Neuro 14,15, 33-35: Cn, Oculomotor And Vestibular

Front 1

What is blepherospasm?

Back 1

the pt closes both eyes tightly and cannot open them again.

Front 2

What is the difference b/t proptosis and exophthalmos.

Back 2

they both refer to bulging out of the eyes. But proptosis is due to tumor and exophthalmos is usually due to Grave's disease.

Front 3

What is bell's phenomenon?

Back 3

Rolling of the eyes when the eyelids are closed.

this phenomenon is natural in all people but the white sclera is observed in Bell's palsy patients because they can't close their eyes.

Front 4

What is Ramsay Hunt syndrome?

Back 4

facial hemiparesis due to herpes virus but the vesicles are seen in the auditory canal.

Front 5

What is the medical term used when a pt can't close their eyes all the way.

Back 5

Lagophthalmos

Front 6

What are crocodile tears?

Back 6

It's a phenomenon observed when a person tries to smile, he cries instead.

This occurs due to aberrant regeneration of CN VII after Bell's palsy. The nerve innervating facial muscles is rerouted to the lacrimal glands.

Front 7

What cranial nerves are in the cavernous sinus? Artery?

Which one is most prone to compression when the ICP is increased?

Back 7

CN III, IV, VI, V1, and V2. Internal carotid artery.

CN VI is most prone to compression.

Front 8

What somatic motor muscles are present in the head?

What branchial motor muscles are present in the head?

Back 8

Extraocular muscles and lingual muscles are somatic.

Mastication, facial expression, pharyngeal/laryngeal, SCM, and trapezious muscles are branchial.

Front 9

Which hole in the cranium is damaged in the following situations?

1. No gag reflex
2. the tongue deviate to the right side
3. can't masticate

Back 9

1. Jugular foramen (CN IX, X, and XI)

2. Hypoglossal canal (CN XII)

3. foramen rotundum (CN V3)

Front 10

A pt has following symptoms:

Ipsilateral anosmia and vision loss
contralateral papilledema.

What is thie called?

Back 10

Foster-kennedy syndrome

Front 11

How is the CN V1 related to migraine?

Back 11

CN V1 innervates intracranial vessels. When the these vessels dilate, they stretch V1 nerve fibers and trigger nociceptors. this will cause migraine.

Front 12

What 4 glands are innervated by CN VII?

What non-CN VII fiber carry the innervation to these glands?

Back 12

Nasal, lacrimal, sublingual, submandibular glands

Greater petrosoal nerve (V2 branch) innervates lacrimal and nasal glands

Chorda tympani nerve (a branch of V3) innervates sublingual and submandibular glands

Front 13

Paralysis of left lower facial muscle indicates lesion what part of the pathway?

Back 13

right Upper motor neuron damage

Front 14

What 2 functions will be lost when chorda tympani is damaged?

Back 14

sublingual and submandibular glandular secretion

loss of sensation from anterior 2/3 of the tongue

Front 15

What would happen to HR and BP if CN X is injured?

Back 15

No baroreceptor reflex.

When there is an increase in BP there is no reflective bradycardia to lower the HR, hence no eventual decrease of BP.

Front 16

What extraocular muscle function is lost when there is a fascicular VII palsy? why?

Which CN VII function is intact in this lesion?

Back 16

ipsilateral VI palsy due to close proximity b/t facial colliculus and nucleus abducens.

Fascicular palsies do not affect taste b/c the nervus intermedius (taste nucleus for anterior 2/3 of tongue) joins the CN VII at its exit zone

Front 17

There is a stoke involving Right posterior aspect of frontal gyrus (in the frontal lobe). Describe the apperance of the gaze.

what if there is a focal epilepsy from the same region?

Back 17

with stroke - The gaze will shift toward the right.

With epilepsy - the gaze will shift to left.

Front 18

List 2 symptoms when there is a lesion in the PPRF.

Back 18

inability to saccade Ipsilateral to the lesion.

Contralateral shifting of the gaze at rest.

Front 19

Describe the horizontal saccade pathway from FEF to CN III nuclei

Back 19

Frontal Eye Field --> superior colliculus --> PPRF --> Abducens nucleus --> to lateral rectus and MLF

MLF crosses and reaches oculomotor nuclei.

Front 20

List the function of following structures in the brain:

1. riMLF
2. Interstitial nucleus of Cajal
3. NPH (nucleus prepositus hypoglossi) and MVN (medial vestibular nuclei)
4. DLPN

Back 20

1. vertical saccade
2. vertical gaze holding
3. horizontal gaze holding
4. Horizontal smooth pursuit

Front 21

Name the syndrome and location the lesion based on following symptoms:

upgazae paresis, can't saccade up, convergence-retraction nystagmus

Back 21

Parinaud's syndrome

compression or lesion of posterior commissure, which contains the Interstitial nucleus of Cajal (responsible for vertical gaze holding)

Most often due to pineal tumor or increased ICP

Front 22

Name the type of ophthalmoplegia based on following symptoms:

paralysis of saccades and pursuit in both eyes, intact VOR, no diplopia.

Back 22

supranuclear ophthalmoplegia

Front 23

what is the disorder called when one has symptoms of Parkinson's and bilateral ophthalmoplegia?

Back 23

progressive supranuclear palsy

Front 24

Describe the symptoms of right internuclear ophthalmoplegia.

Back 24

Right eye can't adduct but normal abduction.

diplopia in lateral gaze

Front 25

Where is the lesion?

Left lateral gaze palsy, no diplopia, Left facial weakness.

Why is there no diplopia?

Back 25

Left abducens nucleus

There is no diplopia because abducens nucleus' close proximity to the PPRF. Lesion in the area knocks out PPRF and consequently disrupts MLF connection to the oculomotor nucleus.

Front 26

How does CN VI reach the orbit from its nucleus.

Back 26

Abducens nucleus --> fascicular tract exits anterior --> pontine cistern --> cavernous sinus --> superior orbital foramen --> orbit

Front 27

A pt has ptosis and can't rotate their eye up. Where is the problem?

Back 27

A lesion in the superior division of oculomotor nucleus, which is responsible for levator palpebrae and superior rectus

Front 28

What extraocular muscles are innervated by CN III?

Which autonomic process is innervated by CN III? what is the name of the nucleus?

Back 28

5 muscles are innervated:
1. superior rectus
2. medial rectus
3. inferior rectus
4. inferior oblique
5. levator palpebrae

pupil constriction Edinger-Westphal nucleus

Front 29

What feature explains the difference b/t pupil-involving and pupil-saving CN III palsy? Common causes of each?

Back 29

They both are infranuclear CN III palsy.

parasympathetic output is on the external area of the CN III.

Pupil-involving CN III palsy tend to occur due to compression (from tumor or aneurysm) or hemorrhage. It is frequently observed in coma. It has worse prognosis than pupil-sparing palsy

Pupil-sparing palsy tend to occur due to ischemia, which disrupts internal fibers.

Front 30

What nerve is damaged.

Tilting head to right to avoid double vision.

Back 30

Left trochlear nerve.

Front 31

Which organ detects angular acceleration?

Acceleration in horizontal plane?
Acceleration in vertical plane?

Back 31

Semicircular canal (anterior, posterior, and horizontal) - angular acceleration

Utricle - horizontal acceleration
Saccule - vertical acceleration

Front 32

Activation of right posterior semicircular canal will move your eyes to which directions?

Back 32

Down and left

Front 33

Nystagmus has 2 components. Which component shows the pathology?
which component determines the direction?

Back 33

Slow - shows the pathology

Fast - determines the direction by convention

Front 34

Central or peripheral nystagmus?
1. vertical or purely torsional nystagmus
2. nystamus increases in the dark
3. negative head impulse sign

Back 34

1. central
2. peripheral
3. central

Front 35

What is the pathophysiology behind BPPV (benign peripheral positional vertigo)?

Back 35

displacement of otolith from utricle or saccule into the semicircular canal.

Displacement into the posterior SCC is most common.

Front 36

Occlusion of PICA or vertebral artery can lead to what syndrome?

How does this lead to vertigo, nausae, and nystamus?

Back 36

lateral medullary syndrome.

Ischemia to the vestibular nuclei in the lateral medulla.

Front 37

What is the pathogenesis of Meniere's syndrome?

Symptoms?

Back 37

engorged labyrinth with increased endolymph content

clinical findings include fluctuating hearing loss, intermittent vertigo, tinnitus, ear fullness.

Front 38

Describe the results of Weber and Rinne tests for sensorineural hearing loss and conductive hearing loss.

Back 38

Sensorineural hearing loss.
Weber - lateralization to the normal ear
Rinne - air > bone

Conductive hearing loss
Weber - lateralization to the abnormal ear
Rinne - bone > air