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Cranial Nerves Flashcards

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1
Q

How would you test CNI in a patient?

A

Ask them “Have you noticed any changes in your sense of smell?”
Rarely smell cards are used

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2
Q

How would you test CNII in a patient?

A 
Visual fields
Ask if any troubles with vision
Glasses/contacts?
Ichihara chart for colour vision
Blind spot testing
Visual acuity - Snellen chart
Opthalmosocpy
Pupillary response
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3
Q

How would you test CNIII, IV and VI in a patient?

A

Eye movements in H pattern.
Ask patient to report any double vision
Observe resting gaze

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4
Q

How would you test CNV in a patient?

A 
Test sensation in all 3 nerve areas
Test power of masseter and temporal muscles
Push jaw open against pressure
Jaw jerk reflex
Corneal reflex
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5
Q

How would you test CNVII in a patient?

A

Raise eyebrows, close eyes tight (against resistance), puff cheeks out, show teeth and whistle
Ask about changes in taste

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6
Q

How would you test CNVIII in a patient?

A 
Soft whisper hearing
Ask if noticed any hearing issues
Webers and Rinne's test
Vestibular ocular reflex
Gait, heel-to-toe walk and Romberg's
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7
Q

How would you test CNIX and X in a patient?

A

Cough, swallow and say AH

Gag reflex

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8
Q

How would you test CN XI in a patient?

A

Shoulder shrug and head turning against resistance

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9
Q

How would you test CNXII in a patient?

A

Open mouth and stick tongue out looking for tongue or uvular devaition
Power of tongue against side of cheek
Observe tongue for wasting or fasciculations

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10
Q

What nerve type(s) does CNI carry?

A

Sensory

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11
Q

What nerve type(s) does CNII carry?

A

Sensory

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12
Q

What nerve type(s) does CNIII carry?

A

Motor (somatic and parasympathetic)

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13
Q

What nerve type(s) does CNIV carry?

A

Motor

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14
Q

What nerve type(s) does CNV carry?

A

Sensory

Motor

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15
Q

What nerve type(s) does CNVI carry?

A

Motor

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16
Q

What nerve type(s) does CNVII carry?

A

Sensory

Motor (parasympathetic + somatic)

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17
Q

What nerve type(s) does CNVIII carry?

A

Sensory

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18
Q

What nerve type(s) does CNIX carry?

A

Sensory

Motor (somatic + parasympathetic)

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19
Q

What nerve type(s) does CNX carry?

A

Sensory (somatic and visceral)

Motor (parasympathetic + somatic)

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20
Q

What nerve type(s) does CNXI carry?

A

Motor

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21
Q

What nerve type(s) does CNXII carry?

A

Motor

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22
Q

What functions does CNI serve?

A

Sense of smell

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23
Q

What functions does CNII serve?

A

Vision

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24
Q

What functions does CNIII serve?

Study These Flashcards
A

SOMATIC
Eye movement: Superior, medial and inferior rectus muscles, inferior oblique muscles. All eye movements apart from outwards, and medial and down.
Eyelid opening: levator palpebrae superioris

PARASYMPATHETIC
Pupillary constriction: sphincter pupillae
Accommodation: ciliary muscle

25
What functions does CNIV serve?
Eye movement: abduction and internal rotation (superior oblique muscle). Moves eye medially and downwards.
26
What functions does CNV serve?
SENSORY Facial sensation: ophthalmic, maxillary and mandibular regions Somatosensation of anterior 2/3 of tongue MOTOR Mastication: masseter, temporalis, medial pterygoid, lateral pterygoid muscles
27
What functions does CNVI serve?
Eye movements: retracts the eye within the orbit (lateral rectus). Moves eye outwards.
28
What functions does CNVII serve?
SENSORY Taste perception of anterior 2/3 of tongue Pain sensation: skin behind ear PARASYMPATHETIC Salivation (submandibular and sublingual glands) Lacrimation ``` SOMATIC Opening and closing of jaw (digastric) Eyelid closing (orbicularis oculi) Tongue elevation (stylohyoid muscle) Movement of stapedius bone (stapedius muscle) ```
29
What functions does CNVIII serve?
Balance and equilibrium | Hearing
30
What functions does CNIX serve?
SENSORY Taste: posterior 1/3 tongue Somatosensation: middle ear and Eustachian tube (tympanic nerve) Visceral sensation: carotid sinus (baroreceptors detect BP) Chemoreception: carotid body (chemoreceptors detect partial pressure of O2 and CO2 and pH) SOMATIC Swallowing: pharyngeal muscles and muscles of upper GIT tract PARASYMPATHETIC Salivation: parotid gland
31
What functions does CNX serve?
SOMATIC SENSORY Somatosensation: external auditory canal, trachea, larynx VISCERAL SENSORY Taste perception: epiglottis and posterior tongue Visceral sensation: aortic body (baroreceptors detect BP) Chemoreception : aortic body (chemoreceptors detect partial pressure of O2 and CO2) PARASYMPATHETIC Lowering HR Blood vessel dilatation Promotes motility of oesophagus, stomach, intestines (up to splenic flexure) and other abdo organs SOMATIC MOTOR Swallowing: pharyngeal muscles and muscles of upper GIT tract Speech: laryngeal muscles
32
What functions does CNXI serve?
``` Turn head (sternocleidomastoid) Elevate shoulders (trapezius) ```
33
What functions does CNXII serve?
Tongue protrusion: intrinsic and extrinsic muscles of the tongue
34
How does a CNI palsy present?
Anosmia
35
How does a CNII palsy present?
Impaired vision
36
How does a CNIII palsy present?
Paralytic squint (eye looks down and out) Ptosis Horizontal diplopia Non-reactive, dilated pupil
37
How does a CNIV palsy present?
Inability to depress and addut eyeball simultaneously (eye shoots upwards in attempted adduction) Diplopia (vertical or oblique) worse on down gaze or if head turned to affected side
38
How does a CNV palsy present?
Absent corneal reflex Anaesthesia of forehead/midface/jaw Muscles of mastication paralysed Jaw deviates towards side of lesion
39
How does a CNVI palsy present?
Horizontal diplopia | Esotropia
40
How does a CNVII palsy present?
Weakness of muscles of facial expression and eye closure Face sags Voluntary eye closure may not be possible LMN - patient can't wrinkle forehead UMN - patient can wrinkle forehead and sagging less prominent
41
How does a CNVIII palsy present?
Sensorineural hearing loss Vertigo Horizontal nystagmus Motion sickness
42
How does a CNIX palsy present?
``` Flaccid paralysis of soft palate Uvula deviates to normal side Sensory loss of soft palate, upper pharynx and posterior 1/3 tongue Mild dysphagia Throat and ear pain ```
43
How does a CNX palsy present?
``` Flaccid paralysis of soft palate - nasal speech and deviation of uvula away from palate Epiglottis paralysis (aspiration) Dysphagia Vocal cord paralysis Dysfunction of vagal nerve of stomach ```
44
How does a CNXI palsy present?
Weakness turning head to contralateral side | Weakness during elevation of ipsilateral shoulder and lateral winging of scapula
45
How does a CNXII palsy present?
Atrophy and fasciculation of tongue on side of lesion | Tongue deviates to side of lesion when protruded
46
What are the main potential causes of a CNI palsy?
Trauma Neurodegenerative disease Congenital SOL
47
What are the main potential causes of a CNII palsy?
Trauma Tumours impaired nutrition Drugs
48
What are the main potential causes of a CNIII palsy?
``` Ischaemic microangiopathy (typically spares pupil involvement) Compression or transection ```
49
What are the main potential causes of a CNIV palsy?
Microvascular damage Trauma Cavernous sinus thrombosis
50
What are the main potential causes of a CNV palsy?
``` Tumour Vascular compression Oral surgery Inflammation of nerve Cavernous sinus thrombosis ```
51
What are the main potential causes of a CNVI palsy?
Tumour Trauma Pseudotumour cerebri Cavernous sinus thrombosis
52
What are the main potential causes of a CNVIII palsy?
Bacterial meningitis Lyme disease Tumour
53
What are the main potential causes of a CNIX palsy?
Often unknown | May be compression by blood vessel
54
What are the main potential causes of a CNX palsy?
Trauma Diabetes Inflammation
55
What are the main potential causes of a CNXI palsy?
Surgeries at the lateral cervical region
56
What are the main potential causes of a CNXII palsy?
Tumours | Trauma
57
What are the potential causes of an UMN lesion in CNVII palsy?
``` Cerebrovascular disease SOLs MS Syphilis HIV Vasculitides ```
58
What are the potential causes of an LMN lesion in CNVII palsy?
``` Idiopathic (Bell's palsy) - pregnancy and DM Cerebrovascular disease Iatrogenic Infective Trauma Neurological Neoplastic HTN in pregnancy Sarcoidosis Sjogrens syndrome and RA ```

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