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I. II. III. V. VI. VII&VIII. IX & X. XII. XI. Bulbus olfactorius. Cranial Nerve I : Olfactory. Bipolar cells. Foramen : cribiform plate of ethmoid Region Entered : nasal cavity Components : special sensory Target : olfactory epithelium Function : smell.

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slide1

I

II

III

V

VI

VII&VIII

IX &X

XII

XI

cranial nerve i olfactory

Bulbus olfactorius

Cranial NerveI:Olfactory

Bipolar

cells

Foramen: cribiform

plate of ethmoid

Region Entered:

nasal cavity

Components:

special sensory

Target:olfactory

epithelium

Function: smell

50 million primary sensory receptor cells in 2.5 cm2

slide4

Second neurons:

First neurons: Unmyelinated

8-20 cilia of 30-200  in length

60  thick layer of mucous (lipid- rich secretion that bathes the surface of the receptors at the epithelium surface)

The mucous lipids assist in transporting the odorant molecules as only volatile materials soluble in the mucous, can interact with the olfactory receptors & produce the signals that our brain interprets as odor

slide6

Lateral stria

anterior olfactory nucleus

pyriform cortex

nucleus of horizontal limb of diagonal band

olfactory tubercle

Medial stria

transitional entorhinal cortex

olfactory tract connections lesion
Olfactory Tract Connections& Lesion
  • Lateral stria primary olfactory cortex (periamygdaloid & prepiriform areas) secondary olfactory cortex (entorhinal area (area 28))
  • Medial stria cross the anterior commisure to join contralateral olfactory bulb

Unilateral anosmia : Compression due to abcess, glioma, meningioma of frontal lob or hypothalamus which may result in ipsilateral optic atropy & contralateral papilledema Foster-Kennedy syndrome

cranial nerve i i o pticus
Cranial Nerve II:Opticus

Foramen:optic

canal of sphenoid

Region Entered:

orbit

Components:

special sensory

Target, Function:

retina-vision

slide10

Visual Path

1st neurone: rod & cone cells of the retina

2nd neurone: bipolar neurones of the retina

3rd neurone: multipolar neurones of the retina

Axons of the ganglion opticum run via the N. opticus to the chiasma

slide11

Visual Path

In the chiasma opticum, fibres of the nasal part of the retina cross to the contralateral side, and those of the temporal part continue ipsilaterally Each tractus opticus consists of fibres transporting the information from the contralateral halves of the visual field corpus geniculatum laterale&mediale (some fibres), hypothalamus go directly to the cortex of the brain

4th neurone: corpus geniculatum laterale areas 17&18 around the sulcus calcarinus (area striata)

slide14

Acute right homonymous hemianopsia in a 59-year-old man due to embolus in the left PCA. (A) MRI shows infarction in the medial left occipital lobe (arrow). (B) Occlusion of the left PCA at its origin (arrow) by an embolus (DSA, left vertebral artery, AP view). (C) The capillary phase (arrow) is absent in the left occipital lobe due to the proximal embolus.

causes of papillitis retrobulbar neuritis
Causes of Papillitis&Retrobulbar Neuritis
  • Multiple sclerosis
  • Viral illness; Syphilis
  • Temporal arteritis & other kinds of

inflammation of the arteries (vasculitis)

  • Poisoning by chemicals: lead, methanol...
  • Tumors that have spread to the optic n.
  • Allergic reactions to beestings
  • Meningitis
  • Uveitis
  • Arteriosclerosis
slide16

Superior Orbital Fissure Syndrome

IV

VI

III

preganglionic parasympathetic

to: ciliary ganglion (innervation of sphincter pupillae and ciliary muscle)

slide17

Foramen: Superior orbital fissure

Region Entered: Orbit

Somatomotor Comp.:

Target, Function:

levator palpebrae sup.

superior rectus

medial rectus

inferior rectus

inferior oblique

Visceromotor Comp.:

preganglionic parasympathetic to: ciliary ganglion

Cranial Nerve III:

Oculomotor

R eye

slide20

THIRD CRANIAL NERVE PALSIES

  • During primary gaze, weakness of
  • the muscles innervated by, result in:
  • Ptosis of the lid
  • Mydriasis
  • Outwardly turned eye
  • Pupil is completelyspared:
  • Myopathy
  • but all other muscles innervated by the 3rd nerve are affected:diabetic 3rd nerve paresis (ischemic process)
slide22

Fixed dilated pupils:3rd nerve compression

  • - Aneurysm of the post. communicating art
  • - Trauma
  • - Intracranial mass lesion
  • - Increasingly unresponsive patient with
  • 3rd n. palsy:transtentorial herniation
  • Neurologic examination with CT or MRI
  • When CT does not show blood: Lumbar puncture (suspected SAH)
  • Cerebral angiography: if aneurysmis suspected
slide23

+Nuc. Ruber infarction in midbrain

Benedict syndrome:

contralat. tremor + İpsilat. 3rd n. palsy & fixed pupilla

Pupillary Reflex:

Afferent: NII

Edinger-Westpal nuc.

Efferent: NIII parasympath.

Argyll Robertson pupil

Accomodation Retained

Light reflex absent

slide25

Horner Syndrome

  • Ptosis
  • Myosis
  • Enophthalmus
  • Loss of sweating on the affected side of the face

From hypothalamus, sympathetic nn. descend ipsilat. through the brainstem & cervical cord & riches the sympathetic chain via the motor root of T1. From there, fibers pass along the outer sheath of the internal carotid artery&its opht.branch &to the pupilla. Fibers to the face travel with the ext. carotid artery

Pancoast tm, mass compress. cervical symp. chain

slide26

Superior Orbital Fissure Syndrome

IV

VI

III

Cranial Nerve IV: Trochlear

Foramen: Superior orbital fissure

Region Entered: Orbit

Components: somatomotor

Target, Function:Superior oblique muscle

slide27

Cranial Nerve IV: Trochlear

Superior oblique

muscle palsies

  • Affect vertical eye position

when the eye is turned inward

  • The patient sees double images:

one above & slightly to the

side of the other

  • By tilting the head to the side

opposite the palsied m.,the pt

may achieve full ocularmotility without double vision

  • Causes: idiopathic, closed head trauma, aneurysms, tm, MS
slide28

Cranial NerveVI: Abducens

Foramen: Superior orbital fissure

Region Entered: Orbit

Components: Somatomotor

Target, Function:

to lateral rectus (best abductor!)

slide29

6th Nerve Palsy

  • Idiopathic: improvement within 2 mo
  • Elderly or diabetic pts: small vessel disease
  • Compression in cavernous sinus: severe
  • headache& anesthesia in the areaof n.V1
  • Increased intracranial pressure:
  • shift in the brain stretch the 6th n.
  • Trauma(basilar skull fracture)
  • Infections &tumors affecting themeninges
  • Aneurysm,MS
  • Wernicke's encephalopathy
slide31

Saccadic Eye Movements

Frontal eye field

(FEF & SEF)

Medial rectus

Lat. rectus

Mesensephalon

MLF

ııı

VI

ıv

Nuc. Abducens

Pons

P

P

R

F

VIIIN

MLF

MLF

Retina

Optik nerve

Corpus geniculatum lat.

Area 17. & 19. FEF

Mesencephalon

Pons (VI. contral. III. & n. nuclei)

slide32

Saccadic Eye Movements

Frontal eye field

(FEF & SEF)

Medial rektus

Lateral rektus

MLF

Mesencephalon

ııı

VI

ıv

Nuc.VI

P

P

R

F

Pons

VIII

MLF

MLF

slide33

Saccadic Eye Movements

Frontal eye field

(FEF & SEF)

Medial rektus

Lateral rektus

Mesencephalon

MLF

VI

ııı

ıv

Nuc. Abducens

Pons

P

P

R

F

VIII

MLF

MLF

slide36

Vestibulo-ocular Reflexe paths

Vertical Gaze

Rapid turn of the head to the left

  • Bilateral control
  • Center: Dorsal rostral mesencephalon
  • 3 integral structures:
  • - riMLF
  • - Cajal’s interstitial nuc.
  • - Posterior commisure
  • Inputs from PPRF & vestibular nuclei
  • Each riMLF projects ipsilaterally to III & IV n. nuclei

Ant. motion of the

fluid in the labyrinth

Cupula is stimulated

Ipsilat. IIIrd & contralat. VIth nerves are stimulated

Eyes turn right in order to sustain forward gaze

slide37
Cranial Nerve V: TrigeminalV1-Trigeminal ophthalmicMajor branches: Lacrimal, Frontal, Nasociliary & Meningeal

Foramen: superior orbital fissure

Region Entered:orbit

Components:general sensory

Target, Function: general sensation from skin and mucosa in region

at & above orbit

cornea reflex
CorneaReflex
  • Afferent:

N V1

  • Efferent:

N VII

(blink)

Ciliary ganglion

v2 trigeminal maxillary infraorbital zygomatic nasopalatine palatine
V2-Trigeminal maxillary Infraorbital,Zygomatic,Nasopalatine,Palatine

Foramen:rotundum

Region Entered:

pterygopalatinefossa

Components:

general sensory

Target, Function:

gen.sensation from

skin & mucosa

in region from

orbit to mouth

v 3 trigeminal mandibular buccal auriculotemporal lingual inf a lveolar meningeal
V3-Trigeminal mandibularBuccal, Auriculotemporal, Lingual, Inf.alveolar & Meningeal

Foramen:ovale

with lesser petrosal

from CN9

Region Entered:

infratemporal fossa

Components:

brachiomotor

Target, Function:

muscles of masticat.

tensor tympani & veli

palatini, mylohyoid

ant. belly digastric

slide45

Lesion of spinal tractV

  • IPSILATERAL deficits
  • in pain & temperature from the face etc.
  • (the pain information never gets to the
  • caudal spinal nucleus)
  • Interruption of the trigeminothalamic tract
  • deficits in pain &temperature on the
  • contralateral side of the face
  • (comprised of axons that have crossed
  • the midline)
slide46

Causes of Sensory Trigeminal Neuropathy

  • Idiopathic
  • Systemic inflammatory disease
  • Sjögren's syndrome
  • Progressive systemic sclerosis (scleroderma)
  • Mixed connective tissue disease
  • Systemic lupus erythematosus
  • Dermatomyositis
  • Rheumatoid arthritis
  • Sarcoidosis
  • Wegener's granulomatosis
  • Undifferentiated connective tissue disease
  • Giant cell arteritis
  • Idiopathic hypertrophic cranial pachymeningitis
  • Multiple sclerosis
  • Tumor
    • Intracranial or extracranial
    • Metastatic
    • Primary: Meningioma, Schwannoma, Epidermoid, Chordoma
  • Trauma
  • Aneurysm
  • Dural external carotid artery cavernous sinus fistula
  • Sickle ceil disease
  • Diabetes mellitus
  • Syringobulbia
  • Infections
  • Sinusitis
  • Herpes simplex
  • Herpes zoster
  • Hepatitis A infection
  • Nonspecific viral infection
  • Tuberculosis
  • Whipple's disease
  • Leprosy
  • Arachnoiditis
  • Tricloroethylene
  • Hydroxystilbamidine
  • Amyloidosis
  • Spinal epidural anesthesia
slide48

TRİGEMİNAL

NEVRALJİ ?

Preganglionik sinir kökleri: Subaraknoid alan

slide50

Facial NerveTemporal, Zygomatic, Buccal, Mandibular, Cervical&Post. Auricular

internal acoustic meatusfacial canalstylomastoid foramen

  • Brachiomotor:m. of facial expr.: stapedius,stylohyoid, mylohyoid, post.belly digastric
  • facial canal middle ear chorda tympani petrotympanic fissure
  • Special sensory: taste, ant. 2/3 tongue: facial canal middle ear chorda tympani petrotympanic fissure
  • Visceromotor:preganglionic parasympathetic tosubmand. ganglia (innervates submand. &sublingual glands)

greater superficial petrosal pterygoid canal

pterygopalatine ganglia tolacrimal, nasal & palatine gl.

slide51

C

Lesion at A: Ipsilateral

  • paralysis of all facialmovements
  • corneal reflex is lost
  • sensory area to ear is lost

Lesionat B:A(+) impaired

  • sublingual, submandi- bular glands’ secretions&
  • taste over ant.2/3 of the tongue
  • hyperacusis

Lesion at C:A&B(+) im-

paired ipsilat.lacrimation

B

A

slide54

Causes of Peripheral Facial Nerve Palsy

  • Idiopathic (Bell's palsy)
  • Infectious:
    • Herpes simplex
    • Herpes zoster
    • Otitis media
    • Borrelia burgdorferi
    • Human immunodeficiency virus
    • Syphilis
    • Infectious mononucleosis
    • Mastoiditis
    • Poliomyelitis
    • Meningitis
    • Malaria
    • Leprosy
    • Rubella
    • Mumps
    • Osteomyelitis
    • Cat scratch disease
  • Inflammatory
    • Guillain-Barré syndrome
    • Sarcoidosis
    • Multiple sclerosis
    • Arteritis
    • Melkersson-Rosenthal syndrome
    • Behçet syndrome
    • Wegener's granulomatosis
    • Lymphomatoid granulomatosis
    • Kawasaki disease
    • Angioedema
    • Pseudotumor (Tolosa-Hunt syndrome)
    • Amyloidosis
    • Idiopathic hypertrophic cranial pachymeningitis
  • Neoplastic
    • Schwannoma
    • Neurofibroma
    • Meningioma
    • Cholesteatoma
    • Parotid gland tumor
    • Metastasis
    • Carcinomatous meningitis
    • Leukemia
  • Metabolic
    • Diabetes mellitus
    • Hypothyroidism
    • Uremia
    • Porphyria
  • Trauma: Surgical trauma to nerve
  • Congenital, Familial
  • Miscellaneous
    • Pregnancy
    • Paget's disease
    • Osteopetrosis
    • Hypertension
    • Diphtheria-pertussis-tetanus vaccination
    • Pontine infarction
    • Myasthenia gravis
    • Traumatic external carotid artery aneurysm
    • Lumbar extradural blood patch
    • Vascular malformation
    • Pseudotumor cerebri
    • Ethylene glycol poisoning
slide59

1st neurone:bipolar cells of the gang. cochleare 2nd neurone:multipolar neurones of nuclei cochleares

slide60

Auditory path.

2nd neurones corpus trapezoideum  opposite side  form lemniscus lat. colliculus inferior 3rdor 4th neurone colliculus superior cerebellum & corpus geniculatum mediale

4th or 5th neurone: Heschl's transverse gyrus & Wernicke's centre of the temporal lobe

slide61

Vestibular path

1st neurone: bipolar cells of the ganglion vestibulare form the N. vestibularis on the floor of the internal acoustic meatus

FLM

2nd & following neurones: from nuc.vestibularis lat. (Deiter's) to: - formatio reticularis - motor nuclei of nerves III, IV & VI - nuc. ruber & as the tr. vestibulosp. into the ant. column of the sp. cord

nuc. ruber

nuc. vestibularis sup. (Bechterew's) supplies some fibres to cerebellum

slide62

Cranial NerveVIII: Vestibulocochlear

Disease affecting hearing

Acoustic neuroma (8th n)

Presbyacusis (cochlea)

Trauma “

Wax (ext.&middle ear)

Otitis media “

Otosclerosis “

Disease affectingbalance

Vascular diseases(b.stem)

Demyelination “

Drugs (DPH, streptomycin)

Viral, benign conditions

Disease affectinghearing &

balance(cochlea&labyrinth)

Meniere

internal auditory meatus

cochleo vestibular disease main symptoms main signs
Cochleo-vestibular Disease Main SymptomsMain Signs
  • Deafness
  • Tinnitus
  • Vertigo
  • Loss of balance
  • Deafness
  • Nystagmus
  • Ataxia
  • Positional nystagmus
cranial nerve i x
Cranial Nerve IX:
  • Foramen:jugular
  • Special visceromotor: Function: elevates pharynx

nucleus ambiguus stylopharyngeus

  • Gen. Sensory Components Function: general sensation ofexternal, middle ear & auditory tube

geniculate ganglionspinal trigeminal nucleus

  • Special Viscerosensory Component:
  • Function: taste, posterior 1/3 tongue=>

inferior petrosal ganglion rostral tractus solitarius

  • Region Entered:infratemporal fossa
  • Gen. Viscerosensory: Sensory receptors of ant. surface epiglottis, root of tongue, border of soft palate, uvula, tonsil, pharynx, eustachian tube, carotid sinus & bodycaudal tractus solitarius
  • Gen.Visceromotor comp.: İnf.salivary nuc.tympani n. lesser petrosal notic ganglionauriculotemporal n.
  • Function: parotid gland secretion
slide66

Microvilli of the taste receptor cells project into an opening in the epithelium, the taste pore, where they make contact with gustatory stimuli.

These epithelial receptor cells make synaptic contact with distal processes of cranial nerves VII, IX, or X

slide68

Nervus Vagus

Special Viscerosensory: taste in epiglottisinf. Gang.rostral tr. solitarius

Special visceromotor: (deglutition phonation)

n. Ambiguuspalatal, pharynx& larynx muscles

General viscerosensory: post.epiglottis,larynx, trachea, bronchi, esopagus, stomach, s. İntestine, colon inf. ganglioncaudal tr. solitarius

General somatosensory: : auricle, ext. auditory meatussup. ganglionspinal trigeminal nuc

General Visceromotor: dorsal motor nucleuspreganglionic parasympathetic to abdomen & thoraxcardiac depression, visc. mov., secretion

slide73

Selected Causes of Vagus Nerve Dysfunction

  • Lateral medullary syndrome
  • Hyperextension
  • injury of upper cervical spine
  • Chronic lead poisoning
  • Radiation therapy to head and neck
  • Glomus vagale tumor
  • Neuroma
  • Schwannoma presenting as cerebellopontine angle mass
  • Nasopharyngeal diphtheria
  • Viral or postviral mononeuritis
  • Herpes simplex
  • Cytomegalovirus
  • Herpes zoster
  • Multiple system atrophy
  • Superior laryngeal neuralgia
slide74

Cranial NerveXI: Spinal Accessory

  • Brachiomotor Comp:

Foramen: exits by jugular; enters by foramen magnumant. horn cells C1-C5

Target:trapezius, sternokleidomastoid

Function:head & shoulder movement

  • Spc.Visceromotor Comp.: Caudal nuc. ambiguusvagus muscles of larynx Function:phonation
slide75

Symptoms of the 11th n. involvement

Torticollis (dystonia)

Asymmetric shoulders

Impaired arm elevation

cranial nerve xi i hypoglossal
Cranial NerveXII:Hypoglossal
  • Foramen: hypoglossal canal
  • Region Entered: neck
  • Components: somatomotor
  • Target, Function:all tongue muscles, except palatoglossus
slide78

Infranuclear paralysis of the right trigeminal, facial, and hypoglossal nerves, showing deviation of the mandible and tongue to the right

slide79

12th n. palsy:

Asymmetry

Deviation

Atrophy

Fasciculations

10th nerve

common condition affecting 9th 10th 12th nerve function
Common Condition Affecting 9th, 10th & 12th Nerve Function
  • Bulbar palsy
  • Dysartria
  • Dysphagia
  • Dysphonia
  • Aspiration
  • Motor neuron disease
  • Cerebrovascular disease
  • Syringobulbia
  • Erosive tm of the skull base
  • Guillain-Barré syndrome
  • Recurrent laryngeal nerve palsy
  • Myastenia gravis