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Questions and Answers

Following a complete lesion of the left optic tract, what specific visual field deficits would be observed, assuming no additional neurological damage?

  • Left nasal hemianopia and right temporal hemianopia.
  • Left homonymous hemianopia.
  • Right homonymous hemianopia. (correct)
  • Bitemporal hemianopia.

If a patient presents with a constricted pupil in the presence of bright light bilaterally, but normal pupillary light reflexes in dim illumination, which anatomical structure is most likely compromised?

  • Lateral geniculate nucleus.
  • Pretectal area. (correct)
  • Optic radiations.
  • Superior colliculus.

A researcher selectively ablates the parvocellular layers of the lateral geniculate nucleus (LGN) in a primate model. Which of the following visual deficits would most likely be observed?

  • Difficulty with saccadic eye movements.
  • Achromatopsia and reduced spatial resolution. (correct)
  • Impaired motion detection.
  • Complete blindness in the contralateral visual field.

Which neuroanatomical pathway is most directly responsible for coordinating reflexive head and eye movements in response to sudden visual stimuli?

<p>Optic tract → Superior Colliculus → Brainstem motor nuclei. (B)</p> Signup and view all the answers

A patient presents with a lesion affecting the geniculo-calcarine tract (optic radiations). Considering the anatomical organization of this pathway, which specific visual field defect would result from damage to Meyer's loop on the right side?

<p>Left superior quadrantanopia. (B)</p> Signup and view all the answers

Damage to the suprachiasmatic nucleus (SCN) of the hypothalamus would most likely result in what specific deficit?

<p>Impaired circadian rhythm. (D)</p> Signup and view all the answers

Considering the embryological development and unique glial cell composition of cranial nerves I and II compared to the remaining cranial nerves, which of the following statements is most accurate regarding their regenerative capacity following axonal injury?

<p>The presence of olfactory ensheathing cells (OECs) in cranial nerve I, and the unique developmental origin of cranial nerve II, results in a greater regenerative potential compared to other cranial nerves, but less than typical peripheral nerves. (C)</p> Signup and view all the answers

A patient presents with isolated loss of taste (ageusia) on the anterior two-thirds of the tongue, but no other cranial nerve deficits are observed. High-resolution MRI reveals no structural lesions in the brainstem. Which of the following is the most likely specific anatomical site of the lesion?

<p>The geniculate ganglion proximal to the branching of the chorda tympani. (D)</p> Signup and view all the answers

Which of the following best describes the functional consequence of a lesion limited to the left lateral geniculate nucleus (LGN)?

<p>Contralateral homonymous hemianopia. (B)</p> Signup and view all the answers

A patient exhibits horizontal diplopia that worsens upon attempted abduction of the right eye. Neuroimaging reveals a microinfarct affecting a specific cranial nerve nucleus. Which specific region within the brainstem is the most probable location of the lesion based on the observed deficit?

<p>The right abducens nucleus in the pons. (D)</p> Signup and view all the answers

Consider a scenario where both the left optic nerve and the right optic tract are completely severed. What is the resulting visual field deficit?

<p>Right homonymous hemianopia and left nasal hemianopia. (A)</p> Signup and view all the answers

A neuro-ophthalmological exam reveals a patient has impaired accommodation and pupillary constriction during near vision, yet pupillary light reflexes are normal. Where is the most probable lesion location?

<p>Edinger-Westphal nucleus. (A)</p> Signup and view all the answers

Following a traumatic brain injury, a patient demonstrates weakness in contralateral shoulder shrugging and head rotation. Electrophysiological studies confirm lower motor neuron dysfunction. Considering the course and decussation patterns of the relevant cranial nerve, where is the most probable lesion location?

<p>The ipsilateral spinal accessory nucleus in the medulla. (D)</p> Signup and view all the answers

Which of the following deficits would be expected after a bilateral lesion restricted to the optic chiasm?

<p>Bitemporal hemianopia. (D)</p> Signup and view all the answers

A researcher is investigating the role of specific transcription factors in the development of cranial nerve motor nuclei within the brainstem. Targeted deletion of which transcription factor would most significantly disrupt the formation of the oculomotor and trochlear nuclei?

<p><code>Otx2</code> (C)</p> Signup and view all the answers

A patient presents with vertigo, nausea, and nystagmus following a viral infection. Audiological testing reveals normal hearing thresholds bilaterally. Advanced neuroimaging demonstrates inflammation specifically targeting a component of the vestibulocochlear nerve. Which portion of the nerve is most likely affected given the patient's symptoms and audiological findings?

<p>The superior vestibular branch. (B)</p> Signup and view all the answers

A patient presents with a complete loss of vision in their right eye following a traumatic injury. Assuming the injury is isolated to a single point along the visual pathway, which specific site is most likely affected, considering the intricate anatomy of visual projections?

<p>The Right Optic Nerve (D)</p> Signup and view all the answers

A neuroanatomist is tracing the efferent projections of the amygdala in a primate model. Which of the following cranial nerve nuclei is least likely to receive direct or indirect input from the amygdala, considering its established role in emotional processing and autonomic regulation?

<p>The trigeminal motor nucleus. (D)</p> Signup and view all the answers

A patient exhibits bitemporal hemianopia. Which specific anatomical structure is most likely compromised, considering the organization of the optic chiasm and the decussation of specific nerve fibers?

<p>The Optic Chiasm (A)</p> Signup and view all the answers

Following neurological insult, a patient demonstrates a left nasal hemianopia. Which precise anatomical location is most likely affected, considering the pathway of visual information from the retina to the visual cortex?

<p>The Left Optic Nerve (D)</p> Signup and view all the answers

A patient exhibits a left homonymous hemianopia. Which anatomical lesion would most likely explain this visual field defect, considering the course of the optic tracts and their termination in the visual cortex?

<p>Damage to the right visual cortex (D)</p> Signup and view all the answers

A patient presents with a visual field defect characterized as left inferior quandrantopia. Which specific anatomical structure along the visual pathway is most likely compromised, considering the retinotopic organization of the optic radiations and the visual cortex?

<p>Damage to the temporal-occipital pathway on the right side. (B)</p> Signup and view all the answers

A patient develops papilledema secondary to intracranial hypertension. Which portion of the visual pathway is directly affected by this condition, leading to visual disturbances?

<p>Optic Nerve (B)</p> Signup and view all the answers

A patient with a pituitary adenoma experiences progressive visual field deficits. How does the expanding mass of the pituitary gland most commonly affect the visual pathway to produce these deficits?

<p>By compressing the optic chiasm, leading to bitemporal hemianopia (B)</p> Signup and view all the answers

A patient exhibits a complete lesion of the left optic tract. What specific visual field deficits would be expected in both eyes, taking into account the anatomical organization of the visual pathways?

<p>Right homonymous hemianopia (B)</p> Signup and view all the answers

A researcher is studying the effects of a neurotoxin that selectively targets and damages the temporal fibers of the optic nerve. What specific visual field defect would be most likely observed in experimental subjects following exposure to this neurotoxin?

<p>Ipsilateral nasal hemianopia (B)</p> Signup and view all the answers

A patient presents with a quadrantanopia that spares the macula. Assuming the lesion is localized to the occipital lobe, which specific vascular event is most likely responsible, considering the dual blood supply to the visual cortex?

<p>Posterior cerebral artery infarct sparing the macular representation (B)</p> Signup and view all the answers

A patient presents with sensorineural hearing loss, tinnitus, episodic vertigo, and a sensation of aural fullness. Electrophysiological studies reveal normal auditory brainstem responses (ABR). However, otoscopy reveals no visible abnormalities or cerumen impaction. Which of the following pathophysiological mechanisms is MOST likely responsible for these findings, considering the normal ABR results?

<p>Endolymphatic hydrops leading to distension of the membranous labyrinth and subsequent disruption of hair cell function, consistent with Ménière's disease. (B)</p> Signup and view all the answers

A researcher is investigating the tonotopic organization of the primary auditory cortex (A1) in macaque monkeys using fMRI. During the experiment, the monkeys are presented with pure tones of varying frequencies. Which of the following experimental designs would be MOST effective in elucidating the precise spatial arrangement of frequency representation within A1, considering the known limitations of fMRI resolution?

<p>Employing a sparse temporal sampling paradigm with silent intervals between tone presentations to minimize adaptation effects and enhance the signal-to-noise ratio for each frequency. (B)</p> Signup and view all the answers

A 68-year-old male reports progressive hearing loss, predominantly affecting his ability to understand speech in noisy environments. Audiological evaluation indicates a mild, sloping high-frequency sensorineural hearing loss bilaterally. Otoacoustic emissions (OAEs) are absent in the high-frequency range. Given these findings, which of the following interventions would MOST directly address the underlying pathophysiological mechanism contributing to his communication difficulties?

<p>Utilization of directional microphones and noise reduction algorithms in hearing aids to improve the signal-to-noise ratio of speech. (B)</p> Signup and view all the answers

A researcher is studying the role of lateral inhibition in auditory processing within the inferior colliculus (IC). Using in vivo electrophysiology, they record neuronal responses to varying sound frequencies presented in isolation and in combination. Which of the following experimental findings would provide the STRONGEST evidence for the presence of lateral inhibition mechanisms shaping the frequency tuning curves of IC neurons?

<p>Simultaneous presentation of a low-intensity sound at a neuron's best frequency and a high-intensity sound at a nearby frequency results in a reduced response to the best frequency. (B)</p> Signup and view all the answers

A patient with a suspected lesion along the auditory pathway exhibits normal hearing thresholds in both ears but demonstrates a significant deficit in sound localization, particularly in the horizontal plane. Furthermore, the patient struggles to understand speech when presented simultaneously from multiple speakers. Based on these findings, where is the MOST probable location of the lesion, considering the neural mechanisms involved in these specific auditory functions?

<p>Lesion of the superior olivary complex (SOC) or the lateral lemniscus within the brainstem. (A)</p> Signup and view all the answers

In a patient presenting with a lesion affecting the primary olfactory cortex, which of the following cognitive deficits would MOST likely be observed, assuming all other neurological functions remain intact?

<p>Inability to recognize familiar odors and associate them with corresponding memories or emotional responses, while retaining the capacity to process the directionality of the odor source. (D)</p> Signup and view all the answers

A patient reports experiencing persistent olfactory hallucinations (dysosmia) following a traumatic brain injury. Advanced neuroimaging reveals no discernible lesions within the primary olfactory cortex. Which of the following alternative neural structures is MOST likely implicated in the genesis of these phantom olfactory sensations?

<p>The amygdala, due to its documented roles in processing emotions intertwined with olfaction and its ability to generate false sensory perceptions based on prior experiences. (B)</p> Signup and view all the answers

A researcher aims to investigate the differential impact of unilateral versus bilateral lesions of the olfactory nerve (CN I) on olfactory function in a population with an unusually high degree of olfactory acuity. Which methodological consideration is CRUCIAL to accurately discern the functional consequences of these lesions?

<p>Implementing a rigorous control for nasal patency via anterior rhinomanometry, as subtle asymmetries in nasal airflow could confound assessment of unilateral olfactory function. (D)</p> Signup and view all the answers

Following a closed head injury, a patient exhibits selective anosmia specifically for the odor of roasted coffee, while retaining the capacity to detect and discriminate a wide array of other odors, including vanilla, peppermint, and lavender. Which of the following neural mechanisms BEST accounts for this highly specific olfactory deficit?

<p>A focal lesion within the olfactory bulb, selectively disrupting the glomeruli and mitral cells responsible for processing the specific combination of volatile organic compounds that constitute the &quot;roasted coffee&quot; percept. (C)</p> Signup and view all the answers

A researcher is studying the effects of targeted gene editing on retinal ganglion cells, specifically aiming to enhance visual acuity without compromising the cells' capacity for light-dark adaptation. Which molecular manipulation would be MOST likely to achieve the desired outcome?

<p>Selective enhancement of gap junction coupling between retinal ganglion cells of similar receptive field properties, thereby increasing spatial summation and improving the signal-to-noise ratio in visual processing. (D)</p> Signup and view all the answers

A patient presents with homonymous hemianopsia subsequent to ischemic infarction affecting the visual pathway. Neuroimaging reveals damage restricted to the left optic tract posterior to the optic chiasm. Which specific functional deficit would MOST likely manifest in this patient?

<p>Compromised perception of the right visual field in <em>both</em> eyes. (C)</p> Signup and view all the answers

A patient with a history of poorly controlled diabetes mellitus presents with progressive vision loss characterized by a gradual dimming of vision and reduced color perception. Ophthalmological examination reveals no evidence of cataracts or macular degeneration. Which of the following pathophysiological mechanisms is MOST likely contributing to this patient's vision loss?

<p>Chronic hyperglycemia-induced osmotic stress and neuronal apoptosis within the retinal ganglion cell layer, resulting in a progressive reduction in the number of functional output neurons. (A)</p> Signup and view all the answers

A researcher is developing a novel therapeutic intervention to promote axonal regeneration in retinal ganglion cells following optic nerve injury. Which molecular target would offer the MOST promising avenue for stimulating robust and sustained axonal regrowth?

<p>Inhibition of myelin-associated glycoprotein (MAG) to alleviate extrinsic inhibitory cues. (A)</p> Signup and view all the answers

Following a stroke affecting the occipital lobe, a patient presents with Anton's syndrome, characterized by cortical blindness coupled with a denial of their visual deficit. Which neural mechanism BEST accounts for this perplexing combination of blindness and anosognosia?

<p>Extensive bilateral damage to V1 coupled with disconnection of visual association cortices from the prefrontal cortex, disrupting visual perception and impairing metacognitive awareness of the deficit. (B)</p> Signup and view all the answers

Flashcards

Cranial Nerves Function

Originate from the brainstem (except I & II). Carry sensory, motor, and autonomic information to/from head, face, neck, and viscera.

Cranial Nerve Nuclei

Located in the brainstem and are considered part of the CNS.

CN I & II vs. Other CN

I & II have no peripheral component and are myelinated by oligodendrocytes (OD) instead of Schwann cells (SC). Other CN have axons/receptors outside the skull, belonging to the PNS.

Sensory vs. Motor Neurons (CN)

Sensory neurons reside outside the brain; motor neurons are within the brainstem.

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Purely Sensory Cranial Nerves

Olfactory (I), Optic (II), Vestibulocochlear (VIII).

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Purely Motor Cranial Nerves

Oculomotor (III), Trochlear (IV), Abducens (VI), Accessory (XI), Hypoglossal (XII)

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Olfactory Nerve (CN I) Pathway

nasal chemoreceptors → olfactory bulb → olfactory tract → 1° olfactory cortex (incl. Orbitofrontal cortex)

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1° Olfactory Cortex

Processes odors; associates them with memories and emotions.

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2° Olfactory Cortex

Processes odor intensity, directionality, and duration.

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Anosmia

Loss of the sense of smell.

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Hyposmia

Reduced ability to smell.

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Hyperosmia

Increased sensitivity to odors.

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Dysosmia

Distorted sense of smell; olfactory hallucinations.

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Visual Acuity

Accuracy of sight.

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Rods

Sensitive to dim light, grayscale images.

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Cones

Sensitive to high-intensity light, color vision.

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Lateral Geniculate Nucleus (LGN)

Relays visual information from the optic tract to the visual cortex.

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Optic Radiations

Tracts that carry visual information from the LGN to the visual cortex.

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Visual Cortex (Brodmann's area 17)

Area of the cerebral cortex that receives and processes visual information.

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Superior Colliculus

Controls reflexive eye and head movements in response to visual stimuli

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Pretectum

Controls pupillary light reflex and lens accommodation.

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Hypothalamus (in vision)

Regulates circadian rhythms based on light exposure.

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Optic Tract

The pathway that carries visual information from the optic chiasm to the LGN, superior colliculus, pretectum and hypothalamus.

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Optic Chiasm

The crossing point where nasal retinal fibers cross to the opposite side of the brain.

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Nasal Retina

Retinal fibers from the side of the retina nearest the nose.

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Temporal Retina

Retinal fibers from the side of the retina nearest the temples.

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Vestibulocochlear Nerve (CN VIII)

A sensory nerve with two branches: cochlear (hearing) and vestibular (head position and movement).

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Function of Ear Divisions

Outer ear receives sound waves. Middle ear converts them to mechanical signals. Inner ear converts mechanical energy into neural signals and translates head movements.

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Auditory System Signal Transduction

Sound waves vibrate the basilar membrane, bending hair cells. Hair cells depolarize, sending signals via the cochlear nerve.

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Types of Deafness

Conductive: outer/middle ear disruption. Sensorineural: receptor/cochlear nerve damage. CNS: brain stem/cortical lesions.

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Semicircular Canal Function

Head movements cause endolymph fluid to flow, moving cilia and activating vestibular nerves for spatial orientation and balance.

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Right Eye Vision Loss (Optic Nerve)

Vision loss in the right eye due to optic nerve damage.

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Bitemporal Hemianopia

Loss of peripheral vision due to damage at the optic chiasm, affecting nasal retinal fibers.

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Left Nasal Hemianopia

Loss of nasal vision on the left side due to damage to the left temporal retinal fibers at the optic nerve.

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Left Homonymous Hemianopia

Loss of left peripheral and right nasal vision due to damage in the optic tract (left nasal and right temporal fibers).

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Left Inferior Quadrantopia

Specific loss of the lower left quadrant of the visual field in both eyes due to damage to optic radiations.

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Optic Nerve Damage Causes

Caused by intracranial pressure or metabolic disorders.

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Nasal Retinal Fibers

Cross at the optic chiasm carrying information from the periphery.

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Study Notes

  • The material covers cranial nerves, their anatomy, and functions.

Learning Objectives

  • Identify cranial nerves
  • Learn their functions/pathways
  • Recognize clinical correlates of cranial nerve lesions

Cranial Nerve Anatomy

  • Cranial nerve nuclei (cell bodies) are in the brainstem and are part of the CNS.
  • Cranial Nerves, except I and II, exit the brain at the midbrain & lead to the medulla.
  • All cranial nerves are seen from the inferior brain, except CN IV.
  • CN I & II, have no peripheral component
  • OD, not SC, myelinates I & II, and the axons and receptors of other cranial nerves exit the skull
  • Sensory neurons of cranial nerves reside outside the brain, while motor neurons are inside the brainstem.
  • Cranial nerves III-XII emerge from the brainstem.

Cranial Nerve Functions

  • Sensory, motor and autonomic information are carried to/from the head, face, neck, and viscera.
  • The nerves receive somatosensory receptor information from the skin, tongue, and muscles of the face.
  • They receive information from special sense receptors for vision, audition, olfaction, and gustation.
  • Proprioception comes from the temporomandibular joint.
  • Motor innervations are supplied to muscles of the face, eyes, tongue, jaw, and neck.
  • Parasympathetic regulation of viscera function and reflexes, like pupil size and lens of the eyes, occurs.
  • Cranial nerves are classified as purely sensory, mixed (sensory & motor), or purely motor.

CN I: Olfactory Nerve (Sensory)

  • Pathway: Nasal chemoreceptors → olfactory bulb → olfactory tract → 1° olfactory cortex (piriform cortex, amygdala, entorhinal cortex, etc.) → 2° olfactory cortex (orbitofrontal cortex or via thalamus, hippocampus etc) → hypothalamus → ANS response.
  • 1° cortex recognizes odors and links them to memories or emotions
  • 2° cortex processes the intensity, directionality, and duration of odors

Olfactory Nerve Examination (CN I)

  • Eyes should be closed for this procedure
  • Test each olfactory nerve by blocking the other nostril, and use coffee or vanilla
  • Injury may result, like from infection, brain tumor, head trauma, epilepsy, URTIs, nasal and paranasal sinus diseases, multiple sclerosis, AD, PD, DM, COVID
  • Injury of the olfactory nerve can lead to: Anosmia, Hyposmia, Hyperosmia, or Dysosmia(olfactory hallucinations
  • A unilateral lesion shows no symptoms, while a bilateral lesion causes loss of the sense of smell.

CN II: Optic Nerve (Sensory)

  • Retina is a thin transparent tissue that lines the back of the eye.
  • Photoreceptors (rods) are sensitive to dim light, for grayscale images.
  • Photoreceptors (cones) are sensitive to high-intensity light and colors
  • Bipolar cells are 2nd order neurons gather information from photoreceptor cells and pass to ganglion cells.
  • Retinal ganglionic cells are multipolar, 3rd order neurons providing visual info directly or indirectly from bipolar cells.

Visual Pathway

  • The optic nerves convey visual acuity from both eyes to the optic chiasm
  • Optic nerves from the nasal retina cross the optic chiasm, while temporal retina nerves stay ipsilateral.
  • After the optic chiasm, the optic tract goes to the lateral geniculate nuclei (of the thalamus) to organize input from the retina before sending it to the visual cortex.
  • It can also go the Superior Collicui (Tectum) for orientating movement of the head and eye.
  • It may also go to the Pretectum for reflex pupil and leans control (CN III)
  • Finally it may go the Hypothalamus for circadian rhythm
  • Damage to the optic nerve can be caused by intracranial hypertension or metabolic disorder

CN VIII Anatomy

  • CN VIII, the vestibulocochlear nerve, is a sensory nerve consisting of 2 branches
  • The cochlear branch transmits hearing information from the cochlea.
  • The vestibular branch transmits head/movement information from the vestibular apparatus and semicircular canal.

The Structure of the Ear

  • Outer ear receives sound waves and passes them to the tympanic membrane.
  • The middle ear has three ossicles (stapes, incus, malleus) to convert sound waves into a mechanical signal toward the oval window
  • The inner ear converts mechanical energy into a neural signal, and translates head position and movements into neural signal.

Auditory System Details

  • Sound goes through the Scala vestibule and Scala tympani, moving perilymph.
  • This vibrates the basilar membrane, causing hair cells bend through the tectorial membrane, depolarizing cells.
  • Apex of the ear is sensitive to low freqeunices
  • Base of the ear is sensitivie to high frequencies

Path of Sound

  • Organ of Corti → cochlear nuclei → inferior colliculus → medial geniculate body → primary auditory cortex
  • Spiral Ganglion → Ventral & Dorsal Cochlear Nuclei → Superior Olive / Inferior Colliculus Medial geniculate Nucleus Auditory Cortices
  • An auditory cortex lesion provides awareness and recognition loss of sounds

Auditory System Disorders

  • Conductive deafness involves disrupted vibrations in the outer or middle ear, potentially from excessive wax
  • Sensorineural deafness involves damage to receptor cells or the cochlear nerve due to Meniere's Disease or acoustic neuroma.
  • CNS deafness involves lesions at the brainstem or cortical level.

Vestibular Apparatus

  • Endolymph fluid inside the three semicircular canals during head rotation to triggers cilia movement; this activates vestibular nerves
  • L horizontal canal activates upon Left cervical rotation.
  • R horizontal canal inhibits upon Left cervical rotation.
  • L posterior canal activates upon Left cervical side-bending.
  • R posterior canal inhibits upon Left cervical side-bending.
  • L superior canal activates upon left
  • R superior canal activates for cervical flexion.

Utricle & Saccule-detect Static vs Vertical vs Horizontal forces

  • The utricle detects linear horizontal acceleration and static horizontal head tilts.
  • The saccule detects linear vertical acceleration and static vertical head tilts.

Examination of Vesitbulocochlear Nerve (CN VIII)

  • Includes Dix-Hallpike testing maneuver for Benign paroxysmal positional vertigo (BPPV)
  • Supine roll test for horizontal BPPV

CN III (Oculomotor), CN IV (Trochlear), CN VI (Abducens)

  • These all motor nerves help the eye move
  • Control of extraocular muscles Reflective responses, like constriction of the pupil and lens muscle Coordination of two eyes The Superior Oblique is controlled by the Trochlear Nerve

Basic Eye Movements

  • Elevation, depression, adduction (in), abduction (out), intorsion (rotate eye towards midline), extorsion (rotate eye outward)
  • Damage to the nerve to the eye will make it drift to different positions

Eye Movement Notes

  • MR adducts, and LR abducts
  • SR elevates, adducts, and causes intorsion.
  • IR depresses, adducts, and causes extorsion.
  • SO depresses, abducts, and causes intorsion.
  • IO elevates, abducts, and causes extorsion.

Brainstem Damage and Eye Function

  • The pupillary reflex and accommodation reflex of intrinsic eye muscles is controlled by CN II/III.
  • Light elicits reflexive constriction of both pupils via CN II and parasympathetic CN III
  • Changes in lens curvature, pupil contraction & eye position is regulated by CN II, Lateral Geniculate body and Visual Cortex.
  • Pupillary reflex: pupil constriction in eye directly stimulated by bright light
  • Consensual reflex: constriction in the other eye
  • Accommodation: in objects under 20cm, ciliary contracts; increases curvature and maintain the focal point.

Oculomotor Nerve (CN III) Palsy

  • Palsy leads to lateral strabismus, ptosis, and nystagmus, and inability to constrict the pupil in bright light
  • Test: look to see if the patient can depress a fully adducted eye

Eye Damage Symptoms

  • Trochlear Nerve (CN IV) damage only effective when it fully adducts the eye
  • MR (III) problem if full adduction
  • If unable to depress the eyeball, this means there is no IR

Nystagmus

  • Involuntary eye movement often from the eye not working

CN XI: Accessory Nerve (Motor)

  • Traditionally, accessory nerve has two parts: cranial and spinal roots
  • It emerges from C1-C5(not brain)
  • Spinal root supplies the sternocleidomastoid and trapezius muscles
  • Innervates the Sternocleidomastoid to tilt, extend and rotate head.
  • This nerve also innervates the Trapezius (upper part) to elevate, retract, and depresses shoulder.
  • Test for nerve damage by looking at bulk, power and tone to observe if muscle works

Damage in the Eye

Ask the patients to try to:

  • Rotate head against resistance
  • Shrug their shoulder and test by pressing again

CN XII: Hypoglossal Nerve (Motor)

  • Innervates intrinsic and extrinsic muscles of the ipsilateral tongue
  • Test for muscle bulk, tone and power
  • Ask the patients to protrude tongue, then elevate

Hypoglossal Damage

  • Lesion results in atrophy, and a deviating, wrinkling tongue towards the lesion

CN V divides into 3 branches

More Notes

  • CN V: Trigeminal nerve, is divided into Opthalmic, Maxillary (both sensory) and Mandibular (both sensory and motor) branch

  • CN V is a mixed nerve providing touch sensation through the face, cornea, anterior (2/3) tongue, and eardrum from the joint

  • CN V muscles of action: Temporalis, Masseter, medial and lateral pyterigoid muscles

  • Tests: Sensitivity of skin, muscle and ability to differentiate the ability of touch. Corneal and jaw jerk reflex

CN VII, Facial Nerve: Mixed

  • Five terminal Branches: Temporal, Zygomatic, Buccal, Mandibular, Cervical
  • Sensory tastes, palate and anterior 2/3 of tongue
  • Autonomic: submandibular and lacrimal gland.
  • Autonomic muscle in the middle ear
  • A corneal reflex test: loop is tested between CN V and CN VII; the eyes can be manual forced to open

Bell's Palsy

A Paresis/paralysis with stress, viral infection immune disorder. It affects the nerve and temporal nerve Men and equal effects happen. To rehab: use steroid, physiotherapy, acupuncture

Ramsay Syndrome

  • A long term issue that cause the same virus.
  • Virus lives in facial nerves causing a paralysis.
  • It happens in the affected ear so it might lead to a hearing loss.

Types of Brain Damage

  • Lower motor The cell would lose control facial expression.
  • Motor Tract
  • Prevent the from left cortex cannot extend of smile, since the face innerverated bilaterally only lower face gets effected

Glossopharyngeal nerve (CN IX): Mixed

Involves 4 nuclei. Including Stylopharyngeus. Involves middle ear and gland, or nucleus

Nerves in the Face

Mucosa in the ear: pharygneal from touchn, tongue etc. Autonomic afferent: cardoid sinus Pararsympathetic: Oric ganglian and parotid gland Motor

Common Damage

Difficulty; is swallowing

Vagus Nerve X

Involves: General afferent : touch pain Speical Sensory tatse, pain, presurre

Can lead damage in the face and difficultly in breathing.

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