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Clin Neuro - Baffes > Cranial Nerves > Flashcards

Cranial Nerves Flashcards

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1
Q

What CN are involved in speech?

A

V - trigeminal (both motor and sensory)

VII - facial (both)

IX - glossopharengeal (both)

X - vagus (both)

XII - hypoglossal (motor)

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2
Q

What are the CN?

Which ones are sensory, motor, or both?

A

I - Olfactory - S

II - Optic - S

III - Oculomotor - M

IV - Trochlear - M

V - Trigeminal - B

VI - Abducens - M

VII - Facial - B

VIII - Vestibulocochlear - S

IX - Glossopharyngeal - B

X - Vagus - B

XI - Accessory - M

XII - Hypoglossal - M

Oh Oh Oh To Touch And Feel Virgin Girls’ Vagina Aah Heaven
Some Say Marry Money But My Brother Says Big Brains Matter More

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3
Q

What is CN I associated with?

A

Smell

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4
Q

What is CN II associated with?

A

Visual acuity

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5
Q

What is CN III associated with?

A

Eye movement

Pupil constriction and accommodation

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6
Q

What is CN IV associated with?

A

Vertical eye movement

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7
Q

What is CN V associated with?

A

Sensory - Face sensation

Motor - Chewing

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8
Q

What is CN VI associated with?

A

Abduction of eyes

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9
Q

What is CN VII associated with?

A

S- anterior 2/3 tongue taste

M- facial expression, crying, salivating

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10
Q

What is CN VIII associated with?

A

Hearing and balance (inner ear)

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11
Q

What is CN IX associated with?

A

S - posterior 1/3 tongue taste, salivating, monitors carotid body & sinus, gag reflex

M- swallowing

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12
Q

What is CN X associated with?

A

S- sensation in pharynx and larynx, parasymp to thoracic and abdominal organs, gag reflex

M- vocal cords, swallows, lifts palate, talks (larynx)

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13
Q

What is CN XI associated with?

A

SCM (head rotation) and trap movement (shoulder shrug)

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14
Q

What is CN XII associated with?

A

Tongue movement and hyoid

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15
Q

Which cranial nerve closes the eyelids?

A

CN VII

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16
Q

Sx of CN III, IV, VI lesion

A

Diplopia (double vision)

Ptosis (droopy eyelid)

Dilated pupils

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17
Q

Horner syndrome is?

A

Horny PAMELA

Ptosis
Anhidrosis (sweating)
Miosis
Enopthalmos
Loss of ciliospinal reflex (pupil fails to dilate when the skin on the back of the neck is pinched)

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18
Q

Which eye muscle is innervated by trochlear (IV) nerve?

A

Superior oblique

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19
Q

What is the classic findings of CN III lesion?

A

Ptosis

Diplopia

Pupils become large and non-reactive to light and accomodation

With the ptotic lid passively elevated, the affected (right) eye is abducted. On attempted down-gaze, the unaffected superior oblique muscle (innervated by CN IV) causes the eye to turn inward.

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20
Q

What is a finding of a CN VI lesion?

A

Eye deviates medially

Difficulty looking laterally (abduction)

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21
Q

What is a finding for CN IV lesions?

A

Eye deviates superiorly

Looking down is difficult*

Diplopia present *superior oblique muscle when contracted, turns the eye downward

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22
Q

Oculomotor palsy causes paralysis of what muscles?

A

Medial, superior, inferior rectus and inferior oblique muscles

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23
Q

With Oculomotor palsy in neutral gaze, what position would the eye rest in?

A

Deviate down and out

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24
Q

Trochlear palsy causes paralysis of which muscle(s)?

A

Superior oblique muscle

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25
In trochlear palsy and in neutral gaze, what location would the eye rest in?
Eye deviates upward
26
Compensatory head position in oculomotor palsy or trochlear palsy or abducens palsy?
trochlear palsy
27
Diplopia in oculomotor palsy or trochlear palsy or abducens palsy?
All of them Oculomotor - worse when looking into muscle weakness Abducens palsy - upon attempted lateral gaze
28
Ptosis (levator palpebrae mm) in oculomotor palsy or trochlear palsy or abducens palsy?
Oculomotor
29
Loss of pupillary reflex to light and acc in oculomotor palsy or trochlear palsy or abducens palsy?
Oculomotor palsy
30
Abducens palsy causes paralysis of what msucle?
Lateral rectus muscle
31
Eye rests in what position with abducens palsy
Deviated inward
32
Which type of palsy is the most common type and why?
Abducens palsy because its the longest CN
33
What is a supranuclear palsy
Degenerative disease involving gradual deterioration and death of parts of the brain. It affects BOTH eyes
34
Supranuclear palsy can affect motor neurons (CN III, IV, VI) or sensory neurons (CN II). What is the difference?
Motor (III, IV, VI) neither eye can move to the contralateral side of lesion. So the eyes “look toward” the lesion. E.g. superior gaze Sensory (CN II): neither eye sees the contra environment (track lesion)
35
What is trigeminal neuralgia also called?
Tic douloureux Facial pain syndrome that develops in middle to late life. F\>M
36
How do you test the trigeminal nerve?
- Sensory function to the face (v1-v3) - Test motor function of mastication muscles + tensor tympani - Test corneal reflex (CN V and VII)
37
What are the divisions of trigeminal nerve?
V1 - opthalmic V2 - maxillary V3 - mandibular
38
Muscles of mastication
Temporal is Masseter Pterygoids
39
What are Sx of trigeminal nerve problem?
Hypo/hyperesthesia in face Fatigue with chewing, claudication Deviation of jaw toward affected side Lock jaw (trismus) Jaw reflex Hearing
40
How do you test for CN VII
- Test muscles of facial expression and observe for dysarthria (B, P, Ms) - Test taste on anterior 2/3 tongue - Test efferent part of corneal reflex with cotton swab should induce rapid bilateral blink (afferent is CN V) - Assess secretormotor function: lacrimal, submandibular, sublingual
41
Peripheral LMN lesion of CN VII causes
Flaccid paresis or paralysis of ipsilateral side of face Ipsi chorea tympani dysfxn - taste Hyperacusis - ipsi stampedius mm causes uncomfortable acute hearing
42
Central (UMN) lesion of CN VII above mid-pons causes
Spastic paralysis and paresis of contralateral face Corneal efferent reflex may be exaggerated
43
What is Bell’s palsy
Peripheral facial paralysis/paresis on ipsi face
44
How do you test vistibulocochlear nerve?
**Acoustic division:** - Whisper test - Weber’s and rinne’s **Vestibular test:** - Caloric test - Hallpike maneuver - Observe nystagmus in neutral gaze and motion
45
What kind of acoustic Sx would a CN VIII deficit have?
Tinnitus Sensorineural hearing loss
46
What kind of vestibular Sx would a CN VIII deficit have?
Vertigo Disequilibrium/ataxia Nystagmus
47
How to test CN IX
Sensation to soft palate (also CN X), tonsillar fossa, inner ear—so test sensation to back of throat/pharynx Gag reflex Taste to posterior 1/3 tongue
48
Sx of glossopharyngeal nerve deficit
- Decreased sensation to soft palate (also CN X) - Impaired gag response - Dysphagia
49
Vagus nerve is responsible for?
- Innervation to soft palate, pharynx, larynx - Parotid innervation
50
CN X tests
- ability to swallow - phonation “ahh” - cough - gag reflex
51
Sx / Signs of CN X deficit
Dysphagia Dysphonia Hoarseness Weak cough
52
How do you test CN IX and X together
Patient open mouth and observe normal elevation of palate when saying “ahh”
53
What do you see with unilateral vagus nerve lesion when patient says “ahh”
Palate pulls toward intact side (away from lesion) as seen by visualizing base of uvula
54
Dysphagia swallowing liquids vs solids implies what problem(s)?
Liquids—neuro deficit Solids—organ obstruction (esophageal strictures, tumor, diverticulum)
55
LMN lesion of CN IX and X leads to? (Unilateral vs bilateral)
Unilateral lesion: Ipsi paralysis of palate, pharynx, larynx - deviation of the uvula (away) - hoarseness and nasal speech Bilateral lesion: - dysphonia/ aphonia - cardiac arrhythmias
56
UMN lesion of CN IX and X leads to? (Unilateral vs bilateral)
Hyperactive gag reflex Unilateral: slight palatal weakness contra to side of lesion Bilateral: dysphagia, dysphonia, dysarthria
57
Spinal accessory nerve (XI) does what?
Motor to SCM and upper trap
58
LMN lesion of CN XI causes?
Marked unilateral weakness, atrophy, fasciculations Drooping shoulder, winging scapula
59
UMN lesion of CN XI causes?
- Moderate transient weakness - Spasticity - Torticolis
60
CN XII does what? How do you test it?
Hypoglossal nerve, motor to the tongue Test: tongue protrusion
61
With the tongue protrusion test, what do you look for?
Atrophy Fasciculations Deviation
62
Unilateral LMN lesion of CN XII — what do you see?
Fasciculations Affects Ipsi tongue so that tongue deviates toward lesion
63
UMN lesion of CN XII — what do you see?
- Moderate and transient weakness - Clumsiness and slowness of motion - Tongue deviates to side OPPOSITE lesion
64

Clin Neuro - Baffes (6 decks)

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