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Lecture 5: 27/02/2022 Presented by: Kavyesh Vivek Cranial Nerves Examination SURGICAL SOCIETY JUNIOR ANATOMY SERIES |ECTURE SERIESContents Examination Anatomy Imaging Pathology presentation Practice questions SURGSOC JAS | LECTURE SERIES Case: Ms X • Ms X presents to A&E at 2pm on a Thursday with a sudden inability to move the left side of her face • You need to perform a neurological examination to identify the likely site of the lesion and rule out any other possible lesion sites SURGSOC JAS |CPA LECTURE SERIES Structure of the Examination Inspection Eyes Face • Sensation (CN V) • Medical paraphernalia • Vision (CN II) • Medication • Movement (CN III, IV • Muscles (CN V) & VI) • Facial • Pathological signs expression (CN VII) Nose & Mouth Ears & Gait Shoulders & Neck • Smell (CN I) • Hearing (CN VIII) • Sternocleidomastoid • (CN IX)lex & swallowing (CN XI) • Balance (CN VIII) • Uvula (CN X) • Trapezius (CN XI) • Tongue (CN XII) SURGSOC JAS | CPA LECTURE SERIES Vision Pupillary light reflex • Visual acuity Fundoscopy • Ipsilateral pupil • Colour vision • Optic disc • Contralateral pupil • Visual fields • Macula & fovea • Ipsilateral & consensual • Blind spots • Retinal vein & artery reflex SURGSOC JAS | CPA LECTURE SERIES Vision Pupillary light reflex • Visual acuity Fundoscopy • Ipsilateral pupil • Colour vision • Optic disc • Contralateral pupil • Visual fields • Macula & fovea • Ipsilateral & consensual • Blind spots • Retinal vein & artery reflex SURGSOC JAS | CPA LECTURE SERIES • Superior rectus: elevation, adduction, Eye internal rotation • Inferior rectus: depression, adduction, external rotation • Medial rectus: adduction • Lateral rectus: abduction • Superior oblique: depression, abduction, internal rotation • Inferior oblique: elevation, abduction, external rotation • Levator palpebrae superioris: elevation of upper eyelid SURGSOC JAS | CPA LECTURE SERIES • I (Olfactory): Cribriform plate Cranial foramina • II (Optic): Optic canal • III (Oculomotor): Superior orbital fissure • IV (Trochlear): Superior orbital fissure • V1 (Trigeminal (ophthalmic)): Superior orbital fissure • V2 (Trigeminal (maxillary)): Foramen rotundum • V3 (Trigeminal (mandibular): Foramen ovale • VI (Abducens): Superior orbital fissure • VII (Facial): Internal acoustic meatus to stylomastoid foramen • VIII (Vestibulocochlear): Internal acoustic meatus • IX (Glossopharyngeal): Jugular foramen • X (Vagus): Jugular foramen • XI (Accessory): Jugular foramen • XII (Hypoglossal): Hypoglossal canal SURGSOC JAS | CPA LECTURE SERIES • I (Olfactory): Cribriform plate Cranial foramina • II (Optic): Optic canal • III (Oculomotor): Superior orbital fissure • IV (Trochlear): Superior orbital fissure • V1 (Trigeminal (ophthalmic)): Superior orbital fissure • V2 (Trigeminal (maxillary)): Foramen rotundum • V3 (Trigeminal (mandibular): Foramen ovale • VI (Abducens): Superior orbital fissure • VII (Facial): Internal acoustic meatus to stylomastoid foramen • VIII (Vestibulocochlear): Internal acoustic meatus • IX (Glossopharyngeal): Jugular foramen • X (Vagus): Jugular foramen • XI (Accessory): Jugular foramen • XII (Hypoglossal): Hypoglossal canal SURGSOC JAS | CPA LECTURE SERIESMs X • Bell’s Palsy • UMN lesion of the 7th cranial nerve (facial nerve) SURGSOC JAS |A LECTURE SERIES Paralysis of lower face on the left side is Which nerve innervates the lateral rectus muscle suggestive of what lesion site? of the eye? Right upper motor neurone Abducens nerve Uvular deviation to the right -hand side is Where does the olfactory nerve exit from? suggestive of what lesion site? Left vagus nerve Cribriform plate Tongue deviation to the -hlafd side is suggestive of what lesion site? Left hypoglossal nerve SURGSOC JAS | CPA LECTURE SERIESKavyesh Vivek kv219@ic.ac.uk