CHRISTINE GLASTONBURY UCSF NEURORADIOLOGY Lingual branches: Taste and Sensation posterior 1. Sensory & motor functions 1/3 tongue Tonsillar & Pharyngeal branches: Sensation 2. Anatomical landmarks Motor: Stylopharyngeus for swallowing Jacobsen Nerve: sensory to middle ear & 3. Imaging findings parasympathetic to parotid [via LSPN + ATN] Hering nerve: Parasympathetic to carotid sinus (baroreceptors) and carotid body (chemoreceptors) Motor: Pharynx and larynx muscles except SP & TVP; + palatoglossus. Sensory (Arnold nerve): External auditory canal, post fossa dura, larynx. Taste: epiglottis, soft palate, pharynx Visceral Sensory & Parasympathetic Motor CHEST and ABDOMEN: Heart [detects aortic BP, slows heart] Esophagus, Stomach, Gut to Splenic Flexure [increases peristalsis & secretions] Sensation of pharynx and middle ear. Sensation of pharynx and middle ear. Taste, Salivation, stylopharyngeus muscle. Taste, Salivation, stylopharyngeus muscle. Carotid body/sinus chemo & baroreceptors Carotid body/sinus chemo & baroreceptors Pharynx and larynx muscles except SP & TVP Pharynx and larynx muscles except SP & TVP Sensation: EAC, post fossa dura, larynx Sensation: EAC, post fossa dura, larynx Taste: epiglottis, soft palate, pharynx Taste: epiglottis, soft palate, pharynx CH/ABD: Increase peristalsis & secretions CH/ABD: Increase peristalsis & secretions MOTOR: MOTOR: All tongue muscles Sternomastoid – rotates head Intrinsic ‐ Longitudinal, transverse, vertical away Extrinsic ‐ Hyoglossus, Genioglossus and Cleidomastoid – tilts head Styloglossus down but not Palatoglossus [CN10] Trapezius –retracts head, elevates, rotates and retracts scapula INTRINSIC & EXTRINSIC MUSCLES EXCEPT ONE PALATOGLOSSSUS MUSCLE POST 1/3 TASTE & SENSATION ANT 2/3 TASTE ANT 2/3 SENSATION Parasympathetic Inferior salivary [9] Dorsal motor nucleus [10] Sensory Solitary nucleus [9,10] Spinal tract nucleus of CN5 Motor CN9‐11 COMPLEX & CN9‐11 SHARE JUG. CN9‐12 ALONG Ambiguus nucleus SHARED NUCLEI IN FORAMEN. CAROTID SHEATH TO Hypoglossal nucleus [12] THE MEDULLA. CN9‐12 ALL NERVES HYOID LEVEL. CN12 OWN NUCLEUS POST SKULL BASE CN10 TO ABDOMEN + spinal accessory nucleus [11] Dorsal CN10, CN9 CN9 Motor Vagal CN11 CN12 Inferior Olivary CN12 Hypoglossal PARS NERVOSA CN9 Inferior petrosal sinus PARS VASCULARIS CN10, CN11 Internal jugular vein HYPOGLOSSAL CANAL CN9‐11 SHARE JUG. CN12 FORAMEN. CN9‐12 ALL NERVES POST SKULL BASE 1: CN9‐11 neuropathy due to pathology arising from jug foramen to hyoid frequently affects more than one nerve! ‐ This may or may not have been detected CN9‐12 ALONG clinically! CAROTID SHEATH TO HYOID LEVEL. CN10 TO ABDOMEN CN9‐11 = VERNET or jugular foramen syndrome CN9‐12 = COLLET‐SICCARD or lacerocondylar syndrome 2: Vagal Neuropathy CN9‐12 + Horner ±CN7 = VILLARET or retroparotid synd. [CN10] divided into UPPER & LOWER by involvement of motor branches! UPPER VAGAL: MR BoS LOWER VAGAL: CT NECK CN9‐12 ALONG CAROTID SHEATH TO HYOID LEVEL. Skull Base Osteomyelitis presenting as Villaret syndrome CN10 TO ABDOMEN UPPER VAGAL PHARYNG. PLEXUS NEUROPATHY Motor:Gag Reflex palate, S&M constrictor Palate elevation Hoarseness plus SUP. LARYNG N. Loss of gag reflex, M: inf constrictor, HYOID HYOID cricothyroid. palatal elevation S: HoPh & SG Lx LOWER VAGAL RECURRENT NEUROPATHY LARYNGEAL N. TVCM: Endolarynx Function Hoarseness only! S: subglottis, cx esop MUST IMAGE VAGUS AND RLN BOTH CN10 Right: to CONTINUE SUBCLAVIAN ART. TO ABDO Left: to AP WINDOW Hoarseness. Hoarseness On further exam: loss DL showed left true plus loss of gag reflex. of taste and sensation vocal cord paralysis MR skull base posterior tongue CT NECK: JUGULAR FORAMEN MASS JUGULAR FORAMEN MASS Smooth remodeling = schwannoma Smooth remodeling = schwannoma Moth‐eaten = paraganglioma Moth‐eaten = paraganglioma Dural tail ± hyperostosis = meningioma Dural tail ± hyperostosis = meningioma ‐‐Mets can mimic last 2‐‐ ‐‐Mets can mimic last 2‐‐ JUGULAR FORAMEN MASS Smooth remodeling = schwannoma Moth‐eaten = paraganglioma Dural tail ± hyperostosis = meningioma ‐‐Mets can mimic last 2‐‐ ManySkull causes base to met consider: Cisternal segment: Perineural tumor Hypoglossal canal: Bony disease, mets, PNT, schwannoma… Upper neck: ICA dissection, PNT, post‐operative, post‐XRT… Tongue base: infiltrating tumor… Lower motor neuron lesion of medullary [motor] nuclei resulting in impaired function of CN9‐12, 7 Dysphagia, Dysphonia, Dysarthria Difficulty chewing Slurring of speech Nasal regurg., choking liquids Upper motor neuron lesion affects the corticobulbar 55yM R CN12 and headaches tracts; emotional lability also 66yM 1 yr speech & swallowing difficulties “which were mainly lingual”. Slurred speech, facial pain. Evaluated by ALS treatment center neurologist. MAIN SENSORY PHARYNX. MAY BE CLUE THAT “RLNP” TASTE POST TONGUE. IS REALLY UPPER VAGAL UNCOMMON ALONE. NEUROPATHY. GRAPHICS: 9 PARS NERVOSA OF 11 L/F JUG FORAMEN MASS JUGULAR FORAMEN. OR PRIOR MND/RND. KENHUB.COM ‐best anatomy website! ART: MAIN MOTOR PHARYNX/LX MOTOR FOR TONGUE Juan Orestes Gatti IF LOWER VAGAL THEN CT DENERVATION = ATROPHY ‐extraordinary Argentinian BoS TO AP WINDOW & RV AND FASCICULATIONS. 10 ENTIRE VAGUS & RLN. 12 MIMICS BoT MASS. artist DON’T FORGET CJCDD!.