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Cranial Nrvs

Name the structures that exit through or enter the foramen magnum. medulla and meninges, spinal accessory nerve, vertebral arteries, anterior and posterior spinal arteries
Name the structures that exit through or enter the jugular foramen. CN IX, X and XI
Name the structures that exit through or enter the internal acoustic meatus. CN VII and VIII
Name the structure(s) that exit through or enter the foramen ovale. V3 of trigeminal nerve
Name the structure(s) that exit through or enter the foramen lacerum. internal cartoid arteries
Name the structure(s) that exit through or enter the foramen rotundum. V2 of trigeminal nerve
Name the structures that exit through or enter the superior orbital fissure. CN III, IV, VI and V1 of trigeminal nerve
Where do the olfactory nerves enter the cranium? cribriform plate of the ethmoid bone
What muscle is most efficient at elevating the globe when it is in line 23 degrees lateral to the straight-ahead position of the eye? superior rectus
What muscle is most responsible for depressing the globe while it is abducted? inferior rectus
Name the extraocular muscles that cause intorsion. superior rectus and superior oblique
Name the extraocular muscles that cause extorsion. inferior rectus and inferior oblique
What extraocular muscle is most efficient as a depressor when the eye is adducted? superior oblique
What extraocular muscle is most efficient as an elevator when the eye is adducted? inferior oblique
Which of the inferior named extraocular muscles is most inferior? inferior oblique
What extraocular muscles in each eye does a physician test when he asks the patient to look to the pt's right and down? inferior rectus in the R eye and superior oblique in the L eye
What will the globe do if the SO muscle is activated while a patient's eye is abducted? intorsion
What will the globe do if the IO muscle is activated while a patient's eye is abducted? extorsion
What is a tertiary action of the SO muscle when the globe is extorted and depressed? abduction
If a pt presented with a lesion of the right 6th CN, what problem might she have? unable to look to the right with the right eye when eyes are looking straight forward
If a pt presented with a lesion of the right 6th CN and its nucleus, what problem might he have? gaze palsy - left MR muscle would move the eye laterally, but very slowly. The LR on the right wouldn't move at all.
If a pt is acutely having a stroke in the lower left midbrain at the level of the trochlear nucleus and site of nerve exit, what might her physician see on the EOM exam? R eye elevated and extorted
Identify the muscle producing: pure vertical up movement of the eye when it is positioned 51 deg toward the nose (adducted). inferior oblique
Identify the muscle producing: pure down movement of the eye when it is rotated 23 deg outward. inferior rectus
Identify the muscle producing: pure intorsion with the eye positioned 39 deg away the nose. superior oblique
Besides the EOM, what else do the motor fibers of CN III directly innervate? levator palpebrae superioris muscle
The loss of ability to accomodate with age is called? presbyopia
If while testing a pt's ability to accomodate, you notice the globes do not converge, what is a probable diagnosis you might be thinking about? midbrain stroke or any type of lesion that would affect the bilat oculomotor nuclei; impingement of CN IIIs as they exit interpeduncular fossa
What is the etiology of the so-called "down and out" eye positioning? CN III/nucleus damage
What might a physician see on EOM exam if a pt has a severed R CN III? the affected eye will be abducted, depressed and slightly intorted
Describe the manifestations of Horner's syndrome. unilateral sx on affected side: mild ptosis of both upper and lower eyelids coupled with a miosis and anhidrosis of upper half of face
What might an astute triage nurse be looking for if she suspects the pt has a R sided CN III parasympathetic nerve problem? R sided mydriasis and moderate to severe ptosis of R eyelid
My ciliary muscles are relaxed because I'm giving my Edinger-Westphal nucleus a break. Which activity will be the easiest for me - reading the newest JAMA issue or spotting a bird across the street? Spotting a bird across the street - relaxed ciliary muscles mean flattened lens, which is best for distance sight
If CN III signs are seen on the R side but not the left, would the lesion more likely involve the nuclei of CN III or the nerve itself? Nerve itself; one nucleus complex feeds parasympathetics to both sides and their close proximity makes it hard to obliterate just one
Define strabismus. misalignment of gaze due to deviation of a globe
What tract is just ventral to the trochlear nucleus in brainstem cross-section? MLF
Which CN is most susceptible to damage after a head injury due to its unorthodox and circuitous route to its target? trochlear nerve
Which nerve is the only one to exit the brainstem dorsally and decussate before reaching its target muscle? CN IV
Following a lesion of the R fourth CN tract, how would the R eye be positioned? normally
Following a lesion of the R fourth CN nucleus, how would the L eye be positioned? extorted and elevated, causing diplopia
A pt with left CN IV damage presents to your office holding her head in a tilted position to ameliorate her diplopia. How is her head positioned? Head tilted to the R to offset the induced extorsion and held with chin downwards to elevate the normal eye to the level the affected eye is abnormally elevated to
Monocular diplopia is due to... cornea, vitreous humor, retina or anterior eye problem
Binocular diplopia is due to... a neurologic issue
3 year-old Trinity is mimicking Nemo on TV and tilts to follow the screen. If she rolls her head to the R, what do her eyes naturally do? Both eyes roll to the left = intorted R eye and extorted L eye
What muscle's paralysis would result in esotropia? inward maintenance of eye is due to LR paralysis
What is the L abducens nucleus responsible for innervating? ipsilateral LR and contralateral MR
What sx are typical of "1-and-a-half syndrome?" unilateral abducens and MLF lesion cause only contralateral LR to be functional
What is typically the cause of bilateral internuclear ophthalmoplegia (INO) in a young pt? multiple sclerosis (MS)
Name the tract that allows the R abducens nucleus to control both the R LR muscle and the L MR muscle. MLF (in this case via L CN III nucleus)
Explain the mechanism behind internuclear ophthalmoplegia. If the L MLF was lesioned, the R CN VI nucleus could move the R LR successfully, but not the L MR. Moving a finger from far to near to test convergence of the globes would rule out a L MR paralysis.
List the 3 nuclei associated with CN VII. salivatory, nucleus solitarius and facial motor nucleus
What might a physician expect to see if her pt has a LR muscle paralysis? the eye would be deviated medially
What is the purpose of the paramedial pontine reticular formation (PPRF)? It allows for smooth voluntary eye movement during lateral gaze by innervating the abducens nucleus ipsilaterally and sending fibers that travel in the MLF to the oculomotor nucleus contralaterally
Where is the PPRF located in a braintem cross-section? Just ventral to the MLF at levels of III, IV and V and in similar place at levels of VI and VII
Which Brodmann's area includes the frontal eye fields (FEF)? Brodmann's area 8
Define saccadic eye movements. rapid movement of eye under conscious control to allow abrupt change of point of fixation
What Brodmann's areas include the extrastriate visual cortex? areas 18-19
3 structures that are important for saccadic eye movements ipsi superior colliculus, ipsi frontal eye fields and contra PPRF
How do the pretectal nuclei communicate with each other? through the posterior commissure
True/False: One test for an intact lateral geniculate nucleus with fully functioning synapses is the swinging light test. false
Fibers coming from the retina traveling in the optic tract eventually reach the pretectal nuclei via what structure? brachium of the superior colliculus
What functions comprise the "near triad?" convergence of the eyes, rounding of both lenses and constriction of the pupils
What CNS infection produces an Argyll-Robertson pupil? syphilis
Explain the mechanism given in the syllabus for an Argyll-Robertson pupil. syphilis likely selectively attacks the fibers that enter the E-W nucleus ventromedially; these fibers are only responsible for destroying light reflex fibers. Near triad fibers are ventrolateral and thus spared.
Argyll-Robertson pupil Accommodation Retained
Explain the path of neuronal activity needed to elicit mydriasis. retina - hypothalamus - reticular formation - down to C8-T2 preganglionic neurons in IML column - up sympathetic chain - superior cervical ganglion - carotid plexus - cavernous sinus - pupil
What ocular exam abnormalities might one expect to see in a pt with an advanced and invasive apical lung tumor? obliteration of sympathetic fibers feeding the affected side's eye - Horner's syndrome sx
True/False: Both autonomic nerves affecting pupillary size make synaptic connections in the ciliary ganglion. False: only para synapses, symp just rides through the ganglion
Eye exam findings: direct light into the R eye shows sluggish pupillary response, direct light into the L causes a brisk constriction of the R pupil. IMMEDIATELY after, direct light in the R pupil shows no constriction, but a steady dilation. Condition? Afferent pupillary defect (APD) caused by optic neuritis or demyelinating syndromes like MS
Which trigeminal nucleus is closest to the MLF in a pontine cross-section? motor is always medial
What structure from the medulla merges with the dorsal horn of the spinal cord? spinal nucleus of CN V is contiguous with substantia gelatinosa as far down as C6
Name all the cranial nerves that provide sensation to the external ear. CN V, VII, IX and X
Identify the relationship btwn the mesencephalic nucleus of CN V and the EOMs. EOMs have sensory receptors that originate in mes. nucleus of trigeminal that relay to CN III, IV and VI to control eye movements
Where are the cell bodies of neurons which provide information about the amount of tension in the masseter muscle? mesencephalic nucleus of CN V
What is the innervation of the muscle that attaches to the malleus? nerve from motor nucleus of trigeminal
What reflex and CN is a young physician testing when he takes a wisp of cotton and touches a pt's eye? corneal reflex, chief sensory nucleus of trigeminal and its peripheral afferent through V1
How will the jaw of a pt who has a L sided trigeminal motor nerve injury be situated? the jaw will be towards the L; the L. lateral pterygoid moves the jaw to the R. Therefore, the strong R. lateral pterygoid will move jaw to same side as lesion
If the nerve going to ocular muscles on the R is severed and a physician takes a wisp of cotton to touch the R cornea, what should she see the pt do? the pt would feel the cotton but blink only on the L side
What CN must be intact in order to send signals to the brain that one has just inhaled ammonia? nasal mucosa sensation and nociceptors - CN V
Name the condition arising from lesions to the motor nucleus or root of CN VII. Bell's palsy
The facial motor nucleus is divided into dorsal and ventral portions; what does each innervate? dorsal - lower face ventral - upper face
One or both of these CNs could be involved in hyperacusis. CN VII - stapedius CN V - tensor tympani
The ventral portion of the facial motor nucleus receives (unilateral/bilateral) innervation from the motor cortex. bilateral
How might one tell the difference btwn Bell's palsy or an acute ischemic stroke of the cerebral motor hemicortex? Bell's palsy affects the nerve after it leaves the facial motor nucleus and thus an entire side of the face. Stroke will cause a total lower face paresis but just weakness of the upper face.
What is the name for palpebral fissure diminishment? lagophthalmos
An UMN lesion in the motor cortex in the facial region would cause what else in addition to facial muscle paralysis in the contralateral lower face? CONTRALATERAL(?) hyperacusis
What do nerve fibers from the superior salivatory nucleus innervate? lacrimal, submandibular and sublingual glands
What is the most easily detectable symptom of a lesion of the division of the facial nerve that arose from the salivatory nucleus? dry eye on the same side as the lesion
What are the CNs involved in swallowing? CN IX, X, XI (bulbar), and XII
Where do fibers innervating the parotid gland originate (what nucleus)? inferior salivatory nucleus
In which direction will the palate deviate in a pt with a glossopharyngeal lower motor nerve lesion? to the unaffected side
A pt comes to you for uncontrolled BP. You test her CNs and notice her palate deviates to the right. What might this tell you? Nothing necessarily, although CN IX brings info from carotid sinus, unilateral 9th nerve deficits should not make a detectable deficit in BP
What comprises the gustatory nucleus? the portion of the nucleus solitarius receiving afferents via CNs VII and IX
If an 84 yr old woman can press her tongue into her R cheek, what is your conclusion about her neuromuscular status? R cerebral cortex, L hypoglossal nucleus and L CN XII are all intact
What section of the brainstem is the hypoglossal nucleus within? medullary tegmentum
What nerve rootlets supply the SCM and trapezius? C1-2 for SCM C3-4 for trapezius
What CN nucleus must be intact to elecit a negative chronotropic effect on the heart? vagus nerve coming from dorsal motor nucleus
Which CN provides the most extensive sensory supply to the pharynx? glossopharyngeal
Which CN(s) innervate the pharyngeal constrictors? CN X and XI
What is the neurologic etiology of dysarthria? any interruption of CN X innervating laryngeal muscles
What else provides motor innervation to the pharynx and larynx besides CN X? bulbar portion of CN XI
True/False: Unilateral lesions of the nucleus ambiguus will not produce detectable alterations of the voice. false
Trace the pathway for saccadic eye movements beginning with the retina. retina -- optic nerve -- optic tract -- lat. geniculate nucleus -- optic radiations -- primary visual cortex -- supp. motor cortex/FEF -- opposite, contralat. PPRF for horiz. eye movements
Input from what 2 structures is needed for initiation and accurate targeting of saccadic eye movements? frontal eye field (Brodmann's area 8) and superior colliculus
Smooth pursuit eye movements require input from what cortical structures for initiation and accurate guidance of eyes to track visual targets? visual cortex and extrastriate visual cortex (Brodmann 18-19)
Created by: sirprakes
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