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Cranial Nerves: Anatomy and Syndromes

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Transcript of Cranial Nerves: Anatomy and Syndromes

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Olfactory Nerve (I)
A sensory nerve (no motor/muscle innervation)
From the olfactory mucosa in the nasal cavity, via the
Ethmoid bone
and into the olfactory bulb of the brain
Optic Nerve (II)
A sensory nerve (no motor/muscle innervation)
From the eyes, via the
optic foramen
, into the thalamus
Decussates at the optic chiasm
Oculomotor Nerve (III)
A motor nerve (not very many “senses” per se)
From the midbrain, through
superior orbital fissure
Superior, medial, inferior rectus, inferior oblique
Iris & lens muscles
Damage = weak eyelids (look tired all the time) and inability to focus vision
Trochlear Nerve (IV)
Innervates superior oblique muscle of the eye
From the midbrain, through
superior orbital fissure
Rotates eye medially: turn your head…notice how your eyes look down for a second…this is a reflex of the Trochlear Nerve
Damage = double vision, eye tends to look up all the time
Trigeminal Nerve (V)
Actually 3 nerves; the largest cranial nerve
A mixed nerve: both sensory and motor signals
Opthalamic (V1): senses in the upper face
Test by touching your eye…if you blink, it works
Exits via
superior orbital fissure
Maxillary (V2): senses on the lower face
Test by loss of feeling in the lower face
Exits via
foramen rotundum
infraorbital foramen
Mandibular (V3): a mixed nerve
Senses in the lower face (lower than the maxillary…under your jaw, upper neck)
Innervation of the masseter and temporalis via
foramen ovale
Damage = inability to chew
Nerve (VIII)
Facial nerve (VII)
Facial nerve (VII)
Notice how the facial and trigeminal nerves originate from the Pons of the brainstem. Pay particular attention to the red lines indicating the top and bottom of the Pons. The facial nerve originates lower on the Pons than the trigeminal nerve.
Facial nerve (VII)
Nerve (IX)
Vagus nerve (X)
A mixed nerve originating from the medulla oblongata & exits via
jugular foramen
Senses taste, hunger, satiety (feeling full after a meal), gastrointestinal pain
Innervates muscles in the larynx (for swallowing), speech muscles, slows the heart rate and influences gastric and intestinal secretions
Trochlear nerve IV palsy, 1 eye limited in rotation (patient’s right eye)
The trigeminal nerve branches superior to the facial nerve, and has many “innervation sites”
Adbucens Nerve (VI)
Patient with left-eye abducens nerve (VI) palsy
Motor nerve (not very many “senses” per se)
Lateral rectus muscle, via
superior orbital fissure
Damage = inability to turn the eye side-side
A mixed nerve
Motor innervation of facial muscles (facial expressions) and salivary glands
From Pons, via
stylomastoid foramen
to digastric, salivary glands & various facial expression muscles
Damage = facial paralysis
Like the trigeminal nerve, the facial nerve has many “branches”. The image above is a good marker for the individual branches. Look for a nerve ganglion that is inferior to the trigeminal nerve.
Patient with facial nerve VII palsy
A sensory nerve
For hearing (cochlea = ear)
Also innervates the hair follicular cells of the ear
Involved in hearing and balance
Damage = hearing and balance loss
A mixed nerve that originates from medulla oblongata & exits via
jugular foramen
Senses taste, oral touch (food texture) and pain from the tongue and ear (piercing, cold/heat)
Innervates pharynx (for swallowing or gagging)
The vagus nerves are usually attached or associated with the carotid arteries.
Vagus nerve (X)
Damage = multiple effects, dependant upon the area of damage
Can be surgically severed if damage is inducing emesis (vomiting)
Vagus nerve (X)
A motor nerve (not very many “senses” per se
Innervates sternocleidomastoid, trapezius, palate & pharynx
For moving the head and swallowing
Motor fibers from C2-C4 inter the skull via
foramen Mgnum
then connects with the vagus nerve & exits the skull via
jugular foramen
Accessory nerve (XI)
Accessory nerve (XI) palsy of the left shoulder
Accessory nerve (XI)
Hypoglossal Nerve (XII)
Trigeminal Nerve (V)
Oculomotor nerve III palsy (eyes rotate in discordance)
Trigeminal Nerve (V)
Facial nerve (VII)
Vagus nerve (X)
Nerve (IX)
A motor nerve that originates at the medulla oblongata & exits via
hypoglossal canal
Innervates the tongue
Notice the hypoglossal canal and the jugular vein UNDER the tongue
Hypoglossal Nerve (XII)
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