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Clinical Neuro - CN

Cranial Nerves Basics

QuestionAnswer
Function of CN 1? smells
Function of CN 2? sees
Function of CN 3,4,6? moves eyes, constricts pupils, accommodates
Function of CN 5? chews and feels front of head afferent loop of corneal blink
Function of CN 7? moves the face, tastes, salivates, cries efferent loop of corneal blink
Function of CN 8? hears, regulates balance
Function of CN 9? tastes, swallows, monitors carotid body and sinus
Function of CN 10? tastes, swallows, lifts palate, talks, communication to and from thoraco-abdominal viscera
Function of CN 11? turns head lifts shoulders
Function of CN 12? moves tongue
What 3 cranial nerves are purely sensory? CN 1 olfactory CN 2 Optic CN 8 Vestibulocochlear
What 5 cranial nerves are purely motor? 3 oculomotor 4 trochlear 6 abducens 11 accessory 12 hypoglossal
What 4 cranial nerves are mixed containing motor and sensory components? 5 trigeminal 7 facial 9 glossopharyngeal 10 vagus
Which of the 5 mixed motor cranial nerves has a visceral component? CN 3
Which of the 4 mixed cranial nerves has only 2 components, and what are the nuclei? CN 5 trigeminal - somatic motor (motor nuc.5), somatic sensory (sens. nuc.5)
Which of the 4 mixed Cranial nerves have their visceral sensory components through the nucleus solitarius? 7, 9, 10
What is the somatic motor nucleus of CN 7? facial nuc.
What is the somatic motor nucleus of CN 9 & 10? Nuc. aMbiguus
What are the visceral motor nuclei of 7, 9, 10? 7 Sup. saliv. nuc. 9 Inf. saliv. nuc 10 dorsal mot. nuc.
In what portion of the brainstem does the sensory nucleus of 5 reside? extends from the midbrain to the spinal cord
In what portion of the brainstem does the sensory nucleus of 8 reside? Caudal pons and medulla
General rule for how CNs exit the brainstem? they exit relatively anterior to the ventricular system and do not cross over to the opposite side on exiting from the brainstem
What CN is the exception to the same side no crossover rule? CN 4, crosses over and passes over the roof of the brainstem
All autonomic CN fibers are of what functional type? parasympathetic
What 2 CNs are involved in opening and closing the eye? CN 7 closes eyes (like a hook pulling a window shade down) CN 3 opens eyes (like 3 pillars)
Clinical difference between upper and lower motor neuron lesion of CN 7? In LMN - the ipsilateral upper and lower face are paralyzed (eye won't close, forehead flat, nasolabial fold flattened) In UMN lesion (stroke) - only contra. face below eyes paralyzed because of bilat. innervation of upper face by both hemispheres
The usual site of injury in Bell's palsy? facial canal (which lies between the internal acoustic meatus and the stylomastoid foramen)
What auditory symptom can be expected in Bell's palsy? hyperacusis, b/c the stapedius muscle is paralyzed and can't dampen the sound waves through the tympanic membrane
What is the clinical finding in an Intranuclear ophthalmoplegia (INO)? A lesion of the MLF causes nystagmus of the abducting eye with absent adduction of the other eye.
How is the side of the INO lesion determined? The lesion is on the side of the eye that should be adducting.
What is a clinical finding in bilateral INO? this will be suspected if neither eye adducts with horizontal gaze.
Finding in unilateral lesion of left CN 12? deviation to the lesion side (left) on tongue protrusion
Finding in bilateral lesion of CN 12? slow and incomplete tongue movements, especially when moving side to side
The left cerebral hemisphere controls which SCM muscle and what function? ipsilateral SCM muscle (left in this case) causes contralateral rotation ( right rotation in this example)
Why is it that a 6th nerve palsy may be a "false localizing sign"? The reason for this is that it has the longest intracranial route of the cranial nerves, therefore it is the most susceptible to pressure that can occur with any cause of increased intracranial pressure.
Which functions should be tested when evaluating CN 9 & CN 10? voluntary - aah/swallow involuntary - gag reflex, has sensory and motor limb
How to distinguish bulbar (LMN) from pseudobulbar (UMN) palsy? unilateral LMN lesion - paresis of palate on lesioned side, uvula deviates to high/normal side bilateral LMN lesion - absent voluntary and reflex activity UMN lesion - must have bilateral palatal weakness (nuc. ambiguus), with hyperactive gag reflex
What are the sensory functions of CN 9 & CN 10? sensation for the pharynx and taste for the posterior one-third of the tongue.
What cranial nerves nuclei are located in the medulla and have localizing value for lesions in this most caudal part of the brainstem? Cranial nerves 9,10,11, and 12
How to check cochlear division of CN 8? check auditory acuity and rinne/weber test
Neurologically caused unilateral hearing loss is almost always caused by damage to what structures? lesion/damage in cochlea sensory organ, the spiral ganglion, the cochlear nerve, or cochlear nucleus
How do you clinically test the vestibular portion of CN 8? test balance, and with the oculocephalic reflex (Doll's eye maneuver) and oculovestibular reflex (ice water calorics).
Describe pathway of the axons for the descending tract of the 5th cranial nerve (pain and temperature)? axons descend to the level of the upper cervical spinal cord before they synapse with neurons of the nucleus of the descending tract of the 5th nerve. Second order neurons then cross over and ascend to the VPM nucleus of the thalamus.
Eye movements are controlled by 4 major oculomotor gaze systems, list them? Saccadic (frontal gaze center to PPRF Smooth Pursuit (parietal-occipital gaze center via cerebellar and vestibular pathways) Vestibulo-ocular (vestibular input) Vergence (optic pathways to oculomotor nuclei) to keep image on fovea
Function of the MLF? The medial longitudinal fasciculus connects the 6th nerve nucleus in pons to the contralateral 3rd nerve nucleus in midbrain for conjugated eye movements.
What subjective sign results when CN 3, 4 and 6 don't work in concert for conjugate eye movements? diplopia (double vision) results.
The 4th CN supplies which muscle and therefore what ocular movements? the superior oblique muscle, which is important to looking down and in (towards the midline).
Which is the only sensory modality with direct access to cerebral cortex without going through the thalamus? Olfaction. The olfactory tracts project mainly to the uncus of the temporal lobes.
Created by: jasonsmithdc on 2011-06-24



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