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Belavadi & Prashanth: Clinical Importance of Cranial Nerves

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Belavadi & Prashanth: Clinical Importance of Cranial Nerves Review Article International Ayurvedic Medical Journal ISSN:2320 5091 CLINICAL IMPORTANCE OF CRANIAL NERVES Belavadi S. N. Prashanth A. S. Dept. of Kayachikitsa, Ayurveda Mahavidyalaya Hubli, Karnataka, India ABSTRACT There are 12 pairs of Cranial nerves in the body having major importance in clinical practice among these Nerves some are Sensory, Some are Motor and some are both. It most important and necessary in every Neurological patient to examine these affected or involved nerves to find out its lesion and this helps to diagnose and plan the treatment in various neurological disorders. In this present article the clinical importance of tweleve pairs of cranial nerves, Location, Examination, Functions and Applied aspects of each Cranial nerve has been discussed. Keywords: Cranial Nerves, Motor function, Sensory, Facial nerve, Motor and Sensory Pathway INTRODUCTION motor neurons lie in nuclei within the Cranial- of or relating to the cranium brain.(3) which encloses the brain; Nerves - Any The 12 pairs of Cranial nerves supply bundle of nerve fibers running to various muscles of Eyeball, Face, Palate, Pharynx, organs and tissues of the body. Cranial Larynx, Tongue and two large muscles of Nerves: Means any of the 12 paired nerves Neck. Besides these are afferent loop to that originate in the Brain stem.(1) special senses like Smell, Sight, Hearing, The systemic examination of Cranial Taste and Touch.(4) nerve is an important part of the Cranial nerves are involved in head and examination of every neurological patient. It neck function, and processes such as eating, may reveal a lesion of a Cranial nerve speech and facial expression. These arise nucleus or its central connections, or it may from the brain as twelve pairs. They pass show an interruption of the lower motor through or into the cranial bones (thus neurons.(2) cranial nerves) and are numbered I to XII Cranial nerve like spinal nerve is a roughly in order from top (rostral) to bottom part of the peripheral nervous system. 12 (caudal). Their functions are those of the pairs of Cranial nerve 10 originate from the head, some are concerned with awareness brain stem but all passes through foramina of, and communication with, the of the skull. environment; and some are concerned with Some Cranial nerve contain only sensory sustenance, the gut tube and movements fibers and thus are called sensory and motor associated with it.(5) fibers and are referred to mixed nerves. The Meaning of 12 cranial nerves: With cell bodies of sensory neurons are found Mnemonic means Of or relating to or outside the brain, whereas the cell bodies of involved the practice of aiding the memory. Belavadi & Prashanth: Clinical Importance of Cranial Nerves Mnemonics- A method or system for Vestibulocochlear nerve (victory): improving the memory.(6) Vestibulum- vestibule, Kokhlos and snail Olfactory nerve (oh): Olfacere- to smell, Primirily Sensory. this is Sensory. Glossopharangeal (Give): Glossa- tongue, Optic nerve (oh): Optikos- Vision, Eye or Pharynx-Throat this is both Motor and Optics this is Sensory. Sensory. Occulomotor nerve (oh): Oculus-eye, Vagus nerve (value): Vagus- Vagrant or motor- mover, this both Motor and sensory. wondering both Motor and Sensory. Troclear nerve (try): Trokholear- pulley, Accessory nerve (and): Accessorius- this is both Motor and sensory. Primarily assisting this is both Motor and sensory. Motor. Primarily Motor. Abducent nerve (again): Ab- away, duces- Hypoglossal nerve (Happiness): Hypo- to lead both Motor and sensory. Primarily below, glossa-tongue. (7) Motor. Cranial Nerves: There are totally 12 pairs Trigeminal nerve (try):: Tri-three, of cranial nerves explained in all modern geminus-twin, trigeminus- three fold for its texts. branches this is both Motor and Sensory. Facial nerve (failure):: Facies- face this is both Motor and Sensory. Table 1: showing cranial nerve location, examination, functions and applied aspects (8), (9), (10) Name Location Examination Functions Applied Olfactory nerve Arises in olfactory mucosa -determine the nasal passages are For smell -unilateral anosmia passes olfactory foramina in clear. -bilateral anosmia the cribriorm plate of -apply some easily recognizable -complete anosmia ethomoid bones and ends in aromatic substance. Ex: oil of Allergic rhinitis cause olfactory bulb. peppermint, oil of cloves, temporary -ask the patient to identify the olfactoryimpairment smell. Optic nerve Arises in the retina of eye -ask the patient whether any Vision Fracture in the orbit, passes through optic foramen change in the eye sight. Visual lesion of vision pathway from optic chaisma acuity should be tested for near Disease cns may results & distant vision by snell`s type vision field loss of -visual fields should be tested by vision activity. closing right eye by looking into Damage- blindness, the examiners right eye. optic neuritis -examination of fundi- by opthalmoscope patient is asked to look distinct objects. - optic disc- creamy pink, retina- pinkish red, blood vessels - macula is examined by asking the patient look directly at the light of the opthalmoscope Oculomotor Motor portion- originates in - this supplies all the extra ocular Mototrfunction- The patient see double midebrain, passes through muscles except superior oblique movements of eyelid and vision(diplopia) orbital fissure and distributed and lateral rectus. eyeball occulomotor of Ptosis, to levator palpebrae superioris -in a complete lesion lense for near vision. Lteral squint of upper eyelid and extrinsic occulomotor nerve eye cannot be Sensoryfunction – eyeball muscle superior moved upward, downward or muscles strabismus patois inferior mideal rectus and inward. pupil dilatation, diplopic. mideal oblique. Sensory parts- consists of the fibers from proprioceptors in eyeball muscles passes through supernal orbital fissure and terminate in Belavadi & Prashanth: Clinical Importance of Cranial Nerves midebrain. Trochlear Motor portion- originate from Supplies superior oblique Motor function- Double vision, midbrain passes through muscles which rotates the eye movements of eye ball. cavernous sinus superior orbital fissure and downward and laterally. Sensory function- in thrombosis, aneurysm distributed to superior truckler nerve paralysis of the internal carotid oblique, muscle, an extinct diplopic and strabismus. artery. eyeball muscle . Sensory portion- consists of fibers of proprioceptors in superior oblique muscle that parts through superior orbital in mide brain. Fissure and terminate in midbrain. Trigeminal This has both motor & Supplies the lateral rectus Motor function-chewing Injury results paralysis sensory roots, passes through muscle which rotates the eye Sensory function- of muscles of trigeminal ganglion and laterally in this lesion patient Convey sensation of mastication and loss of emerge the opthalmc, cannot turn the eye laterally. touch pain temperature. sensation of touch. maxillary and mandbular. The sensory function may be tested by using cotton, a pin over each area of the face. Abducens Motor portion- originate in Motor function- With damage attached pons passes through superior, movements of eyeball eyeball cannot move. orbital fissure, distributed to Sensory function- muscle lateral rectus muscles sense Sensory portion- consists of fibers from proprioceptors in lateral rectus muscles pass through fissers, end inpons. Auditory/ Cochlear branch- arise in This nerve innervates the utricle Cochlear branches Injury causes vertigo, vestibulocochlear spinal organ from spinal and saccule which are sensitive function– convey ataxia, and nystagmus, nerve ganglion passes through the a to static changes in equilibrium. impulsesassociated with Deafness, tinnitus auditory meat’s and ends in hearing. thalamus. Vestibularbranches Vestibular branches- arise in function – semicircular canals succulent conveyimpulsesassociated utricle and forms end in pons with equilibrium. and cerebellum. Glossopharangeal Motor portion- originated in This supplies the Motor function Injury leads to difficulty medulla passes through stylopharyngeus muscle. Sensory Secretion of saliva in swallowing. jugular foramen and fibres innervate the posterior Sensoryfunction Reduced secretion of distributed to stylopharyngens 1/3rd of the tongue for general Taste, regulation of blood saliva, loss of sensation muscles sensation of taste. pressure and muscle. in the throat and loss of Sensory portion-aries from Isolated lesion of this nerve are taste. taste buds on posterior 1/3rd rare and usually involve the Glossopharangeal or tongue & from carotid vagus nerve. neuralgia sinus, passes through jugular foramen, ends in medulla. Contains fibers from somatic sensory receptors on posterior 1/3rd of tongue and proreceiptors in swallowing muscles supplied by motor portion. Vagus Motor portion- originated in -this innervates many important Motor function- Severing of both nerve medulla passes through organs but examination depends Smooth muscles in the upper body jugular foramen and upon testing the branches of contrition & relaxation interferes with terminates in muscles function of pharynx, soft palate, secretion of diagnosis swallowing paralyses, airways, lungs esophagus, and larynx. fluids. vocal cords and heart, stomach, small intestine -the pharyngeal or gag reflex Sensory function- interrupts sensation and gall bladder, may be tested by touching the sensation from visceral from many organs. parasympathetic innervate lateral wall of the pharynx with a organs supplies, muscle, involuntary muscle.
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