questions 9

Cranial Nerves

Topic updated on 11/01/17 8:33am

Overview

Cranial nerves illustration

Illustration by Ava Yap

 
Snapshot
  • A 35-year-old woman presents to the emergency department with left eye vision loss and headache. She was in her usual state of health until 3 hours prior to presentation, when she developed vision loss and eye pain that worsened with eye movement. She reports that approximately 8 months ago she had left arm numbness that self resolved. On physical exam, her visual acuity is 20/185, and a sluggish response to light on the left eye with the swinging flash-light test is noted. (Optic neuritis likely secondary to multiple sclerosis.)
Introduction
 
Cranial Nerves
Cranial Nerve Type Function Cranial Exit
Notes
  • Olfactory nerve (I)
  • Sensory
  • Olfaction
  • Cribiform plate
  • Only CN without thalamic relay to the cortex                        
  • Optic nerve (II)
  • Sensory
  • Vision
  • Optic canal
-
  • Oculomotor nerve (III)
  • Motor
  • Eye movement via the
    • superior, inferior, and medial rectus
    • inferior oblique muscle
  • Pupillary constriction
  • Accomodation
  • Eyelid opening via innervation of the
    • levator palpebrae muscle
  • Superior orbital fissue
  • Center contains output to ocular muscles which is affected primarily 1st by vascular disease
  • Periphery contains parasympathetic output which is affected 1st by compression
  • Trochlear nerve (IV)
  • Motor
  • Eye movement via innervation of the
    • superior oblique muscle
  • Superior orbital fissue
-
  • Trigeminal nerve (V)
  • Motor and sensory
  • Mastication via the mandibular nerve (V3)
  • Facial sensation via the
    • ophthalmic nerve (V1)
    • maxillary nerve (V2)
    • mandibular (V3)
  • Ophthalmic nerve (V1)
    • superior orbital fissure
  • Maxillary nerve (V2)
    • foramen rotundum 
  • Mandibular nerve (V3)
    • foramen ovale
-
  • Abducens nerve (VI)
  • Motor
  • Eye movement via innervation of the
    • lateral rectus
  • Superior orbital fissure
-
  • Facial nerve (VII)
  • Motor and sensory
  • Facial movement
  • Taste from the anterior 2/3 of tongue
  • Lacrimation
  • Salivation via innervation of the
    • submandibular gland
    • sublingual gland
  • Eyelid closing via innervation of the 
    • orbicularis oculi muscle
  • Stapedius 
    • dampens excessive sound
  • Internal auditory meatus
  • Visceral sensation recieved by nucleus solitarius
  • Vestibulocochlear nerve (VIII)
  • Sensory
  • Hearing
  • Balance
  • Internal auditory meatus
-
  • Glossopharyngeal nerve (IX)
  • Motor and sensory
  • Taste from posterior 1/3 of tongue
  • Swallowing
  • Salivation 
    • parotid gland
  • Monitoring carotid body and sinus chemo- and baroreceptors
  • Stylopharngeus
    • elevates pharynx and larynx
  • Jugular foramen
  • Motor output orginates in nucleus ambiguus
  • Visceral sensation recieved by nucleus solitarius
  • Vagus nerve (X)
  • Motor and sensory
  • Taste from epiglottic region
  • Swallowing
  • Palate elevation
  • Midline uvula
  • Talking
  • Coughing
  • Thoracoabdominal viscera
  • Monitoring aortic arch chemo- and baroreceptors
  • Stimulation of auricular branch can cause vasovagal syncope
  • Jugular foramen
  • Motor output orginates in nucleus ambiguus
  • Visceral sensation recieved by nucleus solitarius
  • Parasympathetic fibers to heart, lungs, and upper GI orginates from dorsal motor nucleus
  • Gives recurrent laryngeal nerve which innervates all laryngeal muscles except cricothyroid
  • Accessory nerve (XI)
  • Motor
  • Head turning and shoulder shrugging
    • sternocleidomastoid muscle
    • trapezius
  • Jugular foramen
  • Motor output orginates in nucleus ambiguus
  • Hypoglossal nerve (XII)
  • Motor
  • Tongue movement
  • Hypoglossal canal
-
 


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Qbank (4 Questions)

TAG
(M1.NE.26) Where does the only cranial nerve without a thalamic relay nucleus enter the skull? Topic Review Topic

1. Foramen rotundum
2. Jugular foramen
3. Internal auditory meatus
4. Superior orbital fissure
5. Cribriform plate

PREFERRED RESPONSE ▶
TAG
(M1.NE.40) A 45-year-old man is brought to the emergency department after being found down in the middle of the street. Bystanders reported to the police that they had seen the man as he exited a local bar, where he was subsequently assaulted. He sustained severe facial trauma, including multiple lacerations and facial bone fractures. The man is taken to the operating room by the ENT team, who attempted to reconstruct his facial bones with multiple plates and screws. Several days later, he complains of the inability to open his mouth wide or to completely chew his food, both of which he seemed able to do prior to the surgery. Where does the affected nerve exit the skull? Topic Review Topic

1. Foramen ovale
2. Foramen rotundum
3. Superior orbital fissue
4. Jugular foramen
5. Inferior orbital fissue

PREFERRED RESPONSE ▶
TAG
(M1.NE.41) A 45-year-old man is brought to the emergency department after being found down in the middle of the street. Bystanders reported to the police that they had seen the man as he exited a local bar, and he was subsequently assaulted. He sustained severe facial trauma, including multiple lacerations and facial bone fractures. The man is taken to the operating room by the ENT team, who attempt to reconstruct his facial bones with multiple plates and screws. Several days later, he complains of the inability to open his mouth wide or to completely chew his food, both of which he seemed able to do prior to surgery. Which of the following is a characteristic of the injured nerve branch? Topic Review Topic

1. Sensory component only
2. Voluntary motor component only
3. Voluntary motor and sensory components
4. Parasympathetic component only
5. Sympathetic component only

PREFERRED RESPONSE ▶
TAG
(M1.NE.4756) A 4-year-old male is accompanied by his mother to a head and neck surgeon for a follow-up visit after the patient underwent a branchial cyst operation. The child’s immediate post-operative period was uneventful. However, the mother reports that the child has had trouble speaking since the operation. His words appear more slurred than before. The child’s pain has been well controlled with acetaminophen. The child was born at 34 weeks’ gestation and stayed one day in the neonatal intensive care unit for prematurity prior to being discharged without any abnormal findings. On examination, the incision is clean, dry, non-erythematous, and shows signs of healing. The child is asked to stick out his tongue and findings are shown in Figure A. Which of the following muscles is most likely affected in this patient? Topic Review Topic
FIGURES: A          

1. Mylohyoid
2. Palatoglossus
3. Styloglossus
4. Stylohyoid
5. Stylopharyngeus

PREFERRED RESPONSE ▶
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