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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$sta,us
iii= Strabisus
iv= 9i0lo0ia
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CN ###: Oculootor Nerve
i= (tosis
Causes:
• #0airent of CN### functions
• M$asthenia ,ravis
ii= N$sta,us
?er;$ oveent ofthe e$eball
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CN ###: Oculootor Nerve
iv= 9i0lo0ia
Causes:
Can also ha00en in
CN ###& CN #' + CN'#
iii= Strabisus
- S
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CN #': rochlear Nerve
• A otor cranial nerve
• Su00l$ 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