Podcast
Questions and Answers
Which of the following cranial nerves does NOT have its nucleus located in the midbrain?
Which of the following cranial nerves does NOT have its nucleus located in the midbrain?
- Oculomotor nerve
- Trochlear nerve
- Abducens nerve (correct)
- Edinger-Westphal nucleus
Damage to the nucleus ambiguus in the medulla would MOST likely affect which function?
Damage to the nucleus ambiguus in the medulla would MOST likely affect which function?
- Swallowing (correct)
- Eye movement
- Facial expression
- Hearing
Which of the following cranial nerve carries general somatic efferent (GSE) fibers?
Which of the following cranial nerve carries general somatic efferent (GSE) fibers?
- Vagus nerve (X)
- Oculomotor Nerve (III) (correct)
- Glossopharyngeal nerve (IX)
- Facial nerve (VII)
A patient presents with loss of taste sensation on the posterior one-third of their tongue. Which cranial nerve is MOST likely affected?
A patient presents with loss of taste sensation on the posterior one-third of their tongue. Which cranial nerve is MOST likely affected?
After a traumatic injury, a patient exhibits paralysis of the muscles of facial expression. Which cranial nerve has MOST likely been damaged?
After a traumatic injury, a patient exhibits paralysis of the muscles of facial expression. Which cranial nerve has MOST likely been damaged?
A lesion affecting the abducens nucleus would MOST directly impair:
A lesion affecting the abducens nucleus would MOST directly impair:
A patient has difficulty with balance and hearing. Which cranial nerve is MOST likely affected?
A patient has difficulty with balance and hearing. Which cranial nerve is MOST likely affected?
A patient presents with Vernet syndrome due to jugular foramen compression. Which combination of cranial nerve deficits would you expect to observe?
A patient presents with Vernet syndrome due to jugular foramen compression. Which combination of cranial nerve deficits would you expect to observe?
A patient presents with trigeminal neuralgia characterized by intense, episodic pain in the face. Which branch of the trigeminal nerve is LEAST likely to be involved in this condition?
A patient presents with trigeminal neuralgia characterized by intense, episodic pain in the face. Which branch of the trigeminal nerve is LEAST likely to be involved in this condition?
A vestibular schwannoma (acoustic neuroma) develops where which cranial nerve enters the auditory meatus?
A vestibular schwannoma (acoustic neuroma) develops where which cranial nerve enters the auditory meatus?
Which of the following cranial nerve exits the skull through the superior orbital fissure?
Which of the following cranial nerve exits the skull through the superior orbital fissure?
Through which cranial nerve does the brainstem communicate with muscles responsible for regulating auditory input?
Through which cranial nerve does the brainstem communicate with muscles responsible for regulating auditory input?
Which cranial nerve carries parasympathetic fibers that control the parotid gland?
Which cranial nerve carries parasympathetic fibers that control the parotid gland?
Which cranial nerve plays a major role in detecting chemo- and baro-receptors of the aortic arch?
Which cranial nerve plays a major role in detecting chemo- and baro-receptors of the aortic arch?
What is the role of the spinal accessory nerve?
What is the role of the spinal accessory nerve?
Which cranial nerve innervates both intrinsic and extrinsic muscles of the tongue?
Which cranial nerve innervates both intrinsic and extrinsic muscles of the tongue?
Which of the following represents the correct functional component of the hypoglossal nerve (XII)?
Which of the following represents the correct functional component of the hypoglossal nerve (XII)?
Where is the solitary nucleus located, and what type of information does it receive?
Where is the solitary nucleus located, and what type of information does it receive?
Which cranial nerve relays afferent information that results in the corneal reflex?
Which cranial nerve relays afferent information that results in the corneal reflex?
Which of the following combinations accurately describes the nerves that pass through the jugular foramen?
Which of the following combinations accurately describes the nerves that pass through the jugular foramen?
Which cranial nerve provides parasympathetic innervation to the ciliary muscle and pupillary sphincter?
Which cranial nerve provides parasympathetic innervation to the ciliary muscle and pupillary sphincter?
Which cranial nerve is responsible for innervating the superior oblique muscle of the eye?
Which cranial nerve is responsible for innervating the superior oblique muscle of the eye?
Which cranial nerve is MOST susceptible to compression by an acoustic neuroma, leading to initial symptoms of hearing loss and tinnitus?
Which cranial nerve is MOST susceptible to compression by an acoustic neuroma, leading to initial symptoms of hearing loss and tinnitus?
Which of the following cranial nerves is NOT involved in taste sensation?
Which of the following cranial nerves is NOT involved in taste sensation?
Following a stroke, a patient experiences weakness in the tongue, causing difficulty in speech and swallowing. Which cranial nerve is MOST likely affected?
Following a stroke, a patient experiences weakness in the tongue, causing difficulty in speech and swallowing. Which cranial nerve is MOST likely affected?
A lesion in the pons affects the superior salivatory nucleus. Which of the consequences would be MOST likely?
A lesion in the pons affects the superior salivatory nucleus. Which of the consequences would be MOST likely?
Which of the following is a common symptom associated with damage to the vestibulocochlear nerve?
Which of the following is a common symptom associated with damage to the vestibulocochlear nerve?
Which of the following cranial nerves provides innervation to the laryngeal muscles responsible for voice production?
Which of the following cranial nerves provides innervation to the laryngeal muscles responsible for voice production?
A patient is unable to protrude their tongue straight and deviates towards the right side. Which cranial nerve is likely to have been damaged?
A patient is unable to protrude their tongue straight and deviates towards the right side. Which cranial nerve is likely to have been damaged?
A patient loses the ability to shrug their left shoulder. Which cranial nerve is MOST likely affected?
A patient loses the ability to shrug their left shoulder. Which cranial nerve is MOST likely affected?
A patient is experiencing dry eyes and dry mouth. Damage to which cranial nerve is MOST likely the cause of these symptoms?
A patient is experiencing dry eyes and dry mouth. Damage to which cranial nerve is MOST likely the cause of these symptoms?
Which of the following cranial nerves is primarily responsible for transmitting somatosensory information from the face?
Which of the following cranial nerves is primarily responsible for transmitting somatosensory information from the face?
Damage to the trochlear nerve would MOST directly affect the function of which extraocular muscle?
Damage to the trochlear nerve would MOST directly affect the function of which extraocular muscle?
A patient is diagnosed with a lesion affecting the abducens nerve. Which of the following clinical signs would MOST likely be observed?
A patient is diagnosed with a lesion affecting the abducens nerve. Which of the following clinical signs would MOST likely be observed?
Which of the following CN mediates the motor component of the corneal reflex?
Which of the following CN mediates the motor component of the corneal reflex?
Which foramen does CN V3 pass.
Which foramen does CN V3 pass.
Which nerve is responsible for taste on the anterior 2/3 of the tongue.
Which nerve is responsible for taste on the anterior 2/3 of the tongue.
Flashcards
GSE - general somatic efferent
GSE - general somatic efferent
These nerves control skeletal muscles.
SVE - special visceral efferent
SVE - special visceral efferent
These nerves innervate muscles of branchial arch origin (involved in facial expression, chewing, swallowing).
GVE - general visceral efferent
GVE - general visceral efferent
These nerves control autonomic functions (e.g., glands, smooth muscle).
GSA - general somatic afferent
GSA - general somatic afferent
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GVA - general visceral afferent
GVA - general visceral afferent
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SVA - special visceral afferent
SVA - special visceral afferent
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SSA - special somatic afferent
SSA - special somatic afferent
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GSE Location
GSE Location
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SVE, GVE Location
SVE, GVE Location
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Edinger-Westphal & Oculomotor & Trochlear
Edinger-Westphal & Oculomotor & Trochlear
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Pons: Efferent Nuclei
Pons: Efferent Nuclei
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Medulla: Efferent Nuclei
Medulla: Efferent Nuclei
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Midbrain: Afferent Nuclei
Midbrain: Afferent Nuclei
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Pons: Afferent Nuclei
Pons: Afferent Nuclei
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Medulla: Afferent Nuclei
Medulla: Afferent Nuclei
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I
I
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II
II
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III
III
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IV
IV
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V
V
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VI
VI
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VII
VII
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VIII
VIII
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IX
IX
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X
X
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XI
XI
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XII
XII
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CN I exit point
CN I exit point
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CN II exit point
CN II exit point
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CN III, IV, V1, VI exit point
CN III, IV, V1, VI exit point
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CN V2 exit point
CN V2 exit point
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CN V3 exit point
CN V3 exit point
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CN VII, VIII exit point
CN VII, VIII exit point
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CN IX, X, XI exit point
CN IX, X, XI exit point
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CN XII exit point
CN XII exit point
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Vernet Syndrome
Vernet Syndrome
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CN III (oculomotor) innervations
CN III (oculomotor) innervations
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CN III (Edinger Westphal nucleus) innervates
CN III (Edinger Westphal nucleus) innervates
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CN IV (trochlear) innervates
CN IV (trochlear) innervates
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CN VI (abducens) innervates
CN VI (abducens) innervates
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Study Notes
- Cranial nerves and their nuclei, exit points, and innervations will be covered
- Brainstem nuclei are categorized as efferent and afferent
- Selected examples of CN dysfunction covered include Vernet syndrome of jugular foramen, trigeminal neuralgia, and vestibular schwannoma (acoustic neuroma)
- GSE means general somatic efferent
- SVE means special visceral efferent
- GVE means general visceral efferent
- GSA means general somatic afferent
- GVA means general visceral afferent
- SVA means special visceral afferent
- SSA means special somatic afferent
Brainstem Nuclei - Efferent
- Oculomotor, trochlear, abducens, hypoglossal, and accessory nuclei are featured
- Trigeminal motor, facial motor, and nucleus ambiguus nuclei are featured
- Edinger-Westphal, superior salivatory, inferior salivatory, and dorsal vagal motor nuclei are featured
- For efferent nuclei, GSE is medial, SVE and GVE are lateral
Brainstem Nuclei - Afferent
- Mesencephalic, principal sensory, spinal trigeminal (pars oralis, pars caudalis, substantia gelatinosa) nuclei are featured
- Solitary, vestibular, and cochlear nuclei are featured
- Solitary nucleus contains all of the GVA and SVA
- The trigeminal sensory system contains all of the GSA
Brainstem Locations of Efferent Nuclei
- Midbrain includes Edinger-Westphal nucleus, oculomotor nucleus, and trochlear nucleus (red nucleus)
- Pons includes trigeminal motor nucleus, facial motor nucleus, abducens nucleus, and superior salivatory nucleus
- Medulla includes inferior salivatory nucleus, nucleus ambiguous, hypoglossal nucleus, and dorsal vagal (and glossopharyngeal) nucleus
- Rostral spinal cord contains the accessory nucleus as well as medial, lateral, and intermediate motor columns
- For efferent nuclei, GSE is red, SVE is blue, and GVE is sky blue
Brainstem Locations of Afferent Nuclei
- Midbrain contains the mesencephalic nucleus
- Pons contains vestibular nucleus, spinal trigeminal nucleus, and principal trigeminal nucleus
- Medulla contains solitary nucleus, vestibular nucleus, cochlear nucleus, and spinal trigeminal nucleus
- Rostral Spinal Cord consists of solitary nucleus and spinal trigeminal nucleus
- For afferent nuclei, GSA is pink, GVA and SVA are green, and SSA is gray
Cranial Nerves
- I: Olfactory
- II: Optic
- III: Oculomotor
- IV: Trochlear
- V: Trigeminal
- VI: Abducens
- VII: Facial
- VIII: Vestibulocochlear
- IX: Glossopharyngeal
- X: Vagus
- XI: Spinal Accessory
- XII: Hypoglossal
Cranial Nerve Skull Exit Points
- CN I exits via the cribiform plate
- CN II exits via the optic canal
- CN III, IV, V1, and VI exit via the superior orbital fissure
- CN V2 exits via the foramen rotundum
- CN V3 exits via the foramen ovale
- CN VII and VIII exit via the internal auditory meatus
- CN IX and X exit via the jugular foramen
- CN XI exits via the foramen magnum/jugular
- CN XII exits via the hypoglossal foramen
Jugular Foramen Compression
- Vernet syndrome results from jugular foramen compression
- Loss of taste to the posterior 1/3 of the tongue (IX)
- Dysarthria and dysphagia (X)
- Ipsilateral flaccid paralysis of neck muscles ("look toward lesion", XI)
Cranial Nerves Innervation the Eye
- CN III (oculomotor nucleus) innervates the medial, inferior & superior rectus, inferior oblique and superior levator palpebrae
- CN III (Edinger Westphal nucleus) innervates the ciliary muscles and pupillary sphincter (iris)
- CN IV (trochlear) innervates the superior oblique
- CN VI (abducens) innervates the lateral rectus
- Lateral rectus and contralateral medial rectus work together
- Deficit results in internuclear ophthalmoplegia
- Details for this are in Module IV
CN V - Trigeminal Nerve
- Sensory fibers are analogous to those of DCML and ALS, for most of head region, with occiput of head by C2
- Somatosensory has three divisions from trigeminal ganglion: ophthalmic (V1), maxillary (V2), and mandibular (V3) branches
- Motor fibers innervate masseter, temporalis, and tensor tympani for auditory input regulation
- Trigeminal is for tensor tympani and seventh is for stapedius
- V2,3 leads to trigeminal neuralgia which is episodic pain (‘tic douloureaux’) and ipsilateral loss of sensation followed by loss of afferent corneal reflex (V1)
CN VII - Facial Nerve
- Motor innervation includes 5 branches that supply muscles of facial expression
- Also controls corneal reflex and stapedius muscle (regulation of auditory input)
- Parasympathetic control of lacrimal glands, sublingual, and submandibular glands
- Minor somatosensory component and visceral taste, involving the anterior 2/3 of the tongue
- Solitary nucleus contains all of the VA
CN VIII
- Vestibular, is for semi-circular canals (balance)
- Auditory, Cochlea (hearing)
- SSA
- Covered in Module III on auditory and vestibular systems
CN IX - Glossopharyngeal Nerve
- Controls the stylopharyngeus muscle and parasympathetic control of parotid gland
- Solitary nucleus contains all of the VA
- Visceral contains taste to posterior 1/3 tongue and carotid chemo- and baro-receptors
- There is also a minor somatosensory component
CN X - Vagal Nerve
- Pharyngeal muscles for swallowing and laryngeal muscles for voice are innervated
- Major source of parasympathetic control of heart, lungs and GI tract
- Visceral component for taste of the epiglottis and pharynx, and chemo- baro-receptors of the aortic arch
- Solitary nucleus – all of VA
CN XI - Spinal Accessory Nerve
- Innervation of trapezius and sternocleidomastoid muscles
- Look towards the lesion for ipsilateral paralysis
CN XII- Hypoglossal Nerve
- Intrinsic and extrinsic tongue muscles
Cranial Nerve Nuclei
- Sections on following slides
- Midbrain, middle pons, caudal pons, lower pons
- Middle medulla, caudal medulla
Nuclei Locations
- Midbrain Level: Edinger-Westphal and oculomotor nuclei
- Pons Level: Principal sensory trigeminal and trigeminal motor nuclei
- Caudal Pons Level: Spinal trigeminal, abducens, facial, and vestibular nuclei
- Rostral Medulla: Spinal trigeminal, vestibular, cochlear, and solitary nucleus
- Middle Medulla Level: Spinal trigeminal, vestibular, vagal motor, solitary, nucleus ambiguous, and hypoglossal nuclei
- Caudal Medulla Level: Spinal trigeminal, solitary, nucleus ambiguous, vagal motor, and hypoglossal nuclei
Acoustic Neuroma
- Cerebellopontine angle vestibular schwannoma "acoustic neuroma" is the tumor of myelin sheath on CN VIII
- Compresses several CN nerves that develops where CN VIII enters auditory meatus
- Symptoms include tinnitus (ringing in ears) and balance problems
- Other symptoms include facial pain/sensory loss and ipsilateral ataxia
- Also causes contralateral hemiparesis and dysphagia with impaired gag reflect
- Lesions include CN VIII deficits, cerebellar tract and corticospinal tract issues, and CN IX and X deficits (Vernet's syndrome)
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