Cranial Nerves Powerpoint PDF

Cranial Nerve Examination Original Presentation by: Presented and Dhinu Jayaseelan, PT, adapted by: DPT, OCS, FAAOMPT and Erica Hwang, PT, Joe Signorino, PT, DPT, OCS, FAAOMPT DPT, NCS ...

Cranial Nerve Examination Original Presentation by: Presented and Dhinu Jayaseelan, PT, adapted by: DPT, OCS, FAAOMPT and Erica Hwang, PT, Joe Signorino, PT, DPT, OCS, FAAOMPT DPT, NCS  Objectives Review basic anatomy and the function(s) of each of the 12 cranial nerves Be able to recognize possible signs/symptoms associated with cranial nerve dysfunction Understand appropriate and effective examination techniques to make the diagnosis of cranial nerve dysfunction more likely Be prepared to discuss and apply information in a lab setting  Cranial nerves 12 pairs of nerves that originate from the cerebrum and brainstem and principally provide innervation to head and neck structures. They are functionally organized into distinct nuclei These nerves are also numbered, and can be called by their full name, or just their associated number- typically expressed as a roman numeral. Generally do not decussate– ipsilateral innervation http://teachmeanatomy.info/head/cranial-nerves/summary/ The 12 Cranial Nerves Nerve Function I Olfactory Special sensory II Optic Special sensory III Occulomotor Motor IV Trochlear Motor V Trigeminal Mixed (Both) VI Abducens Motor VII Facial Mixed (Both) VIII Vestibulocochlear Special Sensory IX Glossopharyngeal Mixed (Both) X Vagus Mixed (Both) XI Spinal Accessory Motor XII Hypoglossal Motor Where CNs Cerebrum Originate Brain Stem (Midbrain) (Pons) (Medulla) https://www.lecturio.com/concepts/brain-stem/  Patient Testing Seated (most common, clinically applicable) or Supine with head sustained in rotation – with some testing modifications in order to complete testing Repeat with head rotated in opposite direction Biases for any presence of cervical artery disorder (CAD) https://www.kaltura.com/index.php/extwidget/ preview/partner_id/816122/uiconf_id/44640261/ entry_id/0_w5cntxy8/embed/dynamic?  I. Olfactory (Special Sensory) Function: Transmits afferent signals for sense of smell S/S of Dysfunction: Anosmia, hyposmia, hyperosmia, parosmia (altered smell), cacosmia (awareness of unpleasant odors that do not actually exist) Examination: Pt closes eyes and identifies smell with each nostril http://www.sciencemag.org/sites/default/files/styles/article_main_large/public/ images/cc_nose_16x9.jpg?itok=WXj7iPir  II. Optic (Special Sensory)  Function: ◦ Carry afferent impulses for vision S/S of Dysfunction: Impaired vision (blurring to blindness), field cuts, loss of pupillary constriction Examination: (Each eye individually) Snellen eye chart – Visual Acuity Confrontation – Visual Fields Pupillary light reflex (Afferent Portion of reflex only, Efferent via CN III) http://media.istockphoto.com/photos/eyeball-close-up-picture-id181100798? k=6&m=181100798&s=612x612&w=0&h=3N3z8OMv7b0A8QlyUkpk2EZq9N WmAp3zxhluQnNKjig= https://myneurosurg.com/cranial-anatomy/cranial-nerve-2-optic-nerve/  III. Oculomotor* (Motor Only) Function: Raises the eyelid, eye movement (1 of 3 different cranial nerves), constricts the iris, controls lens shape S/S of Dysfunction: Will rest in an inferior/lateral deviation of the eye, ptosis of the eyelid (drooping), dilation of the ipsilateral pupil (with complete palsy) https://www.eye.com.ph/cranial-nerve-palsy/ Examination: Pupillary light reflex (Efferent portion), extraoccular eye movements, accommodation (convergence)  IV. Trochlear* (Motor) Function: Main function– Motor function to the Superior Oblique muscle which functions to depress an adducted eye S/S of Dysfunction: Diplopia (especially with looking downward as in reading or going down stairs), lateral deviation of eye Head will tilt away from affected side Examination: https://www.tedmontgomery.com/the_eye/eom.html Extraoccular eye movements  V. Trigeminal (Mixed) V1: Function: Opthalmic Carries Sensory impulses from the face Supplies Motor fibers for mastication V2: S/S of Dysfunction: Maxillary Corneal drying, Facial anesthesia and/or pain, weakness/loss of mastication Examination: V3: Corneal reflex(afferent), facial sensation Mandibular (sharp/dull discrimination and light touch), palpation of temporalis and masseter while pt clenches teeth, jaw jerk reflex  VI. Abducens* (Motor) Function: Eye movement (abduction via lateral rectus) S/S of Dysfunction: Complete injury: affected eye rests medially (strabismus) Incomplete injury: affected eye appears in midline at rest, but patient cannot deviate the eye laterally Examination: Extraoccular eye movements https://my.clevelandclinic.org/health/diseases/sixth-nerve  “H” Test SR: Superior Rectus IR: Inferior Rectus SO4, LR6, AR3 MR: Medial Rectus LR: Lateral Rectus (6) *CN III, IV, and VI control eye SO: Superior Oblique movement (4) IO: Internal Oblique  VII. Facial (Mixed) Function: Motor Muscles of Facial expression, taste to the anterior 2/3 of the tongue (sensory), autonomic impulses to the lacrimal and salivary glands, closes eyelids S/S of Dysfunction: Paralysis/weakness of facial expression, loss of taste, inability to close eyelid Examination: Voluntary facial movements (frowning, smiling, wrinkling forehead, puffing cheeks, whistling), taste to anterior 2/3 of tongue, resist closed eyelids (ie attempt to open), corneal reflex (efferent)  VIII. Vestibulocochlear (Special Sensory) Function: Hearing (cochlear portion), balance (vestibular portion) S/S of Dysfunction: Vertigo, tinnitus, hearing loss, deafness, nystagmus, balance impairment Examination: https://www.physio-pedia.com/ Weber’s test (Lateralization with tuning fork), Rinne The_Vestibulocochlear_Nerve_%28CN_VIII%29 test, Rub test, Romberg  IX. Glossopharyngeal (Mixed) Function: A) Parasympathetic innervation to pharynx, larynx, and viscera of thorax and abdomen; B) Supplies the stylopharyngeus muscle; C) taste to the posterior 1/3 of the tongue D) general sensation to the skin of external ear, internal surface of tympanic membrane, and upper pharynx; E) visceral sensory from the carotid sinus & body; S/S of Dysfunction: Loss of taste (posterior 1/3 of tongue), dysphagia, loss of gag reflex Examination (tested with CN X): Phonation- ask for hoarseness in voice, gag reflex (sensory), taste to posteriorThis 1/3,Photo by Unknown Author is licensed under CC BY-SA have patient say “ah”  X. Vagus (Mixed) Function: Visceral sensory: regulates depth of respirations, controls BP, responsible for cough & vomiting reflex Parasympathetic: decrease HR and stimulate GI function Motor: supplies muscles of swallowing, soft palate, uvula, larynx S/S of Dysfunction: Dysphagia (difficulty swallowing), hoarseness of voice, loss of cough reflex (larynx/pharynx), loss of taste (hard palate) Examination (tested with CN IX): Phonation, swallowing, have pt say ‘ah’, gag reflex (motor) https://www.scienceabc.com/humans/what-is- the-uvula-and-what-does-it-do.html XI. Spinal Accessory (Motor) Function: Provides motor innervation to trapezius and SCM S/S of Dysfunction: Weakness noted with scapular elevation (trapezius) or head rotation (SCM), atrophy of innervated muscles Examination: Shoulder shrug, rotation of head to opposite side (with or without resistance)  XII. Hypoglossal (Motor) Function: Supplies the intrinsic muscles of the tongue and most of the extrinsic muscles S/S of Dysfunction: Dysarthria, difficulty swallowing, weakness of ipsilateral side, protrusion of the tongue to side of the lesion, eventual atrophy of affected muscles Examination: Listen to articulation, inspect tongue for wasting/ fasciculations, tongue protrusion Tongue will deviate TOWARDS side of lesion  The 12 Cranial Nerves Nerve Function Mnemonic 1 Mnemonic 2 I Olfactory Special sensory On Ooh II Optic Special sensory Old Ooh III Occulomotor Motor Olympus’s Ooh IV Trochlear Motor Towering To V Trigeminal Mixed (Both) Top Touch VI Abducens Motor A And VII Facial Mixed (Both) Finn Feel VIII Vestibulocochlear Special Sensory And Very IX Glossopharyngeal Mixed (Both) German Good X Vagus Mixed (Both) Vaulted Velvet XI Spinal Accessory Motor And Ah XII Hypoglossal Motor Hopped Heaven  Sensory Only CNs Nerve Function Mnemonic (nerve) I Olfactory Special sensory On II Optic Special sensory Old III Occulomotor Motor Olympus IV Trochlear Motor Towering V Trigeminal Mixed (Both) Top VI Abducens Motor A VII Facial Mixed (Both) Fin VIII Vestibulocochlear Special Sensory And IX Glossopharyngeal Mixed (Both) German X Vagus Mixed (Both) Vaulted XI Spinal Accessory Motor And XII Hypoglossal Motor Hopped CNs that control Motions of the Eye Nerve Function Mnemonic (nerve) I Olfactory Special sensory On II Optic Special sensory Old III Occulomotor Motor Olympus IV Trochlear Motor Towering SO4, LR6, V Trigeminal Mixed (Both) Top AR3 VI Abducens Motor A VII Facial Mixed (Both) Fin VIII Vestibulocochlear Special Sensory And IX Glossopharyngeal Mixed (Both) German X Vagus Mixed (Both) Vaulted XI Spinal Accessory Motor And XII Hypoglossal Motor Hopped https://quizlet.com/295545075/wk-7- cranial-nerves-oh-oh-oh-to-touch-and- feel-very-good-veggies-ahh-heaven-flash- cards/ It’s Time to practice