Cranial Nerves
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Cranial Nerves
Cranial Nerves (1,5,7,8,9,10,11 and 12) Slides not included 9th and 10th Cranial 11th and 12th Cranial 8th Cranial Nerve 5th and 7th Cranial 1st Cranial Nerve Nerves Nerves Nerves (3,7,11,12,13,21,23,24) - (10,16) (12,23) Slides included: (14 to 17) *Slides that are not included mostly are slides of summaries or pictures. Nouf Alabdulkarim. Med 435 Olfactory Nerve [The 1st Cranial Nerve] Special Sensory Olfactory pathway 1st order neuron Receptors Axons of 1st order Neurons Olfactory receptors are specialized, ciliated nerve cells The axons of these bipolar cells 12 -20 fibers form the that lie in the olfactory epithelium. true olfactory nerve fibers. Which passes through the cribriform plate of ethmoid → They join the olfactory bulb Preliminary processing of olfactory information It is within the olfactory bulb, which contains interneurones and large Mitral cells; axons from the latter leave the bulb to form the olfactory tract. nd 2 order neuron • It is formed by the Mitral cells of olfactory bulb. • The axons of these cells form the olfactory tract. • Each tract divides into 2 roots at the anterior perforated substance: Lateral root Medial root Carries olfactory fibers to end in cortex of the Uncus & • crosses midline through anterior commissure adjacent part of Hippocampal gyrus (center of smell). and joins the uncrossed lateral root of opposite side. • It connects olfactory centers of 2 cerebral hemispheres. • So each olfactory center receives smell sensation from both halves of nasal cavity. NB. Olfactory pathway is the only sensory pathway which reaches the cerebral cortex without passing through the Thalamus . -
Neuroanatomy Crash Course
Neuroanatomy Crash Course Jens Vikse ∙ Bendik Myhre ∙ Danielle Mellis Nilsson ∙ Karoline Hanevik Illustrated by: Peder Olai Skjeflo Holman Second edition October 2015 The autonomic nervous system ● Division of the autonomic nervous system …………....……………………………..………….…………... 2 ● Effects of parasympathetic and sympathetic stimulation…………………………...……...……………….. 2 ● Parasympathetic ganglia ……………………………………………………………...…………....………….. 4 Cranial nerves ● Cranial nerve reflexes ………………………………………………………………….…………..…………... 7 ● Olfactory nerve (CN I) ………………………………………………………………….…………..…………... 7 ● Optic nerve (CN II) ……………………………………………………………………..…………...………….. 7 ● Pupillary light reflex …………………………………………………………………….…………...………….. 7 ● Visual field defects ……………………………………………...................................…………..………….. 8 ● Eye dynamics …………………………………………………………………………...…………...………….. 8 ● Oculomotor nerve (CN III) ……………………………………………………………...…………..………….. 9 ● Trochlear nerve (CN IV) ………………………………………………………………..…………..………….. 9 ● Trigeminal nerve (CN V) ……………………………………………………................…………..………….. 9 ● Abducens nerve (CN VI) ………………………………………………………………..…………..………….. 9 ● Facial nerve (CN VII) …………………………………………………………………...…………..………….. 10 ● Vestibulocochlear nerve (CN VIII) …………………………………………………….…………...…………. 10 ● Glossopharyngeal nerve (CN IX) …………………………………………….……….…………...………….. 10 ● Vagus nerve (CN X) …………………………………………………………..………..…………...………….. 10 ● Accessory nerve (CN XI) ……………………………………………………...………..…………..………….. 11 ● Hypoglossal nerve (CN XII) …………………………………………………..………..…………...…………. -
Cranial Nerve Palsy
Cranial Nerve Palsy What is a cranial nerve? Cranial nerves are nerves that lead directly from the brain to parts of our head, face, and trunk. There are 12 pairs of cranial nerves and some are involved in special senses (sight, smell, hearing, taste, feeling) while others control muscles and glands. Which cranial nerves pertain to the eyes? The second cranial nerve is called the optic nerve. It sends visual information from the eye to the brain. The third cranial nerve is called the oculomotor nerve. It is involved with eye movement, eyelid movement, and the function of the pupil and lens inside the eye. The fourth cranial nerve is called the trochlear nerve and the sixth cranial nerve is called the abducens nerve. They each innervate an eye muscle involved in eye movement. The fifth cranial nerve is called the trigeminal nerve. It provides facial touch sensation (including sensation on the eye). What is a cranial nerve palsy? A palsy is a lack of function of a nerve. A cranial nerve palsy may cause a complete or partial weakness or paralysis of the areas served by the affected nerve. In the case of a cranial nerve that has multiple functions (such as the oculomotor nerve), it is possible for a palsy to affect all of the various functions or only some of the functions of that nerve. What are some causes of a cranial nerve palsy? A cranial nerve palsy can occur due to a variety of causes. It can be congenital (present at birth), traumatic, or due to blood vessel disease (hypertension, diabetes, strokes, aneurysms, etc). -
Questions on Human Anatomy
Standard Medical Text-books. ROBERTS’ PRACTICE OF MEDICINE. The Theory and Practice of Medicine. By Frederick T. Roberts, m.d. Third edi- tion. Octavo. Price, cloth, $6.00; leather, $7.00 Recommended at University of Pennsylvania. Long Island College Hospital, Yale and Harvard Colleges, Bishop’s College, Montreal; Uni- versity of Michigan, and over twenty other medical schools. MEIGS & PEPPER ON CHILDREN. A Practical Treatise on Diseases of Children. By J. Forsyth Meigs, m.d., and William Pepper, m.d. 7th edition. 8vo. Price, cloth, $6.00; leather, $7.00 Recommended at thirty-five of the principal medical colleges in the United States, including Bellevue Hospital, New York, University of Pennsylvania, and Long Island College Hospital. BIDDLE’S MATERIA MEDICA. Materia Medica, for the Use of Students and Physicians. By the late Prof. John B Biddle, m.d., Professor of Materia Medica in Jefferson Medical College, Phila- delphia. The Eighth edition. Octavo. Price, cloth, $4.00 Recommended in colleges in all parts of the UnitedStates. BYFORD ON WOMEN. The Diseases and Accidents Incident to Women. By Wm. H. Byford, m.d., Professor of Obstetrics and Diseases of Women and Children in the Chicago Medical College. Third edition, revised. 164 illus. Price, cloth, $5.00; leather, $6.00 “ Being particularly of use where questions of etiology and general treatment are concerned.”—American Journal of Obstetrics. CAZEAUX’S GREAT WORK ON OBSTETRICS. A practical Text-book on Midwifery. The most complete book now before the profession. Sixth edition, illus. Price, cloth, $6.00 ; leather, $7.00 Recommended at nearly fifty medical schools in the United States. -
Exä|Xã Tüà|Väx the Accessory Nerve Rezigalla AA*, EL Ghazaly A*, Ibrahim AA*, Hag Elltayeb MK*
exä|xã TÜà|vÄx The Accessory Nerve Rezigalla AA*, EL Ghazaly A*, Ibrahim AA*, Hag Elltayeb MK* The radical neck dissection (RND) in the management of head and neck cancers may be done in the expense of the spinal accessory nerve (SAN) 1. De-innervations of the muscles supplied by SAN and integrated in the movements of the shoulder joint, often result in shoulder dysfunction. Usually the result is shoulder syndrome which subsequently affects the quality of life1. The modified radical neck dissections (MRND) and selective neck dissection (SND) intend to minimize the dysfunction of the shoulder by preserving the SAN, especially in supra-hyoid neck dissection (Level I-III±IV) and lateral neck dissection (level II-IV)2, 3. This article aims to focus on the SAN to increase the awareness during MRND and SND. Keywords: Spinal accessory, Sternocleidomastoid, Trapezius, Cervical plexus. he accessory nerve is a motor nerve The Cranial Root: but it is considered as containing some The cranial root is the smaller, attached to the sensory fibres. It is formed in the post-olivary sulcus of the medulla oblongata T 8,10 posterior cranial fossa by the union of its (Fig.1) and arises forms the caudal pole of 4, 7, 9 cranial and spinal roots 4-8 (i.e. the internal the nucleus ambiguus (SVE) and possibly 11, 14 and external branches respectively9,10) but also of the dorsal vagal nucleus , although 11 these pass for a short distance only11. The both of them are connected . cranial root joins the vagus nerve and The nucleus ambiguus is the column of large considered as a part of the vagus nerve, being motor neurons that is deeply isolated in the branchial or special visceral efferent reticular formation of the medulla 11 nerve4,5,9,11. -
Structural Brain Abnormalities in Patients with Primary Open-Angle Glaucoma: a Study with 3T MR Imaging
Glaucoma Structural Brain Abnormalities in Patients with Primary Open-Angle Glaucoma: A Study with 3T MR Imaging Wei W. Chen,1–3 Ningli Wang,1,3 Suping Cai,3,4 Zhijia Fang,5 Man Yu,2 Qizhu Wu,5 Li Tang,2 Bo Guo,2 Yuliang Feng,2 Jost B. Jonas,6 Xiaoming Chen,2 Xuyang Liu,3,4 and Qiyong Gong5 PURPOSE. We examined changes of the central nervous system CONCLUSIONS. In patients with POAG, three-dimensional MRI in patients with advanced primary open-angle glaucoma revealed widespread abnormalities in the central nervous (POAG). system beyond the visual cortex. (Invest Ophthalmol Vis Sci. 2013;54:545–554) DOI:10.1167/iovs.12-9893 METHODS. The clinical observational study included 15 patients with bilateral advanced POAG and 15 healthy normal control subjects, matched for age and sex with the study group. Retinal rimary open angle glaucoma (POAG) has been defined nerve fiber layer (RNFL) thickness was measured by optical formerly by intraocular morphologic changes, such as coherence tomography (OCT). Using a 3-dimensional magne- P progressive retinal ganglion cell loss and defects in the retinal tization-prepared rapid gradient-echo sequence (3D–MP-RAGE) nerve fiber layer (RNFL), and by corresponding psychophysical of magnetic resonance imaging (MRI) and optimized voxel- abnormalities, such as visual field loss.1 Recent studies by based morphometry (VBM), we measured the cross-sectional various researchers, however, have suggested that the entire area of the optic nerve and optic chiasm, and the gray matter visual pathway may be involved in glaucoma.2–23 Findings from volume of the brain. -
Congenital Oculomotor Palsy: Associated Neurological and Ophthalmological Findings
CONGENITAL OCULOMOTOR PALSY: ASSOCIATED NEUROLOGICAL AND OPHTHALMOLOGICAL FINDINGS M. D. TSALOUMAS1 and H. E. WILLSHA W2 Birmingham SUMMARY In our group of patients we found a high incidence Congenital fourth and sixth nerve palsies are rarely of neurological abnormalities, in some cases asso associated with other evidence of neurological ahnor ciated with abnormal findings on CT scanning. mality, but there have been conflicting reports in the Aberrant regeneration, preferential fixation with literature on the associations of congenital third nerve the paretic eye, amblyopia of the non-involved eye palsy. In order to clarify the situation we report a series and asymmetric nystagmus have all been reported as 1 3 7 of 14 consecutive cases presenting to a paediatric associated ophthalmic findings. - , -9 However, we tertiary referral service over the last 12 years. In this describe for the first time a phenomenon of digital lid series of children, 5 had associated neurological elevation to allow fixation with the affected eye. Two abnormalities, lending support to the view that con children demonstrated this phenomenon and in each genital third nerve palsy is commonly a manifestation of case the accompanying neurological defect was widespread neurological damage. We also describe for profound. the first time a phenomenon of digital lid elevation to allow fixation with the affected eye. Two children demonstrated this phenomenon and in each case the PATIENTS AND METHODS accompanying neurological defect was profound. The Fourteen children (8 boys, 6 girls) with a diagnosis of frequency and severity of associated deficits is analysed, congenital oculomotor palsy presented to our paed and the mechanism of fixation with the affected eye is iatric tertiary referral centre over the 12 years from discussed. -
Cranial Nerves 1, 5, 7-12
Cranial Nerve I Olfactory Nerve Nerve fiber modality: Special sensory afferent Cranial Nerves 1, 5, 7-12 Function: Olfaction Remarkable features: – Peripheral processes act as sensory receptors (the other special sensory nerves have separate Warren L Felton III, MD receptors) Professor and Associate Chair of Clinical – Primary afferent neurons undergo continuous Activities, Department of Neurology replacement throughout life Associate Professor of Ophthalmology – Primary afferent neurons synapse with secondary neurons in the olfactory bulb without synapsing Chair, Division of Neuro-Ophthalmology first in the thalamus (as do all other sensory VCU School of Medicine neurons) – Pathways to cortical areas are entirely ipsilateral 1 2 Crania Nerve I Cranial Nerve I Clinical Testing Pathology Anosmia, hyposmia: loss of or impaired Frequently overlooked in neurologic olfaction examination – 1% of population, 50% of population >60 years Aromatic stimulus placed under each – Note: patients with bilateral anosmia often report nostril with the other nostril occluded, eg impaired taste (ageusia, hypogeusia), though coffee, cloves, or soap taste is normal when tested Note that noxious stimuli such as Dysosmia: disordered olfaction ammonia are not used due to concomitant – Parosmia: distorted olfaction stimulation of CN V – Olfactory hallucination: presence of perceived odor in the absence of odor Quantitative clinical tests are available: • Aura preceding complex partial seizures of eg, University of Pennsylvania Smell temporal lobe origin -
Surgical Outcomes of 156 Spinal Accessory Nerve Injuries Caused by Lymph Node Biopsy Procedures
SPINE CLINICAL ARTICLE J Neurosurg Spine 23:518–525, 2015 Surgical outcomes of 156 spinal accessory nerve injuries caused by lymph node biopsy procedures Sang Hyun Park, MD, PhD,1 Yoshua Esquenazi, MD,2 David G. Kline, MD,3 and Daniel H. Kim, MD2 1Department of Anesthesiology and Pain Medicine, Jeju National University Medical School, Jeju, Korea; 2Department of Neurosurgery, The University of Texas Health Science Center at Houston Medical School, Houston, Texas; and 3Department of Neurosurgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana OBJECT Iatrogenic injuries to the spinal accessory nerve (SAN) are not uncommon during lymph node biopsy of the posterior cervical triangle (PCT). In this study, the authors review the operative techniques and surgical outcomes of 156 surgical repairs of the SAN following iatrogenic injury during lymph node biopsy procedures. METHODs This retrospective study examines the authors’ clinical and surgical experience with 156 patients with SAN injury between 1980 and 2012. All patients suffered iatrogenic SAN injuries during lymph node biopsy, with the vast majority (154/156, 98.7%) occurring in Zone I of the PCT. Surgery was performed on the basis of anatomical and electro- physiological findings at the time of the operation. The mean follow-up period was 24 months (range 8–44 months). RESULTs Of the 123 patients who underwent graft or suture repair, 107 patients (87%) improved to Grade 3 functional- ity or higher using the Louisiana State University Health Science Center (LSUHSC) grading system. Neurolysis was performed in 29 patients (19%) when the nerve was found in continuity with recordable nerve action potential (NAP) across the lesion. -
Blepharoplasty
Blepharoplasty Bobby Tajudeen Brow position • medial brow as having its medial origin at the level of a vertical line drawn to the nasal alar-facial junction • lateral extent of the brow should reach a point on a line drawn from the nasal alar-facial junction through the lateral canthus of the eye • brow should arch superiorly, well above the supraorbital rim, with the highest point lying at the lateral limbus • Less arched in men • midpupillary line and the inferior brow border should be approximately 2.5 cm. The distance from the superior border of the brow to the anterior hairline should be 5 cm Eyelid aesthetics • The highest point of the upper eyelid is at the medial limbus, and the lowest point of the lower eyelid is at the lateral limbus. • Sharp canthal angles should exist, especially at the lateral canthus. • The upper eyelid orbicularis muscle should be smooth and flat, and the upper eyelid crease should be crisp. The upper lid crease should lie between 8 and 12 mm from the lid margin in the Caucasian patient. • The upper lid margin should cover 1 to 2 mm of the superior limbus, and the lower lid margin should lie at the inferior limbus or 1 mm below the inferior limbus • The lower eyelid should closely appose the globe without any drooping of the lid away from the globe (ectropion) or in toward the globe (entropion) Lid laxity and excess • A pinch test helps determine the degree of excess lid skin that is present. The snap test helps determine the degree of lower lid laxity and is useful in preoperative planning Evaluation • -
Facial Nerves Was Found in This Patient with a Unilateral Pure Motor Stroke Due to Ischaemia in the Pons
73272ournal ofNeurology, Neurosurgery, and Psychiatry 1995;58:732-734 SHORT REPORT J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.58.6.732 on 1 June 1995. Downloaded from Volitional type of facial palsy associated with pontine ischaemia Rudolf T6pper, Christoph Kosinski, Michael Mull Abstract nounced during voluntary contraction A dissociation between voluntary and whereas emotionally triggered contractions emotional facial innervation is described are preserved or at times even exaggerated on in a patient with a pure motor stroke due the paretic side.' In the emotional type of to a unilateral ischaemic pontine infarc- facial palsy the opposite phenomenon can be tion. Voluntary facial innervation of the seen: whereas voluntary triggered contrac- contralateral orbicularis oris muscle was tions are normal, there is facial impairment affected whereas emotionally induced during emotionally triggered movements. innervation of the same muscle was Automatic voluntary dissociation is not spared. This report provides evidence restricted to muscles supplied by the facial that fibres conveying voluntary and emo- nerve: in the bilateral anterior opercular syn- tional commands are still separated in drome automatic voluntary dissociation is Department of the pons. Whereas corticobulbar tracts also seen in masticatory muscles supplied by Neurology carry the information for voluntary facial the trigeminal nerve, in the tongue, and in R Topper innervation, efferents from the amygdala muscles involved in swallowing.2 Whereas the C Kosinski and the lateral hypothalamus are candi- volitional type of facial palsy is thought to be Department of Neuroradiology, dates for the somatomotor aspects of caused by a lesion in the motor cortex or in Technical University emotions. -
A Rare Case of Collett–Sicard Syndrome After Blunt Head Trauma
Case Report Dysphagia and Tongue Deviation: A Rare Case of Collett–Sicard Syndrome after Blunt Head Trauma Eric Tamrazian 1,2 and Bijal Mehta 1,2,* 1 Department of Neurology, David Geffen School of Medicine, Harbor-UCLA Medical Center, Torrance, CA 90502, USA; [email protected] 2 Los Angeles Biomedical Institute, Los Angeles, CA 90095, USA * Correspondence: [email protected] Received: 28 October 2019; Accepted: 14 November 2019; Published: 21 December 2020 Abstract: The jugular foramen and the hypoglossal canal are both apertures located at the base of the skull. Multiple lower cranial nerve palsies tend to occur with injuries to these structures. The pattern of injuries tend to correlate with the combination of nerves damaged. Case Report: A 28-year-old male was involved in an AVP injury while crossing the highway. Exam showed a GCS of 15 AAOx3, with dysphagia, tongue deviation to the right, uvula deviation to the left and a depressed palate. Initial imaging showed B/L frontal traumatic Sub-Arachnoid Hemorrhages (tSAH), Left Frontal Epidural Hematoma and a Basilar Skull Fracture. On second look by a trained Neuroradiologist c At 3 month follow up, patient’s tongue normalized to midline and his dysphagia resolved. Discussion: Collette-Sicard syndrome is a rare condition/syndrome characterized by unilateral palsy of CN: IX, X, XII. This condition has been rarely described as a consequence of blunt head trauma. In most cases, the condition is self-limiting with patients regaining most to all of their neurological functions within 6 months. Nerve traction injuries and soft tissue edema compressing the cranial nerves are the leading two hypothesis.