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CNS V: Motor Aspects of Vision

Opening and Closing Eyelids
Opening eyelids = levator palpebrae muscle innervated by oculomotor
nerve (III)
Closing eyelids = orbicularis oculi muscle innervated by facial nerve
(VII)
Saccadic Eye Movements
Only 1mm of the retina, the fovea, is actually responsible for conscious
perception
90% of retina dedicated to eye movements and pupil constriction
Eyes must move around the visual scene very quickly to build up
the image we see in our mind
Although we only consciously perceive the image falling on the
fovea, the rest of it is made up by our brain, as if we can see the
entire visual field
Extraocular Eye Muscles
4 rectus muscles: superior, inferior, medial, lateral, originating from
tendonous cuff around optic nerve
Moves eye around in a circle
2 oblique muscles: superior and inferior
Muscles that correct gaze due to geometric misalignment
Superior oblique (innervated by trochlear, IV)) = has a
pulley/trochlea that redirects the tendon to attach to sclera
Inferior oblique (innervated by oculomotor, III) = on floor of orbit,
attaches to sclera
Looking medially and laterally = non-issue
However, looking upwards and downwards requires corrective action of
oblique muscles
Because tendonous cuff origin is medial, superior rectus muscle
wouldnt just pull eyeball up, but outwards as well
Lateral rectus innervated by abducens (VI)
Moves eyes laterally = abduction
Medial rectus innervated by oculomotor (III)
Moves eyes medially = adduction
Superior rectus innervated by oculomotor (III)
Pulls eye up, but also outwards/laterally
We require the inferior oblique to contract and pull the eye back
inward, compensating for this outward eye movement, so we can
look straight up

Inferior rectus innervated by oculomotor (III)

Pulls eye down, but also outward
We require superior oblique to pull compensate and pull eye back
inward

Diplopia (Double Vision)

Caused by problems with conjugate eye movements (moving both
eyes in the same fashiob)
Oculomotor (III) palsy
Inability to open eyelids
Eye is abducted, as effect of abducens innervating lateral rectus is
unopposed
Trochlear (IV) palsy
Since trochlear innervates superior oblique, which is needed to look
down, there is difficulty looking down
The eye is looking up, as the effects of the inferior oblique and
superior rectus are unopposed
Abducens (VI) palsy
Innervates lateral rectus, which abducts eye
Eye would be looking medially, as effects of medial rectus are
unopposed
Conjugate Eye Movements
Move eyes together in the same fashion to see distant objects
For horizontal gaze, you are using the medial rectus innervated by
oculomotor, and lateral rectus innervated by abducens nerve
CN3 is in midbrain, CN6 in pons
There must be a circuit that connects these two CNs to enable
horizontal gaze
Lets say we want to look left
Parapontine reticular formation (PPRF) = collection of nuclei at inferior
pons, receives visual input from brain
PPRF then signals both the:
Left abducens nucleus to contract lateral rectus of left eye, so left
eye abducts
Left medial longitudinal fasiculus (MLF), which crosses over in
medulla, innervating the right oculomotor nucleus
Right oculomotor nucleus then contracts right medial rectus,
adducting the right eye

Ultimately, both eyes gaze left

Lesion in MLF = problems with horizontal gaze
Reverse this for gazing right

Convergent Eye Movements

Move eyes in opposite directions so they converge medially in order to
see a nearby object
Contraction of both medial rectus muscles (CN3)
Contraction of ciliary body muscles to focus lens and magnify the
image
Constriction of pupil to increase depth of field so that more nearby
objects are in focus
All of the above can be done in the midbrain, as thats where CN3 is
located
Superior colliculi signals both left and right oculomotor nerves
This causes the contraction of both medial rectus muscles, so both
eyes converge on nearby object
Theres also a nearby parasympathetic nucleus associated with CN3,
travelling along CN3 to ciliary ganglion, where postganglionic nerve
innervates pupil constrictor
This allows for accommodation; pupil constriction allowing for more
depth of field and magnification of nearby objects
Lens shape differs for conjugate and convergent eye movements
Conjugate
Convergent
Lens is stretched as a result of
Parasympathetic fibres
the pull of zonular fibres
innervate ciliary muscle at
front of eye
Good for seeing faraway
Ciliary muscle contracts,
objects
pulling apparatus towards
front, loosening stretch on
zonular fibres
Relaxed zonular fibres allows
lens to round up
Better for seeing nearby
objects
Functions of Iris
Pupil = opening in iris
Iris functions to limit light entering eye
Back of iris has 2 layers of pigmented cells made of dense melanin
granules
Pigmentation present in everybody except albinos

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Blue eyed and brown eyed people have irises that work equally well;
no light can penetrate this double-layer of pigmented cells
Two muscles within the iris
Pupillary sphincter: runs along margin of iris, contracts to constrict
pupil (parasympathetic) = miosis
Preganglionic PS fibres near CN3 in midbrain travels to ciliary
ganglion, postganglionic PS nerve innervates pupillary sphincter
Pupillary dilator: located at edge of iris, goes up towards margin of
pupil, contracts to dilate pupil (sympathetic) = mydriasis
Preganglionic S fibres enter into thoracic paravertebral collateral
ganglion chain, ascending to most superior ganglia,
postganglionic S nerves then run along carotid arteries,
innervating pupillary dilator
Horners Syndrome (Sympathetic lesion)
Sympathetic system so far from eye, many things could go wrong
along the way
Ptosis (eyelid droop), as normal S response keeps eyes open
Miosis, as pupillary dilator unable to oppose pupillary sphincter
Anhydrosis = lack of sweating
Hyperemia = flushed skin due to loss of ability to control smooth
muscle around capillaries
Identify the Lesion
Mydriasis = CN3 lesion
Preganglionic PS nerve that extends to ciliary ganglion (which then
extends out a postganglionic PS nerve innervating the pupillary
constrictor) runs along CN3, so lesion to CN3 would damage this
nerve as well
Miosis = sympathetic NS lesion
Even though ptosis is present, lesion not present on CN3 because
no eyeball abduction present

CNS V: The Ear and Hearing

Cranial Nerves Involved in Hearing
Trigeminal (V) innervates tensor tympani muscle, putting tension on
tympanic membrane, limiting noise entering ear when eating
Facial (VII) innervates stapedius muscle of middle ear, protects against
loud noises
Vestibulocochlear (VIII) for hearing and balance
Vagus (X) as sensory innervation to auditory canal
Basic Anatomy of the Ear
External ear = tympanic membrane out to air

Middle ear: contains some bones

Inner ear = responsible for sound detection
Cochlea
Vestibular apparatus
Both exit through vestibulocochlear nerve

External auditory canal lined by skin which also lines surface of

tympanic membrane
Ceruminous glands secrete earwax to repel insects and dirt
Outer part of external ear is around 2/3 cartilage
Moving deeper into external ear, skin is very strongly adhered to bone
Problem = infection/inflammation of inner part of external ear
creates severe pain, as no connective tissue to relieve pain

Tympanic Membrane (Eardrum)

Bones on far side of tympanic membrane give it a distinct shape
Covered by the same skin lining the external auditory canal,
mucous membrane on inside, with connective tissue between
Removing the tympanic membrane, we can see into the middle ear
Mastoid air sinus = hole present on most posterior wall of middle
ear allowing communication with air cells
Bones (ossicles) hanging from roof of middle ear via ligaments
Ossicles consist of malleus, incus, and stapes
Function is to mechanically relay vibration of tympanic
membrane to oval window membrane of inner ear
Muscles attached to ossicles can dampen ossicle vibrations to prevent
sound to reach inner ear (volume control)
Tensor tympani = innervated by CN5, so during mastication, CN5
also contracts this muscle so we dont hear excessive chewing
sounds
Stapedius = attached from medial wall of middle ear to stapes,
innervated by CN7, so that when exposed to very loud sounds, CN7
contracts stapedius, preventing damage to delicate air cells
Pressure Equilibration in Middle Ear
Ossicles essentially hanging in air-filled sac, which must have balanced
pressure or your head would explode or implode when atmospheric
pressure changes
Auditory tube from pharynx
When swallowing, auditory tube momentarily opens, equilibrating
pressure in middle ear

Mastoid air cells inside the mastoid air sinus will also communicate into
middle ear, and subsequently to back of pharynx
Mastoid process posterior to auditory tube
Actually hollowed out by air sinuses

Complications of Middle Ear Infections

Occurs mostly in children, who sneeze and cough viruses into middle
ear through auditory tube, resulting in middle ear infection
If mucous membrane becomes inflamed, auditory tube has difficulty
opening
This results in high pressure in middle ear, severe pain
Tympanic membrane may rupture, allowing fluid from inflection to
flow out of ear; pain instantly goes away
Infection can spread from middle ear into mastoid air sinus, leading to
chronic mastoiditis
Roof of middle ear is a very thin sheet of temporal bone separating
middle ear and brain
Erosion of temporal bone above middle ear can lead to infection
reaching dura, causing meningitis
Inner Ear
Essentially a system of channels carved
out in petrous portion of temporal bone
Membrane in the channels floats in a fluid
derived from CSF = perilymph
Membrane itself also filled with fluid =
endolymph
Cochlea responsible for hearing
Contains semicircular canals
Hole on inside of skull leading to brain contains CN8
Transmission of Vibration
Tympanic membrane transfers vibrations to ossicles
Stapes relays vibrations to oval window
Vibrations from oval window tap onto vestibular membrane of
cochlear duct
Cochlear duct vibrates, causing endolymph to push onto tectorial
membrane
Tectorial membrane = mucous sheet sitting on tiny sensory hair
cell receptors
When sensory hair cells are bent due to vibrations, they
depolarize, transmitting impulses down the cochlear component
of CN8

Sensory hair cell receptors located on basilar membrane; tension of

basilar membrane dampens vibrations, tuning cochlea to different
frequencies
Basilar membrane made of collagen fibres
Vibrations travel along cochlea in perilymph up to apex of cochlea,
then back down the other side; essentially a hydraulic system
Vibrations relieved at round window located in scala tympani

Hearing Different Frequencies

Length of basilar membrane fibres tunes different parts of cochlea to
different frequencies
Shorter fiber (located at base of cochlea) = high notes
Longer fiber (located at apex of cochlea) = low notes
Exposure to loud sounds more likely to affect shorter fibres at cochlear
base, since amplitude is larger at the beginning, impairing ability to
hear higher frequencies
After CN8 Transmission
Signal travels to medulla, where cochlear nuclei are present to localize
sounds
Signal then ascends to pons, where a synapse is present allowing for
acoustic startle reflex
Signal then relayed to midbrain, where:
Inferior colliculi interacts with superior colliculi to coordinate eye
movements to origin of sound (visual-auditory reflex)
Medial geniculate nucleus of thalamus filters auditory information
E.g. self generated sounds like heartbeat supressed, so only
important sounds reach auditory cortex in temporal lobe
In primary auditory cortex, more deep = treble, more superficial
= bass
Deafness
Conduction deafness = problems with outer or middle ear
Results in reduction in sound amplitude
Causes = wax buildup, ruptured tympanic membrane, damage to
ossicles (arthritis)
Sensory deafness = problems with organ of Corti or CN8
Sensory hair cells affected due to trauma, prolonged noise, drugs,
tumours, Menieres disease (high endolymph pressure damages
sensory hair cells)
Results in rumbling sound as sensory hair cells responsible for treble
affected at cochlear base, so only bass remains

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Tinnitis = continuous hiss, as brain expecting sensory input starts
making it up