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Neurology - Cranial Nerves (dropped image link (CN 10 = *Vagus nerve …
Neurology - Cranial Nerves
*Common CN lesions
Facial
CN 7 = Bells Palsy
--> UMN vs LMN
--> upper eye muscle sparing in UMN since gets BOTH left/right
Trigeminal
= CN 5
--> jaw deviates TOWARDS lesion
Vagus
= CN 10
--> Uvula AWAY from the lesion
--> think uvual = CN 10 and tongue = CN 12 are opposites
Accessory
= CN 11
--> SCM lose CONTRALATERAL head turn
--> TRAPZ - lose same side shrug
Hypoglossal
= CN 12
--> "lick your wounds"
CN 5 - *Trigeminal Nerve
MOTOR
= TMJ muscles of MASTICATION
--> orbicularis occulus and or
CN 5 vs CN 7 Lesions
upper vs. lower face muscles
if only lower facial muscle lost
--> CN 5
Clinical Cases
Clinical Case
Notes
:
note that
Clinical Case
Tongue Anatomy and OSA
all motor to tongue from CN 12 = hypoglossal
--> "up and out and roll"
exception is CN 10 control styloglossal for lifting the tongue to swallow
Notes
:
vagus nerve = CN 10 makes OSA worse
--> since it lifts the tongue against the oropharynx
CN 12 = hypoglossal makes OSA better since lowers tongue
CN 7 = *facial nerve
MOTOR
facial muscles
--> orbicularis occulus
stapedius muscle
(STAPES)
-->CN 7 and 8 run together through the auditory canal of temporal bone
--> think
"SCABIES on the FACE"
= stapedius muscle = facial nerve
SENSATION
Taste anterior 2/3 of tongue
--> note the sensation of anterior 2/3 is CN 5 V3
PARASYMPATHETIC
submaxillary saliva gland
lacrimal gland of eyes
5 Branches of the Facial Nerve
"TEN Zebras headBUTT my CAT"
Temporal, zygomaic, buccal, Mandibular, cervical
CN 7 = *BELLS PALSY
MOTOR
eyes and above are recieve DOUBLE UMN
--> eye muscles are important so recieve motor from both left/right of CN 7
--> eye ptosis ONLY seen in LMN with the entire face drooped
lower face ONLY recieves one UMN
--> lower face = mouth drop is seen in BOTH UMN and LMN forms of BELLS palsy
Hyperacusis
= sensitive to sounds
--> facial nerve innervate the stapedius muscle
--> think
"SCABIES on the FACE"
= stapedius muscle = facial nerve
*Stapedius muscle and Hyperacusus in BELLS palsy
high sensitivity to sounds
--> facial nerve innervate the stapedius muscle
--> think
"SCABIES on the FACE"
= stapedius muscle = facial nerve
*Stapedius and Tensor Tympani muscles of the middle ear
both teh tensor tympani and the stapedius muscle DAMPEN sound in the middle ear
CN 7 = Facial nerve = BELLS palsy
"BELLS will RING
= stapedius muscle highly sensitive
--> smallest skeletal muscle in the body
"MALEUS Tensor Tympani"
= MAN branch of Trigeminal nerve
--> Teensor tympani inserts on the MALEUS
Tongue Anatomy and OSA
all motor to tongue from CN 12 = hypoglossal
--> "up and out and roll"
exception is CN 10 control styloglossal for lifting the tongue to swallow
Notes
:
vagus nerve = CN 10 makes OSA worse
--> since it lifts the tongue against the oropharynx
CN 12 = hypoglossal makes OSA better since lowers tongue
CN 11 = *Accessory nerve
MOTOR
SCM
--> pull back of skull on that side toward the calvicle
--> rotates head to CONTRALATERAL side to look away from the CN11
Trapezius
--> shrugs IPSILATERAL shoulder upwards
CN 11 = *Accessory nerve PALSY
MOTOR
SCM
--> can't turn head to CONTRALATERAL side of lesion
Trapezius
--> can't shrug should on IPSILATERAL shoulder upwards
SCM
--> pull back of skull on that side toward the calvicle
--> rotates head to CONTRALATERAL side to look away from the CN11
CN 3 = *Occulomotor Nerve
MOTOR
= parasympathetic cilliary muscles
--> efferent of pupillary light reflex
Edinger-Westphal nuclei in pupillary reflex
-
Edward Scissor Hands
--> has a
"PAIR of Scissors in EACH hand"
--> orbicularis occulus and or
*Pupillary Light reflex
afferent = CN 2
efferent = CN 3
Edinger-Westphal nuclei in pupillary reflex
-
Edward Scissor Hands
--> has a
"PAIR of Scissors in EACH hand"
--> orbicularis occulus and or
*Parasympathetic vs somatic (muscle) control in CN 3 occulomotor nerve
note that the muscle control from CN 3 is in the inside
the parasympathetic is on the outside
diabetic neuropathy affects the INSIDES of nerves
--> CN 3 occulomotor diabetic neuropathy is the most common eye neuropathy complication from diabeties
--> this doesn't include the common vasculopathies from diabetes in the eye
--> the OUTSIDE parasympathetic, reflexes are intact
CN 9 = *Glossopharyngeal nerve
MOTOR
stylopharyngeal muscle
--> ONLY swallowing muscle of the pharynx innervated by CN 9
--> ALL other swallowing muscles = CN 10
SENSATION
Afferent of
carotid sinus chemo/baroreceptors
--> CN 9 = afferent only, CN10 give efferent SA and AV control
--> CN 10 = aortic arch chemo/baroreceptors
PARASYMPATHETIC
submaxillary saliva gland
lacrimal gland of eyes
*Swallowing Muscles
ALL swallowing muscles = CN 10
stylopharyngeal muscle
--> ONLY exception = stylopharyngeal muscle
--> innervated by CN 9
CN 10 = *Vagus nerve
MOTOR
ALL swallowing muscles = CN 10
stylopharyngeal muscle
--> ONLY exception = stylopharyngeal muscle
--> innervated by CN 9
SENSATION
Afferent of
aortic arch chemo/baroreceptors
--> CN 9 = carotid sinus chemo/baroreceptors
PARASYMPATHETIC
SA and AV node
--> efferent of
BOTH aortic arch and carotid sinus chemo/baroreceptors
-
*Swallowing Muscles and Vagus CN10
ALL swallowing muscles = CN 10
stylopharyngeal muscle
--> ONLY exception = stylopharyngeal muscle
--> innervated by CN 9
-->
stylopharyngeal = "STAYS aLONE"
*Laringeal branches of the Vagus CN10
recurrent laryngeal nerves go back up the neck from the Vagus nerves
--> left recurrent laryngeal nerve wraps under the aortic arch
--> right laryngeal nerve wraps under the right subclavian artery
external larnyngeal nerves go to the thyroid and supply the main front muscle =
cricothyroid
*Laryngeal Muscles
just like the pharyngeal muscles, ALL are innervated by the CN10 Vagus nerve (exception is a different branch of Vagus 10)
ALL Vagus
CN10 exception for
talking laryngeal muscles
--> ONLY exception = cricothyroid muscle
--> innervated by CN 10
Superior laryngeal
branch
-->
SCAR
ALL Vagus
CN10 exception for
swallowing pharyngeal muscles
--> ONLY exception = stylopharyngeal muscle
--> innervated by CN 9
-->
stylopharyngeal = "STAYS aLONE"
Ear canal innervation by CN 10
vagus branches
*Pathways for Cranial Nerves and Blood vessels leaving the skull
CN 2/12 are
SPECIAL
--> have their own CANALS named after them
2 TRIPLET Foremans:
SUPERIOR ORBITAL FISSURE
3,4,6 (+5 v1)
--> all eye muscle CN
--> Trigeminal V1 branch
JUGVLAR FOREMAN
9,10,11 (jugular)
--> INTERNAL jugular vein
--> G = glossopharyngeal
--> V = vagus
--> A = accessory
Trigeminal STANDING ROOM ONLY
SRO CN 5 v1,v2,v3
-->
STANDING
= Sup. Orbital F
-->
ROOM
= F. Rotundum
-->
ONLY
= F. Ovale
*Jugular Foreman Syndrome
affects the jugular vein and 3 CN 9,10,11 that go with it
--> gag refelex, uvula AWAY from the lesion (opposite to lick your wounds) and dysphagia
*Superior Orbital Fissure vs Cavernous Sinus
note the nerves in the Superior Orbital Fissure = SOF go through cavernous sinus first along with the v1 and v2 which go through the cavern first and then through foreman SRO rotunda and ovale
-->
"STANDING ROOM ONLY"
Cavernous sinus has the same SOF nerves = 3,4,6,v1
--> PLUS V2 and v3 of the trigeminal nerve = CN5
*Cavernous Sinus
note the same nerves in the Superior Orbital Fissure = SOF go through cavernous sinus
Cavernous sinus has the same SOF nerves = 3,4,6,v1
--> + structures in SRO = STANDING ROOM ONLY
--> V2 and v3 of the trigeminal nerve = CN5
*Nuclei of Cranial Nerves
Superior and Inferior Tectum of MESenceph Midbrain
-->
"CN 3 is SUPERIOR to CN 4"
--> Superior Tectum = CN 3
--> Inferior Tectum = CN 4
