CRANIAL NERVES

Dede Gunawan

Department of Neurology
Medical Faculty Padjadjaran University -
Dr. Hasan Sadikin General Hospital
Bandung
 What are cranial nerves ?
 Is the twelve pairs of nerve that has its
origin at the base of the brain
 Not all of “ peripheral nerves ” , as the
olfactory bulb and optic nerve are in fact
extention of the Brain
 The rest are differentiated from somatic
peripheral nerve, not only by their
locations, but also they all have different/
spesific functions
Cranial
Nerves
Cranial
Nerve
Nuclei
Motoric
Cranial
Nerves
Nuclei
Sensoric
Cranial
Nerves
Nuclei
 Examples:
Some function as special senses, like
 Olfactory Olfactory nerve (I)
 Vission Optic nerve(II)
 Hearing and equilibrium
Stato-acustic nerve(VIII)
 Taste Trigemimenal-Fascial (V,VII)
Glossopharyngeal (IX)
 Pure motor function
Trochlear (IV)
Abducens(VI)
Hypoglossal (XII)
 What is the use in understanding
cranial nerve
 For localizing diseases at be the base of the
skull or brainstem
 This include knowledge of the anatomy of :
Base of the skull
Structures (nuclei and tracts) in the
brainstem

Help us in clinical diagnosis of brain death, in

the absence of EEG or other diagnostic
apparatus
 Nuclei of Cranial nerves
 Some nuclei serve only one nerve, like the motor
nuclei to the Abducens(VI) nerve
 The Nucleus Solitarius takes fiber from the
anterior 2/3 of the tongue, through the 5th nerve
(Lingual branch), through the chorda tympani,
and the 7th nerve. But from taste buds of the
posterior 1/3, through the glossopharyngeal
nerve
 Distribution Area of Cranial
nerves
 While most extent just around the head,
 Vagus (X), which is a parasympathic nerve sent
it’s fibers to the chest and abdominal cavity,
influencing the heart and the intestines until 2/3
of the colon.
 The olfactory nerve on the other hand is only a
few millimeters long, penetrating the lamina
cribrosa, from the top of the nasal cavity to the
olfactory bulb
 I . Olfactory nerve
 Brings the sense of smell from the nasal cavity
to the Olfactory bulb to the brain.
 Because of so fine it is easily ruptured during a
head injury
 The second cause of illness is frontal base
tumor and olfactory grove meningioma
 Injury to this nerve make people complain of
loss of appetite
N. I
N. I
 II. Optic nerve
 The optic nerve serves our vision
 Injury to the nerve may cause disturbance of ;
Visual acuity : Sharpness of vision or
Visual field defect
 It depends on the cause of illness and the
location of injury
 Papil edema : blurring of the optic disk on
ophthalmoscopic examination, is mostly a
sign of increased intracranial pressure
 but can found also in optic nerve
inflammation and malignant hypertension
N. II
Convergence
and
Accomodation
 III.Oculomotor nerve, IV. trochlear
nerve, VI. Abducens
 All this three-nerve synchronously move both the
eye-ball so that we will have optimal vision
 The 3th and 4th nerve have their nuclei in the
Mesencephalon
 The 6th nerve has it’s nuclei in the pons
 The 6th nerve move the eye-ball to the side, an
the 4th to the mid and downward.
 All other movements of the eye, including
moving the Eyelid upward, are the function of
the 3rd nerve.
 The 6th nerve travels the farthest on the base
of the skull, and is prone to paralysis during
chronic increased intracranial pressure
 In the cavernous sinus, those three nerves
travel together
 All enter the optic cavity through the superior
fissure
N. III, IV and VI
3rd Nerve Nuclei
N. III, IV, V & VI
 Location of injury
 Total ophthalmoplegia, the most likely place is
in the cavernous sinus
 Injury of the brainstem (mesencephalon)
usually gives only a partial 3rd nerve palsy,
but may be accompanied by contra-lateral
hemiplegia
 Injury of the side of the pons, may give 6th
nerve palsy, accompanied by 7th nerve palsy,
and contra-lateral hemiplegia
 Diseases behind of the eye give also mostly
partial ophthalmoplegia
N. III, IV, and VI
 Conjugate eye movement
 The left and right eye move synchronously, so
images is percieved as one in the brain.
 The centre of lateral conjugate movement is at
the side of the 6th Nerve, from where fibers go to
the Nuclei of the Medial Rectus, through the
Medial Lemniscus.
 The center of horizontal movement is at the
superior colliculus at the back of mesencephalon.
 Damage of the Medial Lemniscus causes
Internuclear ophthalmoplegia
Conjugate
movement
 V.Trigeminal Nerve
 This is the main sensory nerve of the face
(Portio Mayor), and inervates the muscles of
mastication (Portio Minor)
 It has three branches: Ophthalmic, Maxilary,
and Mandibular
 Nerve from the taste buds travels first through
the Lingual nerve, than through the Chorda
Tympani of the Fascial nerve (VII), to the
Solitary Nuclei in the midbrain
 Reversely, fibers to the submandibular and
subLingual glands, travel from the superior
Salivatory Nuclei, throught the 7th nerve
(Intermedius) and Chorda Tympani .
N. V
 VII. Fascial nerve
 This nerve predominantly innervates the
fascial muscles
 Taste fibers and motor fiber to the Lacrimal ,
and salivatory gland travel first with the fascial
motor fibers until the fascial channel
 Just after entering the internal acustic meatus
it gives branches to the lacrimal gland.
 The taste and salivatory fibers cross to the
5th nerve through the chorda tympani.
 Before exiting through the external acoustic
meatus, it give a motoric branch to the
stapedius muscle of the tympanic menbrane
N. VII
 Taste
Pathway
 Gland
Innervation
Central and Peripheral Fascial Palsies
 In peripheral fascial palsies, the whole side of
the face is paralysed
 There may also be Gustatory disturbances, and
Tinnitus due to paralysis of the Stapedius
muscle
 Central or Supra-Nuclear palsies like in strokes,
show only paralysis of the lower-half of the face,
as the part of Nuclei serving the upper –half is
bilaterally innervated.
Central 7th palsy Peripheral 7th palsy
 VIII. Stato-acustic nerve
 This is a short nerve traveling with the 7th
nerve at the cerebello-pontine angle to the
Internal auditory foramen. After entering the
petrosal bone it branches to the Cochlea
and semicircular channels
 In traumatic petrosal fractures, it may be
damaged together with the Fascial nerve
 An acoustic sheet meningioma, may cause
an early rise of intracranial pressure
 The acoustic portion, may also be damaged
by Streptomycine
N. VIII
 Central
Pathway of
Cochlear
Nerve
 Central
pathway of
vestibular
nerve
 IX. Glossopharyngeal
 This is a predominantly sensory nerve , serving
the Pharynx and Larynx,
 The Ambiguus Nuclei serve the muscles of the
pharynx and larynx, but the most dominant part
pass through the Vagus nerve
 It takes also nerves from the the Baro and
Chemo-receptors in the carotid Body,
 The fibers of taste buds from the posterior 1/3 of
the tongue and Pharynx also pass through this
nerve to the Solitary Nuclei
N. IX
 X. Vagus Nerve
 This is the most important nerve
 From the Ambiguus Nuclei it sends motor
fibers to most of muscle in the pharyx and
Larynx
 From the Parasympathic Dorsal Nuclei, sends
parasympatic branches to the Thoracic and
Abdominal cavity.
 The superior laryngeal nerve serves the
external Vocal muscles, while the inferior
Laryngeal nerve after went down first and
passing the Brachial vessel on the right and
the aortic arc on the left went back upward to
the muscles of the Vocal cord
N. X
 IX Accessory Nerve
 This is a relative minor nerve
 The cephalic part joint the Vagus nerve
 The cervical part is an in fact somatic
nerve, arises from the cervical medulla,
which past first upward, through the
Foramen Magnum, and then downward to
the Stercocleidomastoideus and Trapezius
muscles
N. XI
 XII Hypoglossal Nerve
 This is a motoric nerve serving the muscles of
the tongue
 We have external muscles, which move the
tongue to all directions, and internal muscles
which can thicked or flatten or curl the tongue
 In stroke, paralysis of one side of the Genio-
hyoid muscle, causes the tongue protrude to the
paralysed side
 In chronic peripheral nerve lesions the tongue
flattened and Fasciculated
N. XII