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Lecture 5: 26/02/2022 Presented by: David Son Cranial Nerves Examination SURGICAL SOCIETY JUNIOR ANATOMY SERIES | CPA LECTURE SERIESContents Examination Anatomy Imaging Pathology presentation Practice questions S U R G S O C J A S | C P A L E C T U R E S E R I E S 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 S U R G S O C J A S | C P A L E C T U R E S E R I E S Structure of the Examination Inspection Eyes Ears & Gait • Medical paraphernalia • Vision (CN II) • Hearing (CN VIII) • Medication • Movement (CN III, IV & • Balance (CN VIII) • Pathological signs VI) Nose & Mouth Face Shoulders & Neck • Smell (CN I) • Sensation (CN V) • Sternocleidomastoid (CN • Gag reflex & swallowing (CN XI) IX) • Muscles (CN V) • Uvula (CN X) • Facial expression (CN • Trapezius (CN XI) • Tongue (CN XII) VII) S U R G S O C J A S | C P A L E C T U R E S E R I E S Vision Pupillary light reflex • Visual acuity Fundoscopy • Ipsilateral pupil • Colour vision • Optic disc • Contralateral pupil • Ipsilateral & consensual • Visual fields • Macula & fovea reflex • Blind spots • Retinal vein & artery S U R G S O C J A S | C P A L E C T U R E S E R I E SEye • Superior rectus: elevation, adduction, 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 S U R G S O C J A S | C P A L E C T U R E S E R I E S • I (Olfactory): Cribriform plate • II (Optic): Optic canal Cranial foramina • 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 S U R G S O C J A S | C P A L E C T U R E S E R I E S • Bell’s Palsy Ms X th • LMN lesion of the 7 cranial nerve (facial nerve) S U R G S O C J A S | C P A L E C T U R E S E R I E S Paralysis of lower face on the left side is suggestive of Which nerve innervates the lateral rectus muscle of what lesion site? the eye? Right upper motor neurone Abducens nerve Uvular deviation to the right-hand side is suggestive of what lesion site? Where does the olfactory nerve exit from? Cribriform plate Left vagus nerve Tongue deviation to the left-hand side is suggestive of what lesion site? Left hypoglossal nerve S U R G S O C J A S | C P A L E C T U R E S E R I E S David Son david.suk20@imperial.ac.uk JAS Leads CPA Lead: Mohamad Abou-Eid (ma2219@ic.ac.uk) Phase 1a Lead: Sree Kanakala (sk1821@ic.ac.uk) Phase 1b Lead: Ananya Jain (aj620@ic.ac.uk) Feedback
