Cranial Nerves Overview

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Questions and Answers

Damage to the cribriform plate of the ethmoid bone would most directly affect which cranial nerve?

  • Trigeminal Nerve (CN V)
  • Oculomotor Nerve (CN III)
  • Olfactory Nerve (CN I) (correct)
  • Facial Nerve (CN VII)
  • Optic Nerve (CN II)

Which cranial nerve is primarily responsible for conveying sensory information related to smell?

  • CN V
  • CN I (correct)
  • CN II
  • CN III
  • CN VIII

A patient presents with anosmia following a head injury. Which cranial nerve is most likely affected?

  • Olfactory nerve (correct)
  • Vestibulocochlear nerve
  • Optic nerve
  • Trigeminal nerve
  • Facial nerve

Which cranial nerve passes through the optic canal?

<p>Optic Nerve (CN II) (D)</p> Signup and view all the answers

Which of the following sets of cranial nerves pass through the superior orbital fissure?

<p>CN III, CN IV, CN VI and V1 (A)</p> Signup and view all the answers

The Foramen Rotundum is the exit point for which cranial nerve branch?

<p>Maxillary branch of Trigeminal (V2) (B)</p> Signup and view all the answers

Through which foramen does the Mandibular branch of the Trigeminal nerve (V3) pass?

<p>Foramen Ovale (E)</p> Signup and view all the answers

Which cranial nerves pass through the internal acoustic meatus?

<p>CN VII and CN VIII (D)</p> Signup and view all the answers

The Jugular Foramen is a significant opening for which group of cranial nerves?

<p>CN IX, CN X, CN XI (E)</p> Signup and view all the answers

Which cranial nerve exits the cranium via the hypoglossal canal?

<p>Hypoglossal Nerve (CN XII) (C)</p> Signup and view all the answers

Which of the following cranial nerves is classified as purely sensory?

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

Which of the following cranial nerves is NOT primarily involved in motor function?

<p>Vestibulocochlear nerve (CN VIII) (E)</p> Signup and view all the answers

Which group of cranial nerves contains parasympathetic components?

<p>CN III, VII, IX, X (B)</p> Signup and view all the answers

The Edinger-Westphal nucleus is associated with which cranial nerve and function?

<p>CN III; pupillary constriction (D)</p> Signup and view all the answers

Which cranial nerve nucleus is located in the pons and is responsible for motor function of facial expression?

<p>Facial Motor Nucleus (E)</p> Signup and view all the answers

The Dorsal Vagal Nucleus is associated with which cranial nerve and what broad function?

<p>CN X; parasympathetic control (A)</p> Signup and view all the answers

Damage to the olfactory bulb would directly impair:

<p>Smell (A)</p> Signup and view all the answers

The olfactory pathway is unique because it directly projects to the olfactory cortex without synapsing in the:

<p>Thalamus (D)</p> Signup and view all the answers

What is the approximate temporal extent of the monocular visual field?

<p>100 degrees (E)</p> Signup and view all the answers

Central (macular) vision is primarily used for activities such as:

<p>Reading and recognizing faces (E)</p> Signup and view all the answers

Binocular vision enhances which of the following visual capabilities most significantly?

<p>Depth perception (D)</p> Signup and view all the answers

In the visual pathway, fibers from the nasal retina of the left eye project to the:

<p>Right lateral geniculate nucleus (D)</p> Signup and view all the answers

A lesion in the optic chiasm would most likely result in which visual field defect?

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

Meyer's loop, a part of the optic radiation, primarily carries information from which part of the visual field?

<p>Inferior visual field (A)</p> Signup and view all the answers

During a confrontation test for the left eye, the patient covers their right eye, and the examiner covers their left eye. What is the purpose of this setup?

<p>To isolate the visual field of the left eye (B)</p> Signup and view all the answers

Snellen's chart is used to assess:

<p>Visual acuity (B)</p> Signup and view all the answers

Cranial nerves III, IV, and VI are primarily responsible for:

<p>Eye movements (B)</p> Signup and view all the answers

Which extraocular muscle does NOT originate from the common tendinous ring?

<p>Inferior Oblique (B)</p> Signup and view all the answers

The medial rectus muscle is primarily responsible for which eye movement?

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

To best test the Superior Rectus muscle, in which position should the eye be placed?

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

Which axis is primarily associated with the movement of elevation and depression of the eye?

<p>Horizontal Axis (D)</p> Signup and view all the answers

The superior oblique muscle primarily performs which movement of the eye?

<p>Depression (E)</p> Signup and view all the answers

To optimally test the Superior Oblique muscle, the eye should be in which position?

<p>Adducted (D)</p> Signup and view all the answers

The mnemonic LR6(SO4)3 indicates that the Lateral Rectus muscle is innervated by CN VI and the Superior Oblique by CN IV. Which cranial nerve innervates all other extraocular muscles?

<p>CN III (E)</p> Signup and view all the answers

Levator palpebrae superioris (LPS) is primarily innervated by which cranial nerve?

<p>CN III (C)</p> Signup and view all the answers

The parasympathetic component of the oculomotor nerve (CN III) controls which intraocular muscles?

<p>Ciliary muscle and sphincter pupillae (E)</p> Signup and view all the answers

Sympathetic innervation to the pupillary dilator muscle originates from which spinal cord level?

<p>T1 (B)</p> Signup and view all the answers

Complete CN III palsy typically results in 'down and out' eye position. This is primarily due to the unopposed action of which muscles?

<p>Lateral rectus and superior oblique (C)</p> Signup and view all the answers

In a patient with diabetic neuropathy affecting CN III, pupil sparing is observed. This suggests that:

<p>Parasympathetic fibers are more centrally located in CN III (C)</p> Signup and view all the answers

The trochlear nerve (CN IV) is unique because it:

<p>Decussates completely in the midbrain (C)</p> Signup and view all the answers

A patient presents with vertical diplopia that worsens when looking down and to the right. Which cranial nerve palsy is most likely?

<p>CN IV (C)</p> Signup and view all the answers

The abducens nerve (CN VI) innervates which extraocular muscle?

<p>Lateral Rectus (A)</p> Signup and view all the answers

Horizontal diplopia that worsens on looking to the affected side is characteristic of palsy of which cranial nerve?

<p>Abducens nerve (CN VI) (C)</p> Signup and view all the answers

In conjugate gaze, simultaneous contraction of the left lateral rectus and right medial rectus muscles would result in:

<p>Gaze to the right (A)</p> Signup and view all the answers

The parapontine reticular formation (PPRF) in the pons is crucial for controlling:

<p>Horizontal gaze (D)</p> Signup and view all the answers

Internuclear ophthalmoplegia (INO) is characterized by:

<p>Failure of adduction in one eye with nystagmus in the abducting eye (C)</p> Signup and view all the answers

Which cranial nerves are typically affected in cavernous sinus thrombosis?

<p>CN III, CN IV, CN VI, and V1 and V2 (A)</p> Signup and view all the answers

The afferent limb of the corneal reflex is mediated by which cranial nerve?

<p>Trigeminal Nerve (CN V) (E)</p> Signup and view all the answers

In the pupillary light reflex, the pretectal nucleus projects bilaterally to which nucleus?

<p>Edinger-Westphal Nucleus (B)</p> Signup and view all the answers

An efferent pupillary defect (like CN III palsy) would result in:

<p>Absence of direct and consensual light reflex in the ipsilateral eye (E)</p> Signup and view all the answers

A Relative Afferent Pupillary Defect (RAPD) indicates:

<p>Unilateral or asymmetric optic nerve or retinal disease (D)</p> Signup and view all the answers

During the swinging flashlight test, if the pupils dilate when light is moved from the left to the right eye, and then constrict normally when light is shone back into the left eye, this indicates RAPD in the:

<p>Right eye (A)</p> Signup and view all the answers

In accommodation-convergence reflex, the blurred image of a near object on the retina acts as the:

<p>Afferent signal/stimulus (E)</p> Signup and view all the answers

Which of the following is NOT a common cause of cranial nerve dysfunction?

<p>Hypothyroidism (D)</p> Signup and view all the answers

The olfactory nerve (CN I) passes through which bony structure to enter the cranium?

<p>Cribriform plate of ethmoid bone (C)</p> Signup and view all the answers

Which cranial nerve is classified as purely sensory based on its primary function?

<p>Vestibulocochlear nerve (CN VIII) (C)</p> Signup and view all the answers

Which of the following cranial nerves is responsible for motor innervation of the tongue?

<p>Hypoglossal nerve (CN XII) (C)</p> Signup and view all the answers

The superior orbital fissure serves as a passage for which group of cranial nerves?

<p>CN III, CN IV, V1, and CN VI (E)</p> Signup and view all the answers

The largest cranial nerve in terms of size is:

<p>Trigeminal nerve (CN V) (D)</p> Signup and view all the answers

Which cranial nerve exits the cranium through the hypoglossal canal?

<p>Hypoglossal nerve (CN XII) (A)</p> Signup and view all the answers

A patient presents with loss of taste sensation in the anterior two-thirds of the tongue. Which cranial nerve is most likely affected?

<p>Facial nerve (CN VII) (B)</p> Signup and view all the answers

The 'tendinous ring,' from which most extraocular muscles originate, is also known as the:

<p>Annulus of Zinn (C)</p> Signup and view all the answers

Movement of the eye towards the nose is termed:

<p>Adduction (E)</p> Signup and view all the answers

The primary action of the medial rectus muscle is:

<p>Adduction (A)</p> Signup and view all the answers

To optimally test the superior rectus muscle, the eye should be positioned in:

<p>Abduction (A)</p> Signup and view all the answers

The axis of eye movement primarily responsible for elevation and depression is the:

<p>Horizontal axis (D)</p> Signup and view all the answers

According to the LR6(SO4)3 mnemonic, which cranial nerve innervates the lateral rectus muscle?

<p>CN VI (C)</p> Signup and view all the answers

The levator palpebrae superioris (LPS) muscle, responsible for eyelid elevation, is primarily innervated by:

<p>Oculomotor nerve (CN III) (E)</p> Signup and view all the answers

In complete CN III palsy, the 'down and out' eye position is a result of the unopposed action of which muscles?

<p>Superior oblique and lateral rectus (E)</p> Signup and view all the answers

Pupil sparing in a CN III palsy, as seen in diabetic neuropathy, suggests that:

<p>Only somatic motor fibers are affected, sparing parasympathetic fibers (C)</p> Signup and view all the answers

The trochlear nerve (CN IV) is unique among cranial nerves because:

<p>It decussates in the brainstem and exits dorsally (E)</p> Signup and view all the answers

A patient presents with vertical diplopia that worsens when looking down and towards their nose (adduction). Which cranial nerve palsy is most likely?

<p>Trochlear nerve (CN IV) palsy (D)</p> Signup and view all the answers

Horizontal diplopia that increases when looking to the side of the affected eye is a hallmark sign of palsy of which cranial nerve?

<p>CN VI (D)</p> Signup and view all the answers

In conjugate gaze to the left, which muscles are simultaneously contracting?

<p>Left lateral rectus and right medial rectus (E)</p> Signup and view all the answers

The parapontine reticular formation (PPRF) in the pons is essential for controlling:

<p>Horizontal gaze (D)</p> Signup and view all the answers

Internuclear ophthalmoplegia (INO) is typically characterized by:

<p>Impaired adduction of the ipsilateral eye (C)</p> Signup and view all the answers

Which group of cranial nerves are most likely to be affected in cavernous sinus thrombosis?

<p>CN III, CN IV, V1, V2, CN VI (C)</p> Signup and view all the answers

In the pupillary light reflex pathway, the pretectal nucleus projects bilaterally to which nucleus?

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

An efferent pupillary defect, such as in CN III palsy, would result in:

<p>Pupillary dilation in the affected eye (A)</p> Signup and view all the answers

In the accommodation-convergence reflex, what acts as the stimulus for the reflex?

<p>Blurred image of a near object on the retina (D)</p> Signup and view all the answers

Which structure is responsible for the decussation of nasal retinal fibers in the visual pathway?

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

Meyer's loop, a part of the optic radiation, carries visual information primarily from which quadrant of the visual field?

<p>Inferior temporal quadrant (D)</p> Signup and view all the answers

Damage to the optic tract on the left side would result in which visual field defect?

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

Flashcards

Causes of CN Dysfunction?

Diabetic/hypertensive neuropathy, stroke, tumors, trauma, vasculitis, congenital issues.

Key Anatomy for Cranial Nerves?

Origin, pathway, and important relations of the cranial nerves.

List the Cranial Nerves

CN I: Olfactory, CN II: Optic, CN III: Oculomotor, CN IV: Trochlear, CN V: Trigeminal, CN VI: Abducens, CN VII: Facial, CN VIII: Vestibulocochlear, CN IX: Glossopharyngeal, CN X: Vagus, CN XI: Accessory, CN XII: Hypoglossal.

CN and Foramina?

CN I: Cribriform plate, CN II: Optic canal, CN III, IV, V(1), VI: Superior orbital fissure, CN V(2): Foramen rotundum, CN V(3): Foramen ovale, CN VII, VIII: Internal acoustic meatus, CN IX, X, XI: Jugular foramen, CN XII: Hypoglossal canal

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Functional Classification of CN?

Sensory (I, II, VIII), Motor (III, IV, VI, XI, XII), Mixed (V, VII, IX, X), Parasympathetic (III, VII, IX, X).

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Olfactory Pathway

Olfactory pwy (CN I) starts in olfactory neuroepithelium, passes through cribriform plate, synapses in olfactory bulb, goes to olfactory cortex.

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Visual Field

Area seen when eye focuses on one point; divided into four quadrants.

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Extent of Monocular Visual Field?

60° nasally, 100° temporally, 60° superiorly, 70° inferiorly.

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Binocular Vision

Combining R and L eye fields; enables depth perception and better perception.

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Visual Field Representation in Retina?

Registers left-right reversed, inverted. Temporal field to Nasal retina & vice versa. Superior field to Inferior retina and vice versa.

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Retina Visual Pathway

Photoreceptors (rods/cones) -> bipolar cells -> ganglion cells -> optic nerve.

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Visual Pathway Components?

Optic nerve -> Optic chiasm -> Optic tract -> Lateral geniculate nucleus -> Optic radiation -> Visual cortex

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Complete Oculomotor Palsy?

Complete ptosis, abduction, dilated pupil.

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Cranial Nerves of Eye Movement?

Motor cranial nerves (III, IV, VI) innervate extra ocular muscles.

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Innervation of Extra Ocular Muscles?

Lateral rectus (VI), Superior oblique (IV), all others (III).

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Levator palpebrae superioris (LPS)?

Elevates eyelid skeletal (CNIII), smooth (sympathetic T1)

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Iris vs. Ciliary MuscleFunction?

Alters pupillary diameter (CNIII). Changes lens curvature (sympathetic T1).

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Postganglionic Neurons?

To internal carotid; supply smooth muscle related to eye .

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Where does the trochlear nerve run?

Runs anteriorly on the lateral wall of the cavernous sinus.

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Trochhlear Nerve Palsy Symptom?

difficulty in reading due- letters, images separate.

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Abducens Palsy

Binocular horizontal diplopia that aggravates with side gaze.

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Voluntary conjugate?

Involuntary eye movements used to locate objects.

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Cavernous Sinus

CN 3,,4 trigeminal pass in lat wall

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reflex function

protects cornea fb touching.

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Study Notes

Why Study Cranial Nerves (CN)?

  • Cranial nerves can be impacted by various medical and surgical conditions.
  • Common causes of CN dysfunction include diabetic/hypertensive neuropathy, stroke, compressive lesions (tumors/aneurysms), trauma (fractures/lacerations), vasculitis, and congenital issues.
  • Knowledge of CN functions, anatomy (origin, pathway, important relations) is essential for diagnostic testing, interpreting neurological signs, and determining causes of dysfunctions.

Overview of Cranial Nerves

  • CN I is the Olfactory nerve, which goes through nerves via bones.
  • CN II is the Optic Nerve, know origin and exit points.
  • CN III is the Oculomotor Nerve, it is between cerebral peduncles.
  • CN IV is the Trochlear Nerve.
  • CN V is the Trigeminal Nerve, the largest nerve.
  • CN VI is the Abducens Nerve, tiny and at the midline.
  • CN VII is the Facial Nerve, lateral location.
  • CN VIII is the Vestibulocochlear Nerve, it is seen at the cerebellopontine angle points of 7 & 8.
  • CN XI is the Glossopharyngeal Nerve.
  • CN X is the Vagus Nerve, located in the medulla between the olive.
  • CN XI is the Accessory Nerve, medulla between the olive and the inferior cerebellar peduncle.
  • CN XII is the Hypoglossal Nerve, located between pyramid and olive.

Cranial Nerves and Their Foramina

  • CN I (Olfactory) passes through the cribriform plate of the ethmoid bone.
  • CN II (Optic) passes through the optic canal.
  • CN III (Oculomotor), CN IV (Trochlear), and CN V1 (Ophthalmic branch of Trigeminal) pass through the superior orbital fissure.
  • CN VI (Abducens) passes through the superior orbital fissure.
  • CN V2 (Maxillary branch of Trigeminal) passes through the foramen rotundum.
  • CN V3 (Mandibular branch of Trigeminal) passes through the foramen ovale.
  • CN VII (Facial) and CN VIII (Vestibulocochlear) pass through the internal acoustic meatus and stylomastoid foramen.
  • CN IX (Glossopharyngeal), CN X (Vagus), and CN XI (Accessory) pass through the jugular foramen.
  • CN XII (Hypoglossal) passes through the hypoglossal canal.

Cranial Nerves and Their Functions (Sensory, Motor, Parasympathetic)

  • CN I (Olfactory), CN II (Optic), and CN VIII (Vestibulocochlear) are sensory nerves.
  • CN III (Oculomotor), CN IV (Trochlear), CN VI (Abducens), CN XI (Accessory), and CN XII (Hypoglossal) are motor nerves.
  • Sensory and motor nerves of mixed function include CN V (Trigeminal), CN VII (Facial), CN IX (Glossopharyngeal), and CN X (Vagus).
  • Parasympathetic nerves include CN III (Oculomotor), CN VII (Facial), CN IX (Glossopharyngeal), and CN X (Vagus).

Olfactory Nerve (CN I) Pathway

  • Olfactory neuroepithelium in the nasal roof sends nerves pass through the cribriform plate of ethmoid
  • Then goes to the olfactory bulb, olfactory tract, and olfactory cortex.
  • Bilateral cortical representation is present.
  • Commonly use alcohol wipe/coffee for assessment.
  • Anosmia can come from damage to olfactory neurons (URTI, head injury) and basal frontal lobe tumours.

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