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General Characteristics:
CRANIAL NERVES
Dr Dyan Roshinta Laksmi Dewi,Sp.S
SMF SARAF
RSUD DR SOEDARSO PONTIANAK
CN I - OLFACTORY
ORIGIN:
INNERVATION:
FUNCTION:
DYSFUNCTION:
Cerebral hemisphere
Nasal mucous membranes.
Sense of smell
Anosmia
CLINICAL EVALUATION
CLINICAL EVALUATION
CN II - OPTIC
of the termination of
the optic nerve by looking through
pupil with ophthalmoscope.
SPECIFIC DYSFUNCTIONS
CN III - OCULOMOTOR
ORIGIN: Midbrain
INNERVATION: EOM's; eyelid; ciliary; and sphincter of iris.
FUNCTION: Eye movement inward (medially), upward, downward, and outward; pupil
constriction, shape and equality; elevates upper eyelid; accommodation
reflex.
DYSFUNCTION:Unable to look up, down, or medial (dysconjugate gaze); ptosis, pupil
dilatation - bilateral or ipsilateral, and loss of accommodation reflex.
CLINICAL EVALUATION
Accommodation.
Lateral rectus
CN VI
Inferior rectus
CN III
Inferior oblique
CN III
Medial rectus
CN III
Superior oblique
CN IV
CN IV - TROCHLEAR
CN VI - ABDUCENS
ORIGIN: Midbrain
INNERVATION: Superior oblique muscle.
FUNCTION: Down and inward movement of
the eye.
DYSFUNCTION: Loss of downward, inner
movement of eye, dysconjugate gaze.
ORIGIN: Pons
INNERVATION: Lateral rectus muscle.
FUNCTION: Outward, lateral movement of
eye.
DYSFUNCTION: Loss of lateral eye
movement, dysconjugate gaze.
CLINICAL EVALUATION
Extraocular movements (EOM's)
CN IV (Trochlear) and CN VI tested with CN III (Oculomotor)
CN V - TRIGEMINAL
ORIGIN: Pons. The sensory nucleus extends from the pons to the midbrain, and
also to the medulla and spinal cord.
CN V - TRIGEMINAL
CLINICAL EVALUATION
SENSATION: Test with patients eye closed. Evaluate pain, temperature, & light
touch to jaw, cheeks, and forehead. Observe response and symmetry.
MOTOR: Open jaw, check for deviation. Have patient bite down, palpate masseter
and temporal muscles. Move jaw laterally against resistance to evaluate weakness
or paralysis.
slight
CN VII- FACIAL
ORIGIN: Pons & medulla.
INNERVATION: Anterior two-thirds of tongue; facial muscles, scalp, ear, and neck.
FUNCTION:
- Control of facial muscles (expressions)
- Motor limb of blink & corneal reflexes
- Secretion of salivary & lacrimal glands
- Sensation of taste, anterior two-thirds tongue.
DYSFUNCTION:
Motor = Facial asymmetry - Ipsilateral weakness/paralysis, right or left, indicative of
damage to motor nucleus or peripheral component (lower motor neuron lesion) EX:
Bell's palsy
Contralateral weakness/paralysis of lower face indicative of contralateral motor
cortex damage (upper motor neuron lesion) or hemispheric lesion, i.e. massive CVA.
Bilateral weakness or paralysis , E.g. myasthenia gravis or Guillian Barre.
Parasympathetic -Loss or excessive tearing or salivation
Sensory= Loss of taste
Combined problem = speech difficulty and drooling/difficulty handling food
CN VII - FACIAL
CLINICAL EVALUATION
MOTOR FUNCTION:
SENSORY FUNCTION:
CN VIII - ACOUSTIC
ORIGIN: Pons and medulla
INNERVATION: Cochlear - ear
Vestibular - ear
FUNCTION: Cochlear - Hearing
Vestibular - Balance, maintenance of body position, and proprioception.
DYSFUNCTION (Cochlear)
- Unilateral deafness
- Loss of sound appreciation
- Tinnitis
- (Rinne Test) AC >BC or both diminished indicative of nerve damage,
BC> AC middle ear disease.
- (Weber Test) Lateralization to good ear is nerve damage, lateralization to
bad ear is, middle ear disease.
DYSFUNCTION (VESTIBULAR)
- Vertigo
- Balance disturbances
Vestibular branch normally not tested unless patient gives history of vertigo or balance
Disturbance history is positive, caloric testing is done by physician.
CN VIII - ACOUSTIC
CLINICAL EVALUATION
CN IX- GLOSSOPHARYNGEAL
and CN X - VAGUS
ORIGIN:
INNERVATION:
FUNCTION:
DYSFUNCTION:
Glossopharyngeal (IX)
Vagus (X)
Medulla
Medulla
CN IX- GLOSSOPHARYNGEAL
and CN X - VAGUS
CLINICAL EVALUATION
CN IX and X considered jointly, actions are seldom compared separately; they are
always tested together.
- Evaluate voice quality (hoarseness or dysarthria)
- Ask patient to open mouth, say "ah", observe for
elevation of soft palate, midline position of uvula.
- Gag reflex, bilaterally
- Swallowing
- Taste (bitter) posterior one-third tongue*
*usually not tested
Negative Findings
- Loss of voice quality, (dysarthria or hoarseness)
- Deviation of uvula toward non-paralyzed side
- Swallowing difficulty or nasal regurgitation
- Vagal irritation (bradycardia)
CN XI - SPINAL ACCESSORY
ORIGIN: Medulla
INNERVATION: Sternocleidomastoid & trapezius muscles
FUNCTION: Motor function sternocleidomastoid & trapezius
DYSFUNCTION: Muscle weakness.
CLINICAL EVALUATION
CN XII -Hypoglossal
ORIGIN: Medulla
INNERVATION: Muscles of the tongue
FUNCTION: Movement of the tongue
DYSFUNCTION:
Unilateral
Flaccid paralysis (peripheral lesion)
- Tongue deviates to side of lesion.
- Isilateral atrophy
- Fasciculation
Spastic paralysis (cortical pathways)
- Tongue deviates to opposite side of lesion
- No atrophy
- Dysarthria and ataxia of tongue
Bilateral
Flaccid paralysis (medullary lesion, MG)
- Dysphagia
- Dysarthria
- Difficulty chewing food
CRANIAL NERVES
I Olfactory
II Optic
III Oculomotor
IV Trochlear
V Trigeminal
VI Abducens
VII Facial
VIII Acoustic
CEREBRAL
HEMISPHERE
MIDBRAIN
PONS
IX Glossopharyngeal
X Vagus
XI Accessory
XII Hypoglossal
MEDULLA