Neuro

Card Set Information

Author:
mizzoupt
ID:
33447
Filename:
Neuro
Updated:
2010-09-11 12:17:06
Tags:
Cranial Nerves
Folders:

Description:
Notes from Cranial Nerve Lecture
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user mizzoupt on FreezingBlue Flashcards. What would you like to do?


  1. What is CN I?
    Olfactory
  2. What is CN II?
    Optic
  3. What is CN III?
    Occulomotor
  4. What is CN IV?
    Trochlear
  5. What is CN V?
    Trigeminal
  6. What is CN VI?
    Abducens
  7. What is CN VII?
    Facial
  8. What is CN VIII?
    Acoustic/Vestibulocochlear
  9. What is CN IX?
    Glossopharyngeal
  10. What is CN X?
    Vagus
  11. What is CN XI?
    Spinal Accessory
  12. What is CN XII?
    Hypoglossal
  13. Fiber types for Olfactory Nerve
    Sensory only
  14. Function of Olfactory
    Smell
  15. How to test Olfactory Nerve
    Pocket Smell Test or other substances with familiar and distinctive aroma (e.g. coffee, mint, etc.); many versions available
  16. Lesion of Olfactory Nerve
    • Lesions can cause loss of smell (anosmia) or taste
    • Some pt. not aware of their own anosmia
  17. Type of fibers for optic nerve
    Sensory only
  18. Optic nerve function
    Vision
  19. Optic Nerve Tests:
    • Test with standard vision tests
    • Look at lecture note for different deficits
  20. Damage to the Optic Nerve will result in:
    • a monocular visual defect due to loss of input from the ipsilateral eye
    • Damage to the Right optic nerve:
  21. Bitemporal Hemianopia
    • Loss of peripheral vision in both eyes
    • This is a compromise of the decussating fibers from both nasal hemiretinas
  22. Hemianopia
  23. Affects the fibers of the ipsilateral temporal hemiretina
    • (Ex: aneurysm of the interanl carotid artery)
    • Occurs with damage to the lateral aspect of the optic chiasm
  24. Homonymous Hemianopia
    • Results in loss of the contralateral visual fields in both eyes
  25. Damage to the Optic Radiation
    Fibers of the optic radiation are considerably more spread out than those of the optic tract. As a result, damage normally only occurs to a portion of the geniculocalcarine tracts:


    *to the fibers of Meyer's loop and/or damage to the temporal lobe portion of the optic radiation results in loss of input from the inferior half (superior visual field) of both contralateral hemiretinas (superior quadrantanopia).


    *to the fibers of the parietal lobe portion of the geniculocalcarine tract results in a loss of input from the superior half (inferior visual field) of both contralateral hemiretinas (inferior quadrantanopia).
  26. superior quadrantanopia
  27. Inferior Quadrantanopia
  28. Oculomotor Nerve fiber type
    Motor only
  29. Oculomotor Function
    • Eye and eyelid movement
    • Somatic: Supplies four of the six extraocular muscles of the eye and the levator palpebrae superioris muscle of the upper eyelid
    • Autonomic: parasympathetic (pupillary constrictor)
  30. Ptosis
    Eyelid drop
  31. Oculomotor Nerve lesions
    • Compressive lesions are peripheral and usually dilate the pupil
    • Ischemic lesions usually affect central portion of the nerve and don't usually dilate the pupil
    • If completely paralyzed, eyes will deviate to the lateral side do result is diplopia
  32. Oculomotor Nerve Testing
    • First: inspect the eyes =
    • look for ptosis
    • note appearance of the eyes
    • check for ocular alignment (the light source reflection should fall at the same location on each eyeball).
    • Test extraocular range of motion: have patient follow a target through the six principal positions of gaze ("H" pattern). The patient is positioned in sitting and is asked to follow an object with their eyes as it is moved vertically, horizontally, and diagonally. The therapist should make sure the patient does not rotate their head during testing and should inspect the patient's eyes for asymmetry: misalignment of the eyes or complaints of diplopia.
    • Specifically for CN 3: note adduction (medial rectus), depression while abducting (inferior oblique), and elevation (superior rectus and inferior oblique).
    • Test pupillary constriction with the light reflex.
    • Positive test indicated by:
    • Tracking deficit
    • asymmetry
    • ptosis
  33. Trochlear Nerve Fiber types
    Motor only
  34. Trochlear nerve function
    Eye Movement (Superior Oblique Muscle)
  35. What is the only nerve to exit the posterior side of the brainstem?
    Trochlear nerve
  36. Trochlear Nerve Testing
    • Test: have patient turn eye downward and outward (paralysis will prevent eye from moving down & out)
    • The patient is positioned in sitting and asked to follow an object such as a writing utensil with their eyes as it is moved in an inferior direction.
    • The therapist should make sure the patient does not move his head downward.
    • A positive test results by an inability to depress and/or complaints of diplopia.
  37. Trigeminal Nerve Fiber Type
    Sensory and Motor
  38. Functions of Trigeminal nerve
    • Motor - muscles of mastication (chewing)
    • Sensory - face
  39. The 3 Branches of the trigeminal nerve are:
    • Opthalmic
    • Maxillary
    • Mandibular
  40. Functions of the opthalmic branch of the trigeminal nerve
    • motor: eyeball, tear gland
    • sensory: eye lining, brow, forehead
  41. Functions of the maxillary branch of the trigeminal nerve
    • motor: muscles of temple
    • sensory: side of forehead, cheek, mouth membranes, lower eyelid
  42. Functions of the mandibular branch of the trigeminal nerve
    • motor: chewing muscles, salivary glands, anterior 2/3 of tongue
    • sensory: teeth and gums of jaw, external ear, temple: tongue-not taste
  43. Symptoms of trigeminal nerve palsy
    • Anesthesia to half of the face
    • Inflammation of cornea
    • Chewing muscles paralyzed
  44. Trigeminal Nerve:
    Sensory Testing
    • The therapist uses a piece of cotton and a safety pin to alternately touch the patient's face. The patient is asked to classify each contact with the face as sharp or dull. A positive test for the sensory component bay be identified by impaired or absent sensation or the inability to differentiate between sharp or dull.
    • Corneal Reflex: Immediate closure of both eyelids should occur as examiner touches temporal aspect of cornea with cotton wisp.
  45. Trigeminal Nerve:
    Motor Testing
    • The motor component is tested by asking the patient to perform madibular protrusion, retrusion, and lateral deviation.
    • A positive test may be indicated by an impaired ability to move the mandible through the specific motions.
  46. Trigeminal Nerve:
    Masseter Reflex
    • The mandible (lower jaw) is tapped at a downward angle just below the lips at the chin while the mouth is held slightly open. In response, the masseter muscles will jerk the mandible upwards. Normally this reflex is absent or very slight.
    • In individuals with upper motor neuron lesions the jaw jerk reflex can be quite pronounced.
  47. Abducens Nerve fiber type
    Motor only
  48. Functions of Abducens nerve
    • Controls eye movements:
    • Contraction of the lateral rectus muscle
    • Controls eye abduction (lateral eye movement)
  49. Abducens Nerve Testing
    • The patient is positioned in sitting. The therapist asks the patient to abduct their eyes without rotating the head.
    • A positive test may be indicated by an inability to abduct the eyes.
  50. Lesions to Abducens Nerve
    • Left-sided pontine lesion can damage the abducens nerve and prevent lateral movement of left eye
    • Lesions can cause patients to be cross-eyed
    • Often injured in skull fractures
  51. Facial Nerve Fiber types
    Both sensory and motor
  52. Facial Nerve functions
    • Branchial motor: muscles for facial expression and has 5 branches
    • Visceral motor: parasympathetic to all glands of head except the parotid
    • General sensory: for ear and tympanic membrane
    • Special sensory: taste, anterior 2/3 tongue
  53. Bell's Palsy
    • Sudden paralysis of one or more nerves in the face
    • Signs: twitching, weakness, drooping eyelid or corner of mouth, drooling from one side of the mouth, eyebrow sagging, inability to close the eye, disappearance of the fold between the nose and upper lip, decreased tearing, and/or loss of taste sensation on the front of the tongue may occur in more severe cases
    • 8-10% recurrence
  54. Causes of Bell's Palsy
    • Cause: herpes simplex virus (HSV) or other virus causes inflammation and swelling of either side facial nerve
    • As the nerve swells due to infection, it becomes compressed and the protective sheath breaks down, interfering with the nerve's ability to communicate with the muscles.
    • Result: characteristic weakness or paralysis of the facial muscles
  55. Picture of Bell's Palsy


    • A) Demonstrates inability to raise the left eyebrow or generate wrinkles on the left side of forehead;
    • B) Demonstrates difficulty closing the left eye and inability to raise the left corner of mouth;
    • C) Demonstrates drooping at the left corner of mouth, loss of the left nasolabial fold, and inability to completely close the left eye. These findings are the result of idiopathic peripheral cranial nerve 7 palsy (Bell's palsy).
  56. Facial Nerve:
    Motor Testing
    • The patient wrinkles her forehead while the two sides are compared.
    • Patient tightly shuts eyelids while examiner attempts to pry open. The two sides are compared.
    • Patient smiles and shows her teeth while the examiner compares the nasolabial folds on either side.
    • Patient is asked to purse lips or whistle.
  57. Facial Nerve:
    Sensory Testing
    • The patient is asked to distinguish between sweet and salty substances placed on the anterior portion of the tongue.
    • A positive test for the sensory component may be identified by an inability to accurately identify sweet and salty substances.
  58. Acoustic/Vestibulocochlear nerve fiber types
    Sensory only
  59. Acoustic/Vestibulocochlear nerve function
    Hearing and balance
  60. Aspirin, Streptomycin, and quinine can damage what?
    Auditory nerve and causes bilateral hearing loss
  61. Acoustic/Vestibulocochlear nerve testing
    The patient is positioned in sitting in a quiet location. The therapist, positioned behind the patient and to one side, slowly brings a ticking watch toward the patient's ear. The therapist records the distance from the ear when the patient is able to identify the ticking sound. The therapist repeats the procedure on the contralateral ear and compares the measurements. A positive test is indicated by an inability to hear the ticking sound at 18-24 inches or a significant bilateral difference.

    Rinne's test - a vibrating tuning fork is placed on the mastoid process (the bony mass just behind the ear), and is then quickly placed around 4cm from the ear hole. The sound should normally be louder next to the ear hole than it is when in contact with the mastoid process, as the bones of the middle ear that amplify sound are bypassed when the sound travels in through the mastoid process. Each ear should be tested independently.

    Weber's test - a vibrating tuning fork is placed against the middle of the forehead. The sound should be equally audible in both ears.
  62. Glossopharyngeal nerve Fiber type
    Both sensory and motor
  63. Glossopharyngeal nerve functions
    • Branchial motor: Stylopharyngeus muscle
    • Visceral motor: Parotid gland
    • General sensory: Sensation posterior 1/3 tongue and internal surface of tympanic membrane
    • Visceral sensory: Carotid body
    • Special Sensory: Taste posterior 1/3 tongue
  64. Glossopharyngeal nerve:
    Motor testing
    The patient is positioned in sitting. The therapist touches the pharynx with a tongue depressor. A positive test may be indicated by lack of gagging.
  65. Glosopharyngeal Nere:
    Sensory Testing
    • The sensory component is tested by assessing the patient's ability to distinguish objects by taste after they are placed on the posterior portion of the tongue. A positive test for the sensory component may be identified by an inability to accurately identify tasted substances, especially sour and bitter substances, placed on the posterior third of the tongue.
    • Also: inability to feel the tongue depressor touch the back of the throat.
  66. Vagus Nerve fiber types
    Both sensory and motor
  67. Clincial presentation of Vagus Nerve
    Clinical presentation: hoarseness, difficulty swallowing; occasionally caused by compression from goiter (thyroid) pressing on part of Vagus nerve
  68. Vagus Nerve functions
    • Somatic motor: muscles of the pharynx/larynx
    • Autonomic motor: parasympathetic to neck, thorax, abdomen
    • General sensory: sensory from pharynx/larynx/viscera
  69. Vagus Nerve Testing
    • The therapist touches the pharynx with a tongue depressor. A positive test may be indicated by a lack of gagging or an inability to feel the tongue depressor touch the back of the throat. If the gag reflex is absent the therapist should carefully assess the movement of the soft palate and uvula.
    • Say “aaah,”---uvula will deviate to strong side away from lesion side or will not elevate if bilateral full paralysis
  70. Spinal Accessory nerve fiber types
    Motor
  71. Spinal Accessory nerve functions
    Some laryngeal muscles and some muscles of the back and neck
  72. Hyperactive Spinal Accessory nerve causes:
    Torticollis
  73. Spinal Accessory nerve testing
    • The patient is positioned in sitting with the arms at the side. The therapist asks the patient to shrug their shoulders and maintain the position while the therapist applies resistance through the shoulders in the direction of shoulder depression. A positive test may be indicated by an inability to maintain the position against resistance.
    • Turn head back to center against resistance
  74. Hypoglossal nerve fiber types
    Motor Only
  75. Hypoglossal nerve testing
    • The therapist asks the patient to protrude the tongue. A positive test may be indicated by an inability to fully protrude the tongue or the tongue deviating to weak side during protrusion.
    • Test speech: have patient repeat a phrase with lots of r’s in it or say “la la la”
    • Patient is instructed to stick out the tongue and then move it laterally against resistance.

What would you like to do?

Home > Flashcards > Print Preview