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NEURO > Disorders of cranial nerves > Flashcards

Disorders of cranial nerves Flashcards

1
Q

REVISION: what are the 12 cranial nerves

A 
olfactory
optic
oculomotor
trochlear
trigeminal
abducens
facial
vestibulocochlear
glossopharyngeal
vagus
accessory
hypoglossal
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2
Q

what are the 4 broad functions pf cranial nerves

A

special senses
ordinary sensation
control of muscle activity
autonomic functions

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3
Q

what cranial nerves control special senses

A

Olfaction (I)

Vision (II)

Taste (VII, IX and X)

Hearing - and balance (VIII)

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4
Q

what cranial nerves control ordinary sensation

A

Mainly the Vth (trigeminal nerve)

the ear from the VIIth (facial) and IXth (glossopharyneal) nerves

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5
Q

what cranial nerves control muscle activity

A

Eye muscles – III (oculomotor), IV (trochlear) and VI (abducence) (LR6,SO4, rest 3)

Muscles of mastication – V (trigeminal)

Muscles of facial expression – VII (facial)

Muscles of larynx and pharynx – mainly X (vagus)

Sternomastoid and trapezius muscles - XI (accessory)

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6
Q

what cranial nerves control autonomic functions (parasympathetic)

A

Pupillary constriction – III (oculomotor)

Lacrimation – VII (facial)

Salivation – submandibular and sublingual glands – VII (facial)

Salivation – parotid gland - IX (glossopharyngeal)

Vagal (X) input to organs in thorax and abdomen

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7
Q

how do you test CNI

A

smell

unilateral or bilateral

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8
Q

how do you test CNII

A 
visual acuity
visual fields
pupillary reactions
fundoscopy
colour vision
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9
Q

how do you test CNIII, IV and VI

A

ptosis
pupil of equal size
pupillary reactions
eye movements - vertical and horizontal

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10
Q

how do you test CNV

A

sensation in ophthalmic, maxillary and mandicular divisions

power in the muscles of mastication

corneal reflex

jaw jerk

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11
Q

how do you test CNVII

A

muscles of facial expression

corneal reflex

taste

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12
Q

how do you test CNVIII

A

hearin
rinnies and webers tests

vestibular function - DIx-hallpike manoevre

untenbergers test - walk in place with eyes closed

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13
Q

how do you test CNIX and X

A

movement of the palate
gag reflex
quality of speech
quality of cough

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14
Q

how do you test CNXI

A

head turning and shoulder shrugging

sternomastoid and trapezius function

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15
Q

how do you test CNXII

A

appearance, movement and power of tongue

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16
Q

what CN are the afferent and efferent for the pupillary laugh reaction

A

afferent – II

efferent – III

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17
Q

what CN are the afferent and efferent for the corneal reflex

A

afferent – V

efferent – VII

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18
Q

what CN are the afferent and efferent for the jaw jerk reflex

A

afferent and efferent – V

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19
Q

what CN are the afferent and efferent for the gag reflex

A

afferent – IX

efferent - X

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20
Q

what CN nuclei are in the midbrain

A

III

IV

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21
Q

what CN nuclei are in the pons

A

V

22
Q

what CN nuclei are in the ponto-medullary junction

A

VI
VII
VIII

23
Q

what CN nuclei are in the medulla

A

IX
X
XI
XII

24
Q

what might unusual combinations of cranial nerve signs indicate

A

chronic or malignant meningitis

25
Q

what might pure motor signs indicate

A

myasthenia gravis

26
Q

how might cranial nerves be damaged within the brain

A

ischaemia

tumour

27
Q

how might cranial nerve be damaged crossing the subarachnoid space

A

meningitis

28
Q

how might cranial nerves be damaged outside of the skull

A

base of skull tumours

eg arising in the nasopharynx

29
Q

what is optic neuritis and how does it present

A

demyelination within the optic nerve

monocular visual loss
pain on eye movement
reduced visual acuity
reduced colour vision

optic disc may be swollen

often associated with multiple sclerosis

30
Q

what nervous systems control pupillary responses

A

contraction - parasympathetic

dilation - sympathetic

31
Q

what does loss of parasympathetic input to the pupil cause

A

fixed, dilated pupil

from e.g. third nerve palsy

32
Q

what does loss of sympathetic input to the pupil cause

A

constricted pupil

33
Q

what are causes of dilated pupils

A

Youth

Dim lighting

Anxiety, excitement

“Mydriatic” eye drops

Amphetamine, cocaine overdose

Third nerve palsy

Brain death

34
Q

what are causes of small pupils

A

Old age

Bright light

“Miotic” eye drops

Opiate overdose

Horner’s Syndrome

35
Q

give examples of some eye movement disorders

A

isolated third nerve palsy

isolated fourth nerve palsy

isolated sixth nerve palsy

supranuclear gaze palsy - inability to look in a particular direction

nystagmus

36
Q

what are the causes and presentation of third nerve palsy

A

microvascular

  • diabetes, hypertension
  • painless, pupil spared

compressive

  • PComA aneurysm, raised ICP
  • painful, pupil affected
37
Q

what are the causes of sixth nerve palsy

A

idiopathic

diabetes

meningitis

raised intracranial pressure

38
Q

what are the causes of nystagmus

A

Congenital

Serious visual impairment

Peripheral vestibular problem

Central vestibular / brainstem disease

Cerebellar disease

Toxins (medication and alcohol)

39
Q

what is trigeminal neuralgia and what causes it

A

Paroxysmal attacks of lancinating pain

Triggers

Middle age and older

Caused by vascular loop
- compression fifth nerve in the posterior fossa

40
Q

what is the treatment of trigeminal neuralgia

A

carbamazepine

surgical options if medication resistant

41
Q

what is bells palsy

A

idiopathic facial nerve palsy

42
Q

how does bells palsy present

A

Unilateral facial weakness

Lower motor neurone type

Often preceded by pain behind ear

Eye closure affected

Risk of corneal damage

43
Q

how is bells palsy treated

A

steroids

44
Q

what causes UMN facial paralysis

A

stroke

tumour

45
Q

what causes LMN facial paralysis

A

Bells palsy
Lyme disease
sarcoid

46
Q

how does vestibular neuritis present

A

sudden onset
disabling vertigo
vomiting
gradual recovery

uncertain cause - viral?

47
Q

what is dysarthria

A

disordered articulation, slurring of speech

48
Q

what is dysphagia

A

difficulty swallowing

49
Q

what is pseudobulbar palsy

A

bilateral UMN lesion

eg vascular lesions in both internal capsules

50
Q

how does pseudo bulbar palsy present

A
  • dysarthria
  • dysphonia
  • dysphagia
  • spastic, immobile tongue
  • brisk jaw jerk
  • brisk gag reflex
51
Q

what is bulbar palsy and how does it present

A

bilateral LMN lesion affecting IX-XII

eg MND, polio, tumours, vascular, lesions of the medulla, syphilis

52
Q

how does bulbar palsy present

A
  • wasted, fasciculating tongue
  • dysarthria
  • dysphonia
  • dysphagia

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NEURO (51 decks)

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