Peripheral Nervous System & Reflex Activity Part B: Cranial Nerves HESC310 4/22/2017 Peripheral Nervous System & Reflex Activity Part B: Cranial Nerves Prepared by Janice Meeking & W. Rose. Figures from Marieb & Hoehn 8th, 9th ed. Portions copyright Pearson Education Axial Skeleton

“On occasion, our trusty truck acts funny—very good vehicle anyhow” Cranial Nerves Twelve pairs of nerves associated with the brain Most are mixed in function; two pairs are purely sensory Each nerve is identified by a number (I through XII) and a name “On occasion, our trusty truck acts funny—very good vehicle anyhow”

Hypoglossal nerve (XII) Filaments of olfactory nerve (I) Frontal lobe Olfactory bulb Olfactory tract Optic nerve (II) Temporal lobe Optic chiasma Infundibulum Optic tract Facial nerve (VII) Oculomotor nerve (III) Vestibulo- cochlear nerve (VIII) Trochlear nerve (IV) Trigeminal nerve (V) Glossopharyngeal nerve (IX) Abducens nerve (VI) Vagus nerve (X) Cerebellum Accessory nerve (XI) Medulla oblongata Hypoglossal nerve (XII) (a) Figure 13.5 (a)

Yes (hearing and balance) Cranial nerves I – VI Sensory function Motor function PS* fibers I Olfactory Yes (smell) No No II Optic Yes (vision) No No III Oculomotor No Yes Yes IV Trochlear No Yes No V Trigeminal Yes (general sensation) Yes No VI Abducens No Yes No Cranial nerves VII – XII Sensory function Motor function PS* fibers VII Facial Yes (taste) Yes Yes VIII Vestibulocochlear Yes (hearing and balance) Some No IX Glossopharyngeal Yes (taste) Yes Yes X Vagus Yes (taste) Yes Yes XI Accessory No Yes No XII Hypoglossal No Yes No *PS = parasympathetic (b) Figure 13.5 (b)

I: The Olfactory Nerves Arise from the olfactory receptor cells of nasal cavity Pass through the cribriform plate of the ethmoid bone Fibers synapse in the olfactory bulbs Pathway terminates in the primary olfactory cortex Purely sensory (olfactory) function

Table 13.2

II: The Optic Nerves Arise from the retinas Pass through the optic canals, converge and partially cross over at the optic chiasma Optic tracts continue to the thalamus, where they synapse Optic radiation fibers run to the occipital (visual) cortex Purely sensory (visual) function

Table 13.2

III: The Oculomotor Nerves Fibers extend from the ventral midbrain through the superior orbital fissures to the extrinsic eye muscles Functions in raising the eyelid, directing the eyeball, constricting the iris (parasympathetic), and controlling lens shape

Table 13.2

IV: The Trochlear Nerves Fibers from the dorsal midbrain enter the orbits via the superior orbital fissures to innervate the superior oblique muscle Primarily a motor nerve that directs the eyeball

Table 13.2

V: The Trigeminal Nerves Largest cranial nerves; fibers extend from pons to face Three divisions Ophthalmic (V1) passes through the superior orbital fissure Maxillary (V2) passes through the foramen rotundum Mandibular (V3) passes through the foramen ovale Convey sensory impulses from various areas of the face (V1) and (V2), and supplies motor fibers (V3) for mastication

Table 13.2

Table 13.2

VI: The Abducens Nerves Fibers from the inferior pons enter the orbits via the superior orbital fissures Primarily a motor, innervating the lateral rectus muscle

Table 13.2

VII: The Facial Nerves Fibers from the pons travel through the internal acoustic meatuses, and emerge through the stylomastoid foramina to the lateral aspect of the face Chief motor nerves of the face with 5 major branches Motor functions include facial expression, parasympathetic impulses to lacrimal and salivary glands Sensory function (taste) from the anterior two-thirds of the tongue

Table 13.2

Table 13.2

VIII: The Vestibulocochlear Nerves Afferent fibers from the hearing receptors (cochlear division) and equilibrium receptors (vestibular division) pass from the inner ear through the internal acoustic meatuses, and enter the brain stem at the pons-medulla border Mostly sensory function; small motor component for adjustment of sensitivity of receptors

Table 13.2

IX: The Glossopharyngeal Nerves Fibers from the medulla leave the skull via the jugular foramen and run to the throat Motor functions: innervate part of the tongue and pharynx for swallowing, and provide parasympathetic fibers to the parotid salivary glands Sensory functions: fibers conduct taste and general sensory impulses from the pharynx and posterior tongue, and impulses from carotid chemoreceptors and baroreceptors

Table 13.2

X: The Vagus Nerves The only cranial nerves that extend beyond the head and neck region Fibers from the medulla exit the skull via the jugular foramen Most motor fibers are parasympathetic fibers that help regulate the activities of the heart, lungs, and abdominal viscera Sensory fibers carry impulses from thoracic and abdominal viscera, baroreceptors, chemoreceptors, and taste buds of posterior tongue and pharynx

Table 13.2

XI: The Accessory Nerves Formed from ventral rootlets from the C1–C5 region of the spinal cord (not the brain) Rootlets pass into the cranium via each foramen magnum Accessory nerves exit the skull via the jugular foramina to innervate the trapezius and sternocleidomastoid muscles

Table 13.2

XII: The Hypoglossal Nerves Fibers from the medulla exit the skull via the hypoglossal canal Innervate extrinsic and intrinsic muscles of the tongue that contribute to swallowing and speech

Table 13.2

Cranial Nerve Testing http://library.med.utah.edu/neurologicexam/html/cranialnerve_normal.html http://library.med.utah.edu/neurologicexam/html/cranialnerve_abnormal.html Abnormal: “Cranial nerves 3, 4, and 6 versions” 1 Normal: “Vestibulo-ocular” (this tests III and VIII) Abnormal: “Cranial Nerve 12- Motor” 3 If time allows: Abnormal: “Cranial nerves 3, 4, and 6 ductions” 2 If time allows: Normal: “Cranial Nerve 12- Motor” 1. Versions: binocular tests, part of a regular exam. Pt. 1 can’t abduct L, i.e. n.6 (L) palsy. Pt.2 limited adduct, elevate, depress L eye, also shows ptosis-+ & dilated pupil, i.e. n.3 (L) palsy. 2. Duction (monocular) tests done iff version results abnormal. Pt can’t medially rotate either eye. Observe nystagmus upon abduction of each eye. This & other results (not shown) suggest bilateral internuclear ophthalmoplegia, often caused by demyelinating lesion affecting medial longitudinal fasciculus (MLF) bilaterally. Adduction defect occurs due to disruption of MLF connections between the abducens nucleus and the lower motor neurons in the oculomotor nucleus that innervate the medial rectus muscle. 3. Atrophy, weakness, r. deviation of tongue due to lesion of r. cranial nerve 12. Movies from the Neurologic Exam and PediNeurologic Exam websites by Paul D. Larsen, M.D., University of Nebraska Medical Center and Suzanne S. Stensaas, Ph.D., University of Utah School of Medicine. Additional materials for Neurologic Exam are drawn from resources provided by Alejandro Stern, Stern Foundation, Buenos Aires, Argentina; Kathleen Digre, M.D., University of Utah; and Daniel Jacobson, M.D., Marshfield Clinic, Wisconsin.