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Clinical Cases of Cranial Nerves (Cavernous Sinus Thrombosis (Ophthalmic…
Clinical Cases of Cranial Nerves
Cavernous Sinus Thrombosis
Ophthalmic Veins carry infection from the face to the cavernous sinus
Initially Medial Strabismus from compression of CN 6; CN 6 is surrounded by blood. Abnormal gaze of the eyes. Lateral Rectus muscle becomes paralyzed gaze goes medially.
Eventually paralysis of extrinsic eye muscles, position of the eye is fixed
Fixation of pupil
Compression of autonomic nerve fibers
Edema of eyelid and pulsating exopthalmos
Paresthesia of skin supplied by the ophthalmic nerve (V1): forehead, upper eyelid, bridge and tip of nose
Horner Syndrome (compression of sympathetics)
Cavernous Sinus: CN3,4,V1,6, Maxillary N., ICA
CN 6 1st nerve to be affected because its surrounded by blood on all sides
CN 3 & 4--> affected caused fixed gaze --> you cannot look anyway. Extrinsic muscles become paralyzed
Facial Paralysis -Bell's Palsy
Paralysis of muscles innervated by CN7
Causes
Inflammation of CN7
Temporal Bone Tumors
Tumor of Parotid Gland
Surgery in the parotid region
Exposure to cold
Psychosomatic
Unknot
Symptoms
Smoothing on the skin wrinkles on affected side
flattening of nasolabial furrow
Inability to blink or close the eyelid
Spilling of tears down the cheek - risk of corneal damage
Hyperacuisis (sensitivity to loud sounds) if lesion is proximal to nerve to stapedius
Inability to close the mouth, resulting in drooling, problems in speaking, and problems eating
Horners Syndrome
Sympathetic innervation of the head is interrupted
Contraction of pupil (paralysis of dilator pupilae)
Ptosis, drooping of upper eyelid (paralysis of smooth muscles)
Loss of sweating (anhydrosis)
Flushing of skin ( paralysis of smooth muscle that constricts cutaneous arteries)