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189 Cards in this Set
- Front
- Back
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What two functions does the trigeminal nerve have?
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Sensory to face, oral cavity, and supratenotrial dura 2. Motor to mastication (SVE- because brachial)
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Where do the 3 divisions of Trigeminal nerve exit skull?
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Superior Orbital Fissure, Rotundum, and Ovale (Standing Room Only, V1,2, and 3)
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What are the 3 letter characteristic words for Trigeminal nerve?
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GSA, and SVE
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What are the muscles invervated by Trigeminal?
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Mastication muscles, tensors tympani and veli pallatini, ant. Belly of digastric, and mylohyoid
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Where is the motor nucleus of trigeminal?
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Lateral pons
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Which division carries motor for trigeminal?
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V3
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How does Sensory Trigeminal look anatomically?
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Sensory nucleus is in the pons, and sends a spinal trigeminal tract down ipsilaterally through medulla
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What is trigeminal Neuralgia?
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Reccurent paroxysms of stabbing pain
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How is trigeminal Neuralgia treated?
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Carbamazepine
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What reflex can be lost if trigeminal is injured?
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Corneal Reflex (afferent is trigeminal), Lacrimation Reflex, and Oculocardiac reflex
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What reflex is increased in the event of trigeminal damage?
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Jaw jerk- upper motor neuron lesions will cause increased jaw jerk when masseter is streched
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What is the jaw jerk reflex?
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Monosynaptic myotactic reflex- standard reflex = Has its own special nucleus- MESENCEPHALIC NUCLEUS
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What is the lower eyelid innervated by sensory?
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V2
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What is the upper oral mucosa innervated by sensory?
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V2
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What is the eternal ear innervated by sensory?
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V3
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What is the temple and TMJ innervated by sensory?
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V3
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What is the back of the head innervated by sensory?
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Cervical nerves
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Where do the 1st order neurons from pain/temp or tacticle/pressure go first for trigeminal nerve?
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Gasserian Ganglion (Trigeminal Ganglion) in Meckels Cave
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In the trigeminal nerve, whats the difference between sensation of Pain/Temp and Vibration/Touch?
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Pain and Temp "dips" to go to Spinal Nucleus, Vibration/Tactile goes Directly Primary Sensory
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What kind of reflex is the corneal reflex?
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Consensual Disynaptic
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What kidn of reflex is the jaw jerk/
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monosynaptic myotactic
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What is the oculocardiac?
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Slows down heart based on the pressure in the eye
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If you have cranial nerve 5 motor problems, whats the sign you will see?
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Jaw is going to deviate to weaker side
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Whats In the cavernous sinus?
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3, 4, V1, V2, and 6 (free floating), and Internal carotid, also Postganglionic sympathetics
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What happens if 11 has a lesion: which side can u turn to, what shoulder is affected
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SCM helps turn face to opposite side, so contralateral, Shoulder droop (Trapezius) is same side
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What is a cranial nerve 10 lesion (motor sign)?
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Uvula deviates away from lesion
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What is Clarke's Nucleus?
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Gives rise to Spinocerebellar tract
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Where is the sacral parasympathetic nucleus/
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S2-S4
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Where is the sympathetic nucleus?
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C8 to L3
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Where is they sympathetic nucleus to the eye, cilospinal center?
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C8 to T2
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What does he ankle jerk test?
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S1-2- Gastroc
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What does the knee jerk test?
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L3-L4 - Quad
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What does the biceps jerk test?
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C5-C6 - Biceps
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What does the Triceps jerk test?
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C7-C8
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How many neurons are there in the sympathetic pathway to the eye?
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3 hypothalamus to Ciliospinal nucleus (c8-T1), there to Superior Cervical Ganglion, and then there to th eye)
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What three places do the sympathetics go to from the superior cervical ganglion?
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Smooth muscle of eye and Sphincter pupillae, sweat glands of upper face (internal cartoid), and sweat glands of face
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At what stage of its progresion can syringomyelia, cause horner;s?
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Late
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Whats the landmark for pudendal nerve block?
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Ischial spine
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What nerve root is sensory to the posterior half of the skull?
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C2
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What nerve root is the high turtleneck distribution?
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C3
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The nipple line what dermatome?
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t4 at the teat pore
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What is the dermatome at the xyphoid process?
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Xyphoid has 7 letters. So T7
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What nerve root is for the penis or anus, and erection?
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S2 3 4
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What nerve root is at the umbillicus and causes referred pain from appendicitis?
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T10 at the belly butTEN
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What nerve root does the knee caps?
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L4, down on all 4s
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During acute cholecystis there is referred pain to right shoulder. What nerve ?
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Phrenic Nerve
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Whats the dermatome for the igunial ligament?
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L1 (I L L 1)
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What is the dermatome for a low collar shirt?
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C4
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Intrafusal stretch stimulates which fiber in a muscle spindle?
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Ia.
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Are muscle spindles perpendicular or parallel to the extrafusal fibers?
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Parallel
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What purpose do muscle spindles serve?
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To monitor muscle length, and stimulate monosynaptic refelx
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What does 1a afferent go to?
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To alpha motor neuron in spinal cord, which stimulates EXTRAFUSAL contraction due to stretch
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What is the function of the gamma neuron?
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To contract INTRAFUSAL fibers for sensitivity
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How are golgi tendon organs oriented to the fibers?
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Perpendicular to muscle
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What is the purpose of golgi tendon organs?
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To monitor tension to prevent tear
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What is the afferent from the golgi tendon?
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1b, which then inhibits alpha motor neuron
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What does the 1b afferent do?
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Inhibits the alpha motor neuron
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What is the gamma motor neuron stimulated by?
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CNS
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What part of muscle does the gamma motor neuron contract?
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Intrafusal fibers
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What reflex causes extension of the babies hand when startled?
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Moro
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What reflex is caused by search for the nipple and causes turning of the head?
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Rooting
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What reflex is caused by putting your finger in the babie's hand
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Palmar reflex- grasping
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What lobe of brain can get damage causing reemergence of baby reflexes?
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Front lobe (motor cortex right?)
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When do the primitive reflexes disappear?
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Within the first year
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Which 3 nerves lie dorsally and medialy in the brainstem?
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3, 6 and 12
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What releases melatonin and is involved in circadian rhythms?
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Pineal gland
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What coordinates consensual vertical gaze center?
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Sup Colliculus
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What Coordinates auditory in the brainstem?
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Inf Colliculus
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What condition leads to paralysis of vertical gaze?
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Parinaud syndrome
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What can cause Parinaud syndrome?
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Pinealoma and Cerebral aquaduct compression
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What side of the brainstem are the colliculi, pineal body located?
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Dorsal side, with the peduncles
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What is the only cranial nerve to have no thalamic relay?
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Olfactory
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What are the three letter designation for type of info the olfactory nerve?
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SVA
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What are the first order neurons of the olfactor tract called?
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Olfactor receptor cells
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Where do the olfactory receptor cells project?
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To the Mitral cells in the olfactory bulb
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What tract leaves the olfactory bulb?
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Olfactory tract and lateral olfactory stria
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Where does info from the olfactory bulb go?
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To the amygdala and the Primary Olfactor Cortex
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What does the Primary olfactory cortex consist of?
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Piriform cortex
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Where does the olfactor nerve leave the Cranial cavity?
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Cribiform plate of Ethmoid
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What is Foster Kennedy syndrome?
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Anterior fossa meningioma causes ipsilateral anosmia, optic atropy, and contralateral papilledema
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What kind of information is carried on the optic nerve?
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Special somatic Afferent (SSA)
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What two functions does the optic nerve have?
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Vision and pupillary light reflex (afferent limb)
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What is special about cranial nerve 2?
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Not really a nerve, simply a tract of the diencephalon
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What type of nerve is the Oculomotor nerve?
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General Somatic and Visceral Efferent (GSE and GVE)
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Where does the oculomotor nerve exit the cranial cavity?
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Superior Orbital fissure
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What muscles does the oculomotor do?
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Medial rectus, Inf oblique, sup rectus, and inf rectus and LEVATOR PALPEBRAE
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What muscles intort the eye?
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SIN - superior muscle intort the eye
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What is the funciton of levator palpebrae?
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To elevate the eyelid when the eyes look upward
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What is the visercal component of the oculomotor nerve?
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Carries Parasympathetics to the cilliary ganglion
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Where do parasympathetics to the eye come from?
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Edinger Westphal nucleus in the dorsal midbrain, next to oculomotor nucleus
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What kind of sympathetic fibers does the cilliary ganglion have?P
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Post-synaptic
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Where do the sympathetic nerve fibers run in the cavernous sinus?
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With the Internal carotid (unlike parasymps)
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What kind of parasympathetic fibers synapse in the ciliary ganglion?
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Presynaptic
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Why does oculomotor palsy only affect parasympathetics?
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There are only parasympathetics there, the sympathetics travel with the ICA and join the sympathetic root , and nasocilliary nerve (From opthalamic)
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What causes oculomotor palsy?
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PCA Aneurysm, Transtentorial hernation (epi or subdural hematoma), Diabetes (I HAD oculomotor palsy, herniation, Aneurysm, and diabetes)
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What can cause a transtentorial hernation leading to oculomotor palsy?
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Epidural or subdural hematoma
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What are the Sx of a Oculomotor palsy?
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Down and out eye, Ptosis, Loss of Parasymps=Dilated eye and lose accomodation
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What hernaiates in a transtentorial herniation?
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The uncus and puts pressure on the oculomotor nerve
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What is the only muscle of trochlear?
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Superior Oblique- Intorts (SIN), and depresses(from medial position) and abducts
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There are two distinguishing features of trochlear from other nerves. What are they?
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It comes out dorsally, the nuclei are contralateral and send out fibers that decussate
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Where does the trochlear nerve exit the cranial cavity?
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In the Superior orbital fissure
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What is the trochlear nerve exteremly susceptible to?
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Trauma because its so long (pop out of the back, or tumors)
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What are the sx of Trochlar nerve palsy?
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Extorted affected eye since SO intorts , so compensatory head tilts towards the eye that is messed up, problems reading
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Why does the head tilt in 4th nerve palsy?
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Affected eye is extorted, since it cant intort, and the other eye can, we tilt our head to make the other eye intort to make up for our (faulty) natural extorsion
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How do you test to check for Superior oblique function?
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Ask patient to look medially with eye or interest, and then have them look down.
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How do you test Supeior rectus function?
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Abduct eye and then look supeior (remember the S and I cross)
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How do you test the inferior oblique?
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Look lateraly and superiorly
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How do you test the inferior rectus?
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Look laterally and inferiorly
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What are the two rules I made up to remember eye testing?
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Remember superior oblique, and Remember to test the obliques look medially
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What does the abducent nerve innervate?
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Lateral rectus - Pure GSE
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What does the abducent nerve palsy look like?
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Convergent medial strabismus, and diplopia greatest when trying to gaze laterally towards the side
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What is the most common isolated cranial nerve palsy?
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Cranial nerve 6 - very long
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What can cause Cranial Nerve 6 palsy?
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High Intracranial Pressure, (Subarachnoid Hemorrhage, etc)
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Where does Cranial nerve 6 exit the skull?
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Superior Orbital fissure
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What does the Facial Nerve do?
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Facial Muscles (SVE) also (stapedius, stylohyoid, post belly digastric), Taste (SVA), Autonomics to Glands -GVE, posterior surface of ear (GSA)
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In what form does the facial nerve exit the brainstem?
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Motor and intermediate branches (separately)
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Where does the facial nerve exit fossa?
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Internal Auditory Meatus, then facial canal, and stylomastoid foramen
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What happens to the facial and intermediate nerve in the facial canale?
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They fuse, and widen to form the geniculate ganglion.
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What is found in the geniculate ganglion?
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All sensory first order neuron cell bodies
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Where does the ear sensory info GSA component project to after bringing back info from external ear?
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Spinal Trigmeinal Tract and nucleus
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What nerve of the facial carries the ear sensory info?
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Post. Aur Branch of Facial
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What brainstem nucleus does the Taste info from the ant 2/3 of tongue go to?
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Nucleus of the Solitary tract
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Whats the pathway for taste on the facial nerve?
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Receptor to lingual nerve to chorda tympani to intermediate nerve to Nucleus of solitary tract to the VPM
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Whats the pathway for GVE (parasymps) from Superior Salivatory nucleus out to lacrimal gland?
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Superior Salivatory nucleus to intermediate nerve to Greater Petrosal nerve to pterygopalatine ganglion to lacrimal gland
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Whats the pathway for GVE (parasymps) from Superior Salivatory nucleus out to submandibular gland?
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SSN to Intermediate nerve through the geniculate ganglion to the chorda tympani to Submandibular ganglion, which innervates both submandibular and sublingual
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Where does Taste project from solitary nucleus?
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To the VPM, which then projects to the gustatory cortex in the parietal lobe
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Where do parasympathetics for the Facial nerve start off?
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SSN -Superior Salivatory nucleus
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Whats Mobius syndrome?
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Congenital loss of 6 and 7
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What syndrome is highly associated with bilateral facial nerve paralysis?
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Guillan Barre syndrome
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What conditions does Bell's palsy often occur with?
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Aids, Lyme disease, Herpes, Sarcoid, Tumor, and Diabetes (ALH Bell' STD)
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Which nerve innervates the soft palate?
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Facial sensory
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Wher does the glossopharyngeal nerve exit the cranial fossa?
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Jugular foramen with 10, 11 and the vein
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What are the functions of the Glossopharngeal nerve?
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Parasymps to Parotid, Stylopharygenus, Taste from back of tongue, feeling from back of oral cavity and cartoid sinus and body
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Pathway info from carotid sinus and carotid body?
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Primary cell body in inferior petrosal ganglion, to Nucleus of Solitary tract,
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What reflexes does the GVA component of 9 play in?
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Carotid sinus reflex and gag reflex
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Where does taste from 9 go (pathway)?
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Inferior petrosal to nucleus of solitary tract
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Where does the SVE (stylopharngues) component of 9 arise?
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Nucleus Ambiguus of lateral medulla (pica syndrome)
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What is the pathway of GVE for 9 parasymps to parotid?
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Inferior Salivtory nucleus of medulla, to tympanic and lesser petrosal nerves, to otic ganglion to auriculotemporal nerve on V3
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What all is carried from the nucleus of the solitary tract?
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Taste, Cartoid sinus info (baroreceptors), and Gut distention
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What are all functions of the vagus nerve briefly?
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Taste from back of throat SVA, Autonomic innervation to everything down to left colic flexure (GVE), Branchial arch muscles of larynx and pharynx (SVE), Infratentorial dura Ear hole (GSA),visceral afferent to left colic flexure (GVA)
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What vagal nucleus mediates its Parasympathetic innervations?
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Dorsal Motor of vagus in the medulla
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What vagal nucleus mediates its taste?
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Solitary tract
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What vagal nucleus mediates its motor to muscles of larynx and pharnx?
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Nucleus Ambiguus in lateral medulla
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What vagal nucleus mediates its sensory to infratentorial dura and external ear and tympani membrane?
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Spinal nucleus of trigeminal
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What vagal nucleus mediates its visceral afferets?
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Nodose ganglion to Solitary Tract
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What three reflexes does the vagus efferent for?
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Gag and Carotid sinus reflex (9), Oculocardiac (from V1- increased eye pressure)
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Where does the external ear hole sensory of vagus have its 1st order neurons?
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Jugular ganglion
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Where does vagus exit the skull?
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Jugular foramen
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When vagus is travelling down through thoracic, what does it travel in?
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Carotid Sheath (posteriorly)
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What does nucleus ambiguus do?
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Pharnyx and larynx muscles and striated muscle of esophagus= 9. 10 and 11
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What does the Nucleus of Solitary Tract do?
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All taste information, gut distention and carotid sinus baroreceptors (9 and 10 viscerals)
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What does the Dorsal Motor Nucleus do?
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parasympathetics from vagus get sent out from there
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How does the accessory nerve take its path from wherever its starts to the SCM and trapezius?
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C1-C6 nerve roots (spinal)arise from ant horn and ascend through foramen magnum, and leave through jugular
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What part does accesory nerve play in the pharnxy and larynx?
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Accesory poriton of 11 comes from nucleus ambiguus and joins vagal to innervate all but cricothyroid
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What does 12 innervate?
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Intrinsic and extrinsic muscles of the toungue (all glossus except "Palato"
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What are the extrinsic tongue muscles?
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Genioglossus, Stylo and hyo
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How does hypoglossal pass through cranial cavity?
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Hypoglossal canal
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What goes through the foramen spinosum?
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Middle Meningeal artery
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What goes through the foramen magnum?
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Vertebral arteries, brain stem, and CN 11
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Whats the afferent for the gag reflex?
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Nine
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Whats the efferent for the gag reflex?
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9 and 10 from the nucleus ambiguus
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What can Cavernous sinus syndrome cause ?
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Opthalmoplegia and V1 and V2 sensory loss
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What nerves are tested with Kuh kuh sound?
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Ten - Palate elevation
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What nerves are testd wih la la sound?
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Twelve
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What nerves are tested with m sound/
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seven
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How do you test 10, 12 and 7 all together?
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Say KALAMITY"
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What glossus muscle isnt innervated by Twelve?
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Palatoglossus
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All the muscles with "palat" in their name are innervated by Vagus. True or False
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False, Tensor Veli Palatini
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