Masociliary branch of opthalmic branch of trigeminal
  • ⇒ Passes through semilunar ganglion
  • ⇒ Spinal nucleus of trigeminal nerve
  • ⇒ Facial motor nucleus (both sides!)
  • ⇒ Temporal branch of facial nerve
  • ⇒ Orbicularis occuli
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14
Q

What is acoustic neuroma?

A

Pressure of 5th nerve in cerebello-pontine junction

⇒ Problems with corneal reflex

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15
Q

What is trigeminal neuralgia?

A

Problem with trigeminal 5th nerve.

Lancinating pain (stabbing)

Unkown aetiology

Affects 60-70 year olds.

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16
Q

What is the function of the 7th cranial nerve?

  • Name
  • Branches
A

Facial 7th

  • Sensory
    • Ant 2/3 tongue [Chorda Tympani branch]
  • Motor
    • Face [to zanzibar..]
    • Stapedius muscle [Stapedius branch]
  • Parasympathetic
    • Salivary/ lacrimal [Greatr petrosal nerve branch] glands

Branches (To Zanzibar By Motor Car)

  • Temporal
  • Zygomatic
  • Buccal
  • Marginal mandibular
  • Cervical
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17
Q

Draw the nuclei to the 7th nerve

A
18
Q

Draw a diagram detailing the upper and lower motor facial nerve lesions

A
19
Q

Draw the passage of the 7th nerve and the branches it gives off

A
20
Q

Outline the pathophysiology of Bell’s palsy

Describe;

  • Cause
  • Location of lesion & associated structures
A

Inflammation (unknown cause) in the facial canal as it exits via the stylomastoid foramen causes facial palsy.

Facial canal contains;

  • Stapedial nerve [sound]
  • Chorda tympani nerve [taste]
  • Facial nerve exiting via Stylomastoid canal [facial expression]
21
Q

Outline the symptoms & signs of Bell’s palsy

A

Symptoms

  • Unilateral facial weakness [facial]
  • Ipsilateral numbness/ pain around ear
  • Ageusia [chorda tympani]
  • Hyperacusis [stapedius palsy]

LMN lesion so its unilateral.

Greater superficial petrosal muscle is spared (and hence lacrimation)

22
Q

What are important differentials & relevent investigations of Bell’s palsy?

A

7th Nerve Palsy;

  • Ramsey Hunt syndrome [Varicella zoster in Geniculate nucleus, check VZV AB]
  • Lyme disease [check Borrelia (bacteria) AB]
23
Q

Outline the management of Bell’s palsy

A

Non.

  • Acute: Prednisolone
  • Remind to close eyes, tape at night, lagophthalmos: lid loading with gold
24
Q

What is an acoustic neuroma?

How might it affect the 7th nerve and why

Draw a diagram perhaps?

A

aka Vestibular schwannoma

Benign brain tumour growing on the 8th cranial nerve

May affect 7th nerve as 7 & 8 enter the I.A.M together.

All functions may be lost

25
Q

What is Ramsay-Hunt syndrome?

Any specific signs & investigations?

Any treatment?

A

Complete facial nerve palsy due to Geniculate Herpes Zoster (Varicella Zoster Virus)

Vesicular rash, check for VZV AB

Anti-virals (aciclovir) + prednisolone

26
Q

Traumatic injury to the eardrum can cause a loss of taste

Why?

A
  • Chorda tympani, a segment of the facial nerve, converys taste from ant 2/3 tongue
  • Runs very close to the eardrum
27
Q

What is the name & function of the 8th nerve?

A

Vestibulocochlear nerve

  • Sensory - vestibular apparatus & cochlear
28
Q

What is an acoustic neuroma?

A

aka Schwannomas

Slowly enlarge ⇒ progressive deafness

May affect other cerebellopontine angle structures (5th nerve - sensory face & loss of corneal reflex, or 7th - facial weakness)

29
Q

What is the name & function of the 9th nerve?

A

Glossopharangeal nerve

  • Sensory
    • Carotid sinus & body
    • Post 1/3rd tongue
    • Eustachian tube, mid. ear
    • Upper pharynx
  • Motor
    • Stylopharangeus muscle
  • Parasympathetic
    • Parotid & salivary
30
Q

What is the name an function of the 10th nerve?

A

Vagus

  • Sensory
    • Pharynx, larynx, oesophagus
    • External ear
    • Aortic body & arch
    • Thoracic & abdo viscera
  • Motor
    • Soft palate, pharynx, larynx
    • Upper oesophagus
  • Parasympathetic
    • Thoracic & abdo viscera
31
Q

Outline the major symptoms of damage to the nerves/ nuclei (eg in the medulla by vascular, motor neurone disease) or around the jugular foramen

A

Hoarse voice

Dysphagia [swallowing difficulty]

Sagging of soft palate

32
Q

Outline the gag reflex

A

Sensory 9th nerve

Motor 10th nerve

33
Q

What is the name & function of the 11th nerve?

A

Accessory nerve

  • Motor - sternoclidomastoid & trapezius
34
Q

What is the 12th nerves name and function

A

Hypoglossal

  • Motor - int & ext muscles of tongue
35
Q

Outline the presentation of a unilateral lesion to the hypoglossal nerve

A

Tongue will point towards the lesion

(The hypoglossals job is to protrude the tongue forward, if one side doesnt work [lesion] then only the other will push it out and it will sway towards the side with the lesion)

36
Q

Outline the cause and presentation of bulbar weakness

A

Causes

  • Ischaemia
  • Encephalitis
  • Motor neurone disease
  • Syringobulbia (rare cavity in midbrain)

Presentation

  • Tongue wasting + fasiculation
  • Dysphagia
  • Dysarthria
37
Q

Pupillary reflexes may be normal at C6 injury, but absent at T4

Why?

A
  • Sympathetic innervation to head comes from spinal nerves
38
Q

Why can treatment of flushing out the external auditory meatus lead to feelings of nausea & vomiting?

A

Pressure changes in external meatus in relation to middle ear can lead to dizzines & consequently nausea

39
Q

Outline Bulbar palsy

Explain its presentation

A

CN 9-12 referred to as ‘bulb’ as they emerge from the medulla

A lesion in the medulla would affect nerves 9-12;

  • Dysphonia
  • Dysphagia
  • Dysarthria
  • Weakness, wasting & fasiculation of the tongue
40
Q

Draw the vestibulo-ocular reflex

Outline the effects of turning, hot & cold water

A
41
Q

What neurones are involved in the gag reflex?

A

Sensory - Glossopharangeal

Motor - Vagus

[overlap]

42
Q

Why may pinching the tongue cause lacrimation & salivation?

A

Facial nerve does Ant 2/3 tongue sensory & Salivary & lacrimal glands parasympathetically

Finals Neurology (40 decks)

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