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Cranial Nerves/ Autonomics Flashcards

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1
Q

General Somatic Afferent

A

Convey pain, temperature, tactile, pressure and proprioception - conveyed primarily by the Trigeminal Nerve (V)
ECTODERM

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2
Q

General Visceral Afferent

A

Visceral pain (stretch, ischemia) and reflexes. The vagus nerve has a huge distribution of GVA fibers to the mucosa of the posterior 1/3 of the tongue and cardiac blood vessels. Gut, dull, aching, burning - poorly localized pain

  • Cranial Nerve (X)
  • Endoderm
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3
Q

General Somatic Efferent

A

Fibers innervate muscles of myotonic origin - of the tongue and extra-oscular muscles

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4
Q

General Visceral Efferent

A

Fibers associated with the parasympathetic fibers

CN III
CN VII
CN IX
CN X

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5
Q

Special Visceral Afferent

A

Fibers convey olfactory (smell) and taste information. Taste buds, tongue, olfactory mucosa. The taste buds of the anterior 2/3 of the tongue and posterior 1/3 of the tongue are innervated by VII and IX nerves respectively.

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6
Q

What cranial nerves supply the taste and sensation to the anterior 2/3 of the tongue?

A

Taste:
CN (VII) - Facial Nerve
Sensation:
CN (V) Trigeminal Nerve V3

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7
Q

What cranial nerves supply taste and sensation to the posterior 1/3 of the tongue?

A

CN IX Glossopharyngeal N.

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8
Q

Special Visceral Efferent

A

Fibers that innervate muscles of branchiomeric origin such as the muscles of mastication (V), facial expression (VII), larynx and pharynx (X) - except stylopharyngeus IX

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9
Q

What nerve innervates the larynx and pharynx?

A

CN X - Vagus N.

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10
Q

What nerve innervates the muscle of mastication?

A

CN V - Trigeminal N.

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11
Q

What nerve innervates muscles of facial expression?

A

CN VII - Facial N.

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12
Q

What nerve innervates the stylophargyneous M.?

A

CN IX - glossopharyngeal N.

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13
Q

What nerve innervates glands in the head - lacrimal gland, submandibular gland, sublingual gland

A

CN VII - Facial N. - NOT THE PARTOID GLAND
*Lacrimation and salivation
Lacrimation reflex - (motor) V1 - VII

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14
Q

What nerve innervates the parotid gland?

A

CN IX - Glossopharyngeal N.

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15
Q

What nerve innervates an ear muscle?

- Stapedius N .

A

CN VII - Facial N.

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16
Q

Lacrimation Reflex

A

Lacrimation reflex V1 - VII (Facial Nerve)

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17
Q

Corneal Reflex

A

VI - VII (Facial Nerve)

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18
Q

Special Somatic Afferent

A

Fibers associated with optic II and vestibule-cochealar (VIII) nerves

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19
Q

Sensory Nuclei - Trigeminal Sensory Nuclei * GSA

A

The trigeminal sensory nuclei is THE sensory nucleus for all sensations from the face. The GSA (ectoderm - pain, temperature, tactile, pressure)

CN V
CN VII
CN IX
CN X

These nerves will enter INTO the trigeminal sensory nuclei

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20
Q

Sensory Nuclei - Solitary Nucleus *SVA GVA

A

The solitary Nucleus (SVA, GVA) is THE sensory nucleus for general nations from the posterior 1/3 of the tongue to the mid portion of the transverse colon. Receives taste information from the anterior 2/3 of the tongue (VII), posterior 1/3 of the tongue (IX), and epiglottis (X)

  • Salivary
  • Lacrimation
  • Carotid
  • Gag and Cough Reflexes
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21
Q

What nerve innervates the epiglottis region?

A

Cranial Nerve X

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22
Q

Motor Nuclei - General Somatic Efferents - two muscles of myotonic origin (Tongue, extra ocular muscles)

Name the GSE Column

A

Oculomotor Nucleus - eye via CN III
Trochlear Nucleus - eye via CN IV
Abducens Nucleus - eye via CN VI
Hypoglossal Nucleus - tongue via CN XII

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23
Q

Oculomotor Nucleus *GSE motor nuclei

Motor Nuclei - General Somatic Efferents - two muscles of myotonic origin (Tongue, extra ocular muscles)

A

Innervates the superior, inferior and medial rectified, inferior oblique, and elevator palabrae - elevates eyelid via branches of the Oculomotor M

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24
Q

Trochelar Nucleus

Motor Nuclei - General Somatic Efferents - two muscles of myotonic origin (Tongue, extra ocular muscles)

A

IV - innervates the superior oblique muscle (DOWN, IN) - reading/ stairs

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25
Abducens Nucleus Motor Nuclei - General Somatic Efferents - two muscles of myotonic origin (Tongue, extra ocular muscles)
Lateral rectus ms.
26
Hypoglossal nucleus Motor Nuclei - General Somatic Efferents - two muscles of myotonic origin (Tongue, extra ocular muscles)
Innervates all the muscles associated with the tongue - except the palatoglossus
27
GVE - Parasympathetic Column How do they work? What are the nerves?
Preganglionic parasympathetic fibers will come out of the nucleus, send preganglionic fibers to a ganglia to synapse. Postganglionic fibers will piggy back on the trigeminal nerve. CN III - Oculomotor N. CN V - Facial N. CN IX - Glossopharyngeal N. CN X - Vagus N.
28
GVE Parasympathetic Column | Edwinger-Westphal Nucleus
Sends preganglionic fibers to the ciliary ganglia via branches of the oculomotor n. (III). The ciliary ganglion sends post-ganglionic fibers piggy back on the trigeminal nerve (V) to the ciliary muscles of the lens and the pupillary constrictor muscles
29
GVE Parasympathetic Column | Superior Salivary Nucleus
VII - Facial Nerve Sphenopalatine (lacrimal gland) and Submandibular ganglia (submandibular gland and sublingual glands) Piggy back on the Trigeminal N.
30
GVE Parasympathetic Column | Inferior Salivatory Nucleus
IX Otic Ganglion Parotid gland Piggy back on the Trigeminal N.
31
GVE Parasympathetic Column | Dorsal Motor Nucleus
X | Larynx, pharynx, thorax, abdomen, SM - scattered to the heart, lungs and intestines.
32
Which nerve innervates the SCM and Trapezius M?
Spinal Accessory N. CN XI
33
The nucleus ambiguous innervates what? SVE - special visceral efferent - muscles of branchiomeric origin
Stylopharyngeus - CN IX | Palatoglossus and muscles of the palate, pharynx and larynx - CN X
34
What nerves exit the jugular foramen?
CN IX, X, XI
35
Vernet's Syndrome
Vernet's syndrome A basilar skull fracture due to trauma may involve the jugular foramen, and result in an ipsilateral IX, X, and XI paralysis. Look for Battle’s sign (bruising behind the pinna and/or over the mastoid process). It may be accompanied with “raccoon” eyes. Fractures of the base of the skull require a lot of force; therefore, always examine the patient for possible neurological (brain/spine) injury.
36
Collet's or Sicard's Syndrome (Villaret's) Syndrome
Collet's or Sicard's syndrome may be due to an injury in the retroparotid space. It was initially described during the last two World Wars. Generally, they involve an ipsilateral paralysis of cranial nerves IX-XII, and the cervical sympathetic trunk. Destruction of the latter would result in Horner's syndrome. Penetrating wound's, bleeds, cranial nerve involvement Posterior area - Retroparotid space
37
Horner's Syndrome - transient symptoms
Common sequela of spinal cord or neck trauma - above T1. Cut the cervical sympathetic trunk in the neck. It may be caused by interruption of the cervical sympathetic trunk; transection of the spinal cord above T1 (partial or complete), surgical or traumatic destruction of the cervical sympathetic chain, transient signs and symptoms Signs and symptoms: UNILATERAL 1. Slight ptosis UNILATERAL - drooping of eyelid 2. Pupillary Constriction (mitosis) due to paralysis of dilator pupillae muscle 3. Anhidrosis and blushing - vasodilation of the skin due to the loss of sympathetic innervation of the blood vessels (flush, dry skin) ANISOCORIA Notice a difference in pupil size Little or delayed opening of the pupil in dimmed light P A M Sympathetics cause eyes to DILATE - with this knocked out the eyes will constrict
38
Parasympathetic NS Preganglionic fibers are found in the _____. The preganglionic parasympathetic axons will course with which cranial nerves (4)?
Brainstem CN III CN VII CN IX CN X
39
Olfactory Nerve
CN I SENSORY/ SVA Smell Pathway = Cribriform plate of the ethomoid bone - it will synapse in the olfactory bulb Afferent fibers wil NOT go to the thalamus Anosmia = loss of smell Damage by trauma - skull fracture, infections, tumors
40
Optic N
CN II SENSORY/ SSA Sight Pathway = optic canal of the sphenoid bone, not a peripheral nerve, arises from the diencephalon
41
What are the nerves that go to the ocular muscles?
CN III, CN IV, CN VI
42
Oculomotor - Has two types of innervation what are they? - What muscles does it innervate?
CN III M/ GVE/ GSE 1. Somatic Motor - Efferent * MOVES EYE - Superior rectus m. (up) - Inferior rectus m. (down) - Medial rectus m. (middle) - Inferior rectus m. (inferior) - Inferior oblique m. (superior rotation) - Levator Palpbrae - elevates the eyelid 2. Parasympathetic Efferent (visceral efferent): - Sphincter pupillae - pupillary CONSTRICTION - Ciliary muscle (near vision)
43
SO4LR6
Superior Oblique m (inferior rotation) - CN 4 | Lateral rectus m. CN6
44
What is oculomotor palsy?
CN III | Right eye: downward and outward gaze, dilated pupil, eyelid has to be manually elevated due to ptosis
45
Trochlear N.
``` CN IV M - GSE Eye movement (somatic motor) Smallest cranial nerve Superor oblique M. - Inferior rotation Turns eye down and in - reading/ stairs ```
46
Trochlear N. Palsy
Palsy = Strabismus (cross-eyed) *creepy mutant girl and Diplopia (double vision) - Eye tilted outward --> up and out - Unable to look down/ in - Head is tilted AWAY from the affected side to compensate
47
Abducens N.
CN VI M/ GSE Ocular Muscles - Lateral Rectus M. --> laterally (abducts the eye) Eye test: moving the pen going from R-->L
48
Abducens N. Palsy
Diplopia - one eye is crossed | can't laterally look out of the affected eye
49
Trigeminal Nerve What is the sensory function? What are the 3 divisions
CN V B - SVE/ GSA Sensory - touch, pain, temperature to the face 3 divisions 1. Ophthalmic V1 2. Maxillary V2 3. Mandibular V3 - sensation to the anterior 2/3 of the tongue
50
Trigeminal Nerve What is the motor function?
Muscles of mastication - Chewing | Mandibular V3
51
What are the branches off of V1?
Ophthalmic V1 - Lacrimal N - Frontal N. > Supratrochlear N., Supraorbital N. - Nasociliary N. > Long and short ciliary n, infratrochlear n, ethmoidal, anterior (internal nasal and external nasal) and posterior - Meningeal Branch - from the tentorium cerebella
52
What are the branches of V2?
Maxillary V2 - Zygomatic N. > Zygomatictemporal, Zygomatic facial - Infraorbital N > External nasal and Superior Labial - Superior Alveolar N. - Nasociliary - Palatine> Orbital, great and lesser palatine, pharyngeal - Meningeal
53
What are the branches of V3?
Mandibular V3 Somatic Sensory: - Buccal - Lingual - Inferior Alveolar --> Dental, Incisive, Mental - Auriculotemporal - Meningeal Somatic Motor: - Medial pterygoid (tensor veli palatini, tensor tympani) - Lateral pterygoid - Masseteric - Deep temporal - Mylohyoid > Nerve to mylohyoid and nerve to anterior belly of digastric
54
Which nerve is involved in the jaw-jerk reflex?
V3 (In/ Out)
55
Which nerves are involved in the corneal reflex?
V1 (in) --> VII (out) BLINK Touch eye with Q tip input senses by V1 of CN V Transmit to VII bilaterally --> VII causes the BLINK
56
which nerves are involved in lacrimation?
V1 (in) --> VII (M)
57
Trigeminal Palsy - name clinical features
Palsy: - Numb face (sensory) - Weak jaw (motor) --> deviates TO the affected side - Trigeminal Neuralgia (recurrent, sudden sharp pains, tic douloreux - painful tic, so intense that you wince)
58
Facial Nerve
CN VII B -Muscles of facial expression (motor) - cry/frown - Taste (anterior 2/3) - Salivation, lacrimation --> innervates all the glands in the head EXCEPT the Parotid Gland (IX) - lacrimal, submandibular and sublingual glands - Ear muscle (stapedius) - Special Feature: Dual UMN Innervation - 5 branches - Involved in lacrimation (motor) and corneal reflex (motor)
59
What nerve innervates the Stapedius M. in the ear?
Cranial N. VII | facial
60
What are the branches of the facial nerve?
- Temporal Nerve - Zygomatic Nerve - Buccal Nerve --> FACIAL EXPRESSION (buccinator m.) - Marginal Branch of the Mandibular N. - Cervical Nerve --> Platysma M
61
What is facial nerve dual innervation?
The upper half of your brain receives innervation from both sides of the brain. Lower half of your face receives innervation from the contralateral side
62
What is Facial Nerve Palsy? - Clinical correlations
- Loss of corneal reflex (motor output) - Loss of taste to the anterior 2/3 of the tongue - Hyperacusis (stapedius M. paralysis) - hearing disorder, the patient can't tolerate loud sounds
63
Bell's Palsy
- Idiopathic mononeuropathy of CN VII - Sudden paralysis of facial expression - Usually resolves in weeks to months - Has to stick finger in mouth to keep food from falling out - make sure eye is moist
64
Vestibulocochlear N.
VIII S/ SSA Hearing/ Balance/ Equilibrium Cochlear: Hearing, lesions = loss of hearing, tinnitus Vestibular: Equilibrium, compensatory eye movement. Lesions: vertigo, nystagmus, vomiting, nausea
65
Glossopharyngeal N.
CN IX B - motor and sensory / GVE, SVE, SVA Taste bud, tongue, olfactory muscle Taste/ Sensation in the posterior 1/3 of the tongue Salivation - PAROTID GLAND Carotid Body and Sinus - Chemo and baroreceptor *BP Stylopharyngeous - elevates the pharynx for swalllowing/ gagging Involved in gag reflex - sensory In 9 Out 10
66
Glossopharyngeal nerve palsy
Palsy: - Loss of gag reflex - Loss of taste posterior 1/3 of the tongue - Loss of sensation upper pharynx Hemodynamimc effects - Tricks body into thinking LOW BP, so the body will increase BP, vasoconstriction and increase BP
67
Vagus N.
CN X B / GVA/ SVA/ GVE GVA = endoderm * viscera and blood vessels ``` Taste - super-epiglottic region Swallowing - Dysphagia = Vagus N. - innervates most of the pharynx and larynx muscles * motor Palate elevation Midline uvula Talking Coughing Gag reflex - In 9 Out 10 *Motor ``` Autonomic System: - Parasympathetic: to the thoracoabdominal viscera - Aortic Arch* chemo/baroreceptor
68
Taste to the supra-epiglottic region is innervated via
The Vagus N. CN X
69
Nucleus Solitarius
Visceral S*ensory Information - taste, baroreceptors, gut distention --> VII, IX, X
70
Nucleus Ambiguous
M*otor Innervation of pharynx, larynx, upper esophagus (swallowing and palate elevation) - IX, X , XI These nerves exit the jugular foramen
71
Dorsal Motor Nucleus
Sends autonomics (parasympathetic) fibers to heart, lungs, upper GI - CN X
72
Vagus N. Palsy
Palsy: - Hoarseness, dysphagia, dysarthria - Loss of gag reflex - Loss of sensation pharynx and larynx - Weak side of palate collapse (lower) - Uvula deviates AWAY from affected side Hemodynamics Effect: - unopposed sympathetic stimulation of the heart - Result = increased HR [Aortic Arch] - Vasovagal Syncope
73
Vasovagal Syncope
Most common use of syncope (fainting) Trigger to Vagus N. - increased parasympathetic outflow via the vagus N. This will decrease HR, Decrease BP --> Fainting Many triggers = hot weather, prolonged standing, pain, sight of blood
74
Accessory N.
``` XI M / GSE Motor - branchial type Receives information from C1,C2, C3 SCM, Trapezius Turning head, shoulder shrugging ```
75
Accessory N. Palsy
- Palsy = difficulty turning the head toward normal side (SCM), drooping of the shoulder on the affected side
76
Hypoglossal N.
XII M/ GSE Motor and tongue movement Palsy = protrusion of the tongue TOWARD the affected side - lick the lesion *PALATOGLOSSAL MUSCLE OF THE TONGUE IS INNERVATED BY THE VAGUS N.
77
Most muscles of the tongue are innervated by the hypoglossal N. (M) except for the ____ which is innervated by the ____
Palatoglossal M. Innervated by the Vagus N.
78
_______ separates the anterior 2/3 from the posterior 1/3 of the tongue
Terminal Sulcus
79
Pupillary Reflex
Sense II Out CN IIII - Constricts the pupil - sympathetic
80
What nerve travels through the cribiform plate
CN 1 - olfactory n.
81
What nerves travel through the optic canal?
CN II - Optic N. with the Ophthalmic A.
82
What nerves travel through the superior orbital fissure
CN III - Oculomotor N. CN IV - Trochelar N. CN V ( V1 ) - Trigeminal - opthalmic divison VI Abducens
83
What nerve travels through the Foramen Rotundum?
V2 - Maxillary Divison
84
What nerve travels through the Foramen Ovale?
V3 - Mandibular division
85
What artery travels through the Foramen spinosum?
Middle meningeal A.
86
What nerves travels through the internal auditory meatus?
VII, VIII - Facial N. - Vestibulocochlear N.
87
What nerve travels through the hypoglossal canal?
CN XII - hypoglossal N
88
What nerve travels through the jugular foramen
CN IX, X, XI
89
What runs through the foramen magnum?
Brainstem Spinal root of CN XI Vertebral arteries

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