cranial nerves lesions

8/20/2019 Cranial Nerves Lesions

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CRANIAL NERVESLESIONS

Nur Adilah Mohd Radzi

SN: 24MN: 27


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Objectives

• Functions of all the cranial nerves

• Coon e!ects of lesions of thecranial nerves

• Clinical e"aination


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#ntroduction

• 12 pairs of cranialnerves

• Contains onl$ sensor$%bres Sensorycranial nerves: #& ## and'###

• (redoinantl$ otor infunction Motorcranial nerve: ###& #'&'#& )# and )##

• *oth sensor$ +otor %bres Mixedcranial nerve: '&

'##& #) and )

• Lesion: A re,ion inan or,an- tissue

.hich has su!ereddaa,e throu,hinjur$ or disease


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CN #: Olfactor$ Nerve

• Sensor$ cranial nerve

• Function: Smell

• Resides on the roof of

the nasal cavit$ Fro the olfactor$ucosa forainaon the cribrifor0late olfactor$bulb olfactor$ tract


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CN #: Olfactor$ nerve

• 1esion Anosia&$0osia& (arosia&Olfactor$ hallucination

• Anosmia &yposmia – 3nilaterall$ uour

of olfactor$ bulb orfrontal lobe&

Menin,ioa – *ilaterall$ Coon

cold& ead injur$&Atro0hic rhinitis

• !arosmia 5distortion of sellsensation6

• Ol"actory#all$cination

Causes:

Mental disorders

80ile0s$

ead injur$


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CN #: Clinical 8"aination

• Sell is tested ineach nostril se0aratel$ b$ 0lacin, stiuli

under one nostriland occludin, theo00osin, nostril

• 8,: oran,e-leon0eel& co!ee& orvine,ar


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CN ##: O0tic Nerve•

Function: 'ision


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CN ##: O0tic Nerve

• 1esion visual %eld defects + loss ofvisual acuit$

• Causes of lesion: – Fractures in the orbit

– *rain lesions

– %amae alon t#e vis$al pat#'ay

– 9iseases of the nervous s$ste – (ituitar$ ,land tuor

– Cerebral aneur$s


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CN ##: %amae alon t#e vis$alpat#'ay


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CN ##: Clinical 8"aination

• est for: Acuit$& Colour& Fields&Ree"es


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CN ##: Clinical 8"aination

• Vis$al (elds aretested b$ as;in,the 0atient to loo;

directl$ at $ou.hilst $ou .i,,leone of $our %n,ersin each of the four


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CN ###' + '#: Oculootor& rochlear

+ Abducens

• Function: Control the uscles thatove the e$eballs

• 1esion: Strabisus& 0tosis& di0lo0ia

• Causes of daa,e: – raua to the s;ull or brain

– Co0ression

– 1esions of the su0erior orbital %ssure


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CN ###' + '#: Clinical8"aination

• he %n,er isoved in an **s#ape and the

0atient is as;ed tore0ortan$ diplopia

• (u0illar$ ree"

• he accoodationree" is tested b$ovin, the tar,etto.ards the

0atient>s nose


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CN ###: Oculootor Nerve

• A otor nerve

• Functions:

Control

oveents ofe$eball

Controls the sizeof 0u0il

#nvolved inaccoodation ofvision

• he lesion in thisnerve a$ result

in:i= (tosis

ii= N$sta,us

iii= Strabisus

iv= 9i0lo0ia


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i= (tosis

Causes:

• #0airent of CN### functions

• M$asthenia ,ravis

ii= N$sta,us

?er;$ oveent ofthe e$eball


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iv= 9i0lo0ia

Causes:

Can also ha00en in

CN ###& CN #' + CN'#

iii= Strabisus

- S


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CN #': rochlear Nerve

• A otor cranial nerve

• Su00l$ s$perior o+li,$e m$scle ofe$es

• Function: 9e0ress e$es .hen inadduction

• 1esion @ 9i0lo0ia 5double vision6


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CN ': ri,einal Nerve

• Mi"ed cranial nerve& lar,est

• branches:

i= 'B: O0thalic Nerve 8$e

ii= ': Ma"illar$ Nerve

300er ja.boneiii= 'D: Mandibular Nerve

1o.er ja.bone

•. Functions:

Carr$in, ,eneral sensation

fro di!erent 0art of theface& head + nec;

Mastication

• Lesion .ill cause:

– Sensory de%cit

– Motor de%cit

– Re)ex de%cit

Characterized b$:

1oss sensation of touch&te0erature and

0ro0rioce0tion- !aralysis of the uscle

of mastication

- 1oss of corneal ree"


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CN ': ri,einal Nerve

1esion of E or ore branches:

-rieminal ne$ralia.tic do$lo$re$x/

Shar0 cuttin,-tearin, 0ain&lasts for fe. seconds toinutes

Coon in 0eo0le GH $earsold

Causes: 1oo0in, blood vessel&defective $elin sheath

Can be the %rst si,n of adisease: 9iabetes& ulti0lesclerosis& lac; vitain *B


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CN ': Clinical 8"aination

E= 1i,ht touch& 0ain+ te0erature

2= Corneal ree"

= Muscle ofastication5asseter +te0oralisuscles6

4= ?a. jer;


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CN '#: Abducens Nerve

• A otor nerve

• #nnervates lateralrectus uscle

• 1esion a$ causedi0lo0ia and s


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CN '##: Facial Nerve

• Mi"ed nerve

• Functions:

Facial e"0ressions&

aste sensation5anterior 2-6


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CN '##: Facial Nerve

• 1esion *ellIs (als$

• Causes: – 'iral or bacterial

infection

– 9aa,e to the nerve b$traua& tuors + stro;e

• CN '## lesion also

causes:- 9r$ corneaJ loss of taste on

anterior t.o third ofton,ue=


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CN '##: Clinical 8"aination

10 C#ec "or "acialexpression

i= Raise both e$ebro.s

ii= Fro.niii= Close both e$es

ti,htl$

iv= Sho. both u00er

and lo.er teethv= Sile

vi= (u! out both chee;s

2= Chec; for tastesensation


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CN '###: 'estibulocochlearNerve

• Sensor$ cranialnerve

• 2 branches:

I0 Vesti+$lar Carr$ i0ulsesfore,$ili+ri$m

II0 Coc#lear Carr$ i0ulsesfor #earin


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CN '###: 'estibulocochlearNerveLesion to vesti+$lar+ranc#

– 'erti,o

– Ata"ia

– N$sta,us

Lesion to coc#lear+ranc#

initus&

9eafness

Causes:- raua-

Middle earinfection- 1esions


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CN '###: Clinical 8"aination

earin, function

E= Khis0er

2= RinneIs est

= KeberIs test

'estibular function

E= Chec; the 0atienthistor$ ,iddiness&dizziness& verti,o

2= Rober,Is test= N$sta,us


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CN #): Llosso0har$n,ealNerve

• 1esions:

i= %ysp#aia 59icult$ in

s.allo.in,6ii= Aptylia 59ecrease salivasecretion6

iii= Ae$sia 51ossof taste sensation6

iv= oarseness

v03lossop#aryneal ne$ralia

Re0eatede0isodes of severepain in the ton,ue&throat& ear& and

tonsils& lastin, froa fe. seconds to afe. inutesCauses of 1esion:

raua& (ressin,

of blood vessels&


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CN #): Clinical 8"aination

E= aste sensation5(osteriorl$6

2= La, ree"


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CN ): 'a,us Nerve

• Mi"ed nerve

• Kidel$ distributed in the head& nec;&thora" and abdoen


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CN ): 'a,us Nerve

• Lesion:1oss of 0har$n,eal + 0alatal ree"

Lastric acid secretion& ,all bladder e0t$in,

9$s0ha,ia ach$cardia& i0airent to blood 0ressure

re,ulation

3vula deviates to the health$ side(aral$sis to the vocal cords

a0honia


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CN ): 'a,us Nerve

• Causes of lesion:

Mass in the 0osterior fossa

*on$ fracture daa,e the e"itfro ju,ular foraen

Neuritis 5e,: her0es zoster6


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CN ): Clinical 8"aination

E= Observe the arch of 0alate + uvula.hen the 0atient sa$ aaahI

2= La, ree"

= 'isceral function


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CN )#: Accessor$ Nerve

• Motor cranial nerve

• 2 %bres: Cranial %bre + S0inal %bre

•

S0inal %bre has 2 0arts: – Cranial 0ortion s.allo.in, oveent

5lar$n"& 0har$n"& soft 0alate

– S0inal 0ortion ead + shoulder

oveents 5sternocleidoastoid +tra0ezius uscle6


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CN )#: Accessor$ Nerve

Lesions mayca$se:

- #nabilit$ to raise

shoulders

droo0in, ofshoulder

- 9icult$ to turn

head

Ca$ses o" Lesion:

- Mass lesion at thebase of the s;ull

- #nterru0tion ofnerve due to

co0lication ofl$0h node bio0s$


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CN )#: Clinical 8"aination

• ra0ezius + sternocleidoastoiduscles


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CN )##: $0o,lossal Nerve

• Motor cranial nerve

• Functions:Moveent of

ton,ue& assist ins0eech +s.allo.in,


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CN )##: $0o,lossal Nerve

Lesion mayprod$ce:

- 9$sarthria

- 9$s0ha,ia- Atro0h$ +

.ea;ness ofton,ue

Ca$ses o" lesion:

-

*on$ fracture- Mass lesion

- Con,enitalalforation 5rare6

- Carotid dissection


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CN )##: Clinical 8"aination

• #ns0ect for ton,ue atro0h$&fasciculation or as$etr$

• Chec; for the stren,th of the ton,ueuscles


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Conclusion


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References

• (rinci0les of Anato$ + (h$siolo,$& Eth 8dition&Lerard ?= ortora + *r$an 9erric;son

• Fundaentals of Neurolo,$& Mar; Muenthaler&

einrish Mattle .ith 8than aub& #nternational8dition

• e"tboo; of (h$sical (h$siolo,$& L (al + (ravati

(al& 2nd

8dition

• Current Medical 9ia,nosis + reatent5CM96&ierne$& Mc(hee + (a0ada;is 1an,e& 4rd

cranial nerves lesions

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