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Neuro Pathology > Disorders of the Cranial Nerves > Flashcards

Disorders of the Cranial Nerves Flashcards

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1
Q

Functions of the cranial nerves

A

Special senses
Ordinary senses
Control of muscle activity
Autonomic functions

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2
Q

What special senses do cranial nerves provide?

A

Olfaction (I)
Vision (II)
Taste (VII, IX and X)
Hearing and balance (VIII)

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3
Q

What cranial nerves provide ordinary sensations?

A

V (trigeminal)

Ear from VII (facial) and IXth (glossopharyngeal)

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4
Q

What control of muscle activity do cranial nerves provide?

A 
Eye muscles
- III, IV, VI
Muscles of mastication 
- V
Muscles of facial expression 
- VII
Muscles of larynx and pharynx 
- X
Sternocleidomastoid and trapezius muscles - XI
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5
Q

What autonomic functions do cranial nerves provide?

A

Pupillary constriction - III
Lacrimation - VII
Salvation of submandibular and sublingual glands - VII
Salvation of parotid glands - IX
Input to organs in thorax and abdomen - X

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6
Q

How do we test CN I?

A

Unilateral or bilateral smell loss

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7
Q

How do we test CN II?

A 
Visual acuity
Visual fields
Pupillary reactions
Fundoscopy 
Colour vision
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8
Q

How do we test CN III, IV and VI?

A

Any ptosis
Pupils of equal size
Pupillary reaction
Vertical and horizontal eye movements

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9
Q

How do we test CN V?

A

Sensation in opthalmic, maxillary and mandibular divisions
Power in muscles of mastication
Corneal reflex
Jaw jerk

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10
Q

How do we test CN VII?

A

Muscles of facial expression
Corneal reflex
Taste

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11
Q

How do we test CN VIII?

A

Hearing - rhinnes and webers
Vestibular function
- dix hallpike manouvre
- weinbergers test

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12
Q

How do we test CN IX and X?

A

Movement of palate
Gag reflex
Quality of speech
Quality of cough

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13
Q

How do we test CN XI?

A

Head turning and shoulder shrugging

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14
Q

How do we test CN XII?

A

Appearance, movement and power of the tongue

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15
Q

Which CNs are responsible for the pupillary light reactions? (both afferent and efferent)

A

Afferent - II

Efferent - III

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16
Q

Which CNs are responsible for the CN reflexes of the corneal reflex? (afferent and efferent)

A

Afferent - V

Efferent - VII

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17
Q

Which CNs are responsible for the jaw jerk? (Afferent and efferent)

A

Both V

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18
Q

Which CNs are responsible for the gag reflex? (afferent and efferent)

A

Afferent - IX

Efferent - X

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19
Q

Causes of dilated pupils

A 
Youth 
Dim lighting 
Anxiety
Excitement
"Mydriatic eye drops"
Amphetamine
Cocaine overdose 
Third nerve palsy
Brain death
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20
Q

Causes of small pupils

A 
Old age
Bright light 
"Miotic" eye drops
Opiate overdose
Horner's syndrome
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21
Q

Examples of eye movement disorders

A 
Isolated 3rd nerve palsy 
Isolated 4th nerve palsy 
Isolated 6th nerve palsy 
Combination of above
Supranuclear gaze palsy 
Nystagmus
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22
Q

Causes of isolated third nerve palsy

A 
Microvascular 
- DM
- HTN 
Compressive
- posterior communicating artery aneurysm 
- rasied ICP
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23
Q

What helps to distinguish between micro vascular and compressive causes of isolated 3rd nerve palsy?

A

Microvascular - painless, pupil spared

Compressive - painful, pupil affected

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24
Q

Causes of isolated 6th nerve palsy

A

Idiopathic
DM
Meningitis
Raised ICP

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25
Causes of nystagmus
``` Congenital Serious visual impairment Peripheral vestibular problem Central vestibular/brainstem disease Cerebellar disease Toxins (medication and alcohol) ```
26
What is trigeminal neuralgia?
Paroxysmal attacks of lacinating (stabbing/piercing) pain
27
Who gets trigeminal neuralgia?
> middle aged patients
28
Pathology of trigeminal neuralgia
Vascular loop - compression fifth nerve in the posterior fossa
29
Treatment of trigeminal neuralgia
Carbamazepine | Surgery if medication resistant
30
Another name for bells palsy
Idiopathic facial nerve palsy
31
Presentation of bells palsy
``` Unilateral facial weakness Preceded by pain behind ear Eye closure affected May also have - altered taste - dry eyes - hyperacusis ```
32
Which of CNS or PNS is affected in bells palsy?
PNS
33
What is there a risk of in bells palsy?
Corneal damage
34
Treatment of bells palsy
Prednisolone (within 72 hours of onset) Eye care - artificial tears - eye lubricants
35
What would cause an UMN facial palsy?
Stroke | Tumour
36
What would cause a LMN facial palsy?
Bells palsy Lyme Sarcoid
37
What is vestibular neuritis?
Infection of the vestibular nerve in the inner ear
38
Presentation of vestibular neuritis
Sudden onset Disabling vertigo Vomiting Gradual recovery
39
Definition of dysarthria
Disordered articulation, slurring of speech
40
Definition of dysphagia
Difficulty swallowing
41
Which of UMN or LMN is affected in bulbar palsy?
LMN
42
Which of UMN or LMN is affected in pseudobulbar palsy?
UMN
43
Which of bulbar and pseudobulbar palsy has both dysarthria and dysphagia?
Both
44
Pathology of pseudobulbar palsy
Bilateral UMN lesions e.g. in vascular lesions of both internal campuses, MND
45
Presentation of pseudobulbar palsy
``` Dysarthria Dysphonia Dysphagia Spastic, immobile tongue Brisk jaw jerk Brisk gag reflex ```
46
Pathology of bulbar palsy
Bilateral LMN lesions affecting IX-XII e.g. MND, polio, tumours, vascular lesions of medulla, syphillis
47
Presentation of bulbar palsy
Wasted, fasculating tongue Dysarthria Dysphonia Dysphagia
48
Where are CNs III and IV found?
Midbrain
49
Where are CNs V, VI and VIII found?
Pons
50
Where is the CN VIII found?
Pontomedullary junction
51
Where are CNs IX, X, XI and XII found?
Medulla
52
Where can CNs be damaged?
In the brain e.g. by ischaemia, tumour Crossing the subarachnoid space by e.g. meningitis Outside of the skull e.g. by base of skull tumour in nasopharynx
53
What is optic neuritis?
Demyelination within the optic nerve
54
Presentation of optic neurtis
``` Monocular visual loss Pain on eye movement Reduced visual acuity Reduced colour vision Optic disc may be swollen ```
55
What is optic neuritis usually associated with?
MS
56
Bilateral CN III signs would indicate a problem where?
Midbrain
57
A combination of CN II, IV and VI signs would indicate a problem where?
Superior orbital fissure
58
A combination of CN VI and VII signs would indicate a problem where?
Pons
59
A combination of CN V and VIII signs would indicate a problem where?
Cerebellopontine angle
60
Unsual combination of cranial nerve signs may indicate what?
Chronic or malignant meningitis
61
Pure motor signs by CN may indicate what?
Myastenia gravis
62
What does a parasympathetic response do to the pupil?
Constricts it
63
What does loss of a parasympathetic input to the pupil result in?
A fixed dilated pupil
64
What does a sympathetic response do to the pupil?
Dilates the pupil
65
What can damage anywhere in the sympathetic pathway to the pupil result in?
A constricted pupil
66
What causes homonymous hemianopias?
Lesions of - optic tract OR - optic radiation OR - occipital cortex
67
Homonymous hemianopia and WHAT would indicate damage to the occipital cortex?
Macula sparing
68
What causes homonymous quadrantanopias?
Lesions of - temporal lobe (superior) - parietal lobe (inferior)
69
What is the pneumonic to remember what homonymous quarantanopias are caused by which lobe?
PITS - parietal inferior - temporal superior
70
What causes bitemporal hemianopia?
Lesion of optic chiasm
71
Upper quadrant defect vs lower quadrant defect in bitemporal hemianopia
Upper > lower = inferior chiasmal compression, commonly a pituitary tumour Lower > upper = superior chiasmal compression, commonly a craniopharyngioma
72
What does a defect in CN VI result in?
Defective eye abduction | Horizontal diplopia
73
What is facial nerve palsy the most common neurological manifestation of?
Sarcoidosis
74
Who is bells palsy more common in?
Pregnant women
75
What CN is susceptible to damage early in the course of raised ICP and why?
Abducens nerve | Long course of the nerve

Neuro Pathology (21 decks)

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