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2444758459470IVTrochlearSO 400IVTrochlearSO 429768808489950Midbrain00Midbrain21336008489950Origin00Origin1127125845947029768808818880Between posterior cerebral artery and superior cerebellar artery in lateral wall of cavernous sinus (lateral to III) superior orbital fissure SO makes you look down and in00Between posterior cerebral artery and superior cerebellar artery in lateral wall of cavernous sinus (lateral to III) superior orbital fissure SO makes you look down and in21336008815070Course00Course21336009449435Symptoms00Symptoms29768809449435Can’t look down and in; head tilted to opposite side00Can’t look down and in; head tilted to opposite side19710409812655Mononeuritis multiplex; multiple sclerosis; GBS; increased intracranial pressure; diphtheria; botulism; diabetes; HTN00Mononeuritis multiplex; multiple sclerosis; GBS; increased intracranial pressure; diphtheria; botulism; diabetes; HTN11271259812655Aetiology00Aetiology2451106264275IIIOculo-motorSR, MR, IR, IOPara-sympatheticLPS00IIIOculo-motorSR, MR, IR, IOPara-sympatheticLPS11271257800975Aetiology00Aetiology19710407800976Diabetes + HTN most common cause – but spare pupil as ischaemic to central fibres firstCancer (eg. Brain, nasopharyngeal), aneurysm, arteritis, multiple sclerosis, GBS (MFS), increased intracranial pressure, diptheria, botulism00Diabetes + HTN most common cause – but spare pupil as ischaemic to central fibres firstCancer (eg. Brain, nasopharyngeal), aneurysm, arteritis, multiple sclerosis, GBS (MFS), increased intracranial pressure, diptheria, botulism19710407471410Ptosis; down and out (can’t look up and in); mydriasis; no light / accommodation reflex00Ptosis; down and out (can’t look up and in); mydriasis; no light / accommodation reflex11271257471410Symptoms00Symptoms21336006294755Origin00Origin29768806294755Anterior midbrain00Anterior midbrain29768806623685Between posterior cerebral artery and superior cerebellar artery lateral wall and roof of cavernous sinus superior orbital fissure between 2 heads of lateral rectus superior division to SR and LPS, inferior division to MR, IR, IO, parasympathetic ciliary ganglion (which runs on outside of nerve)00Between posterior cerebral artery and superior cerebellar artery lateral wall and roof of cavernous sinus superior orbital fissure between 2 heads of lateral rectus superior division to SR and LPS, inferior division to MR, IR, IO, parasympathetic ciliary ganglion (which runs on outside of nerve)21336006619875Course00Course112712562642752451102298700IIOptic00IIOptic11271253595370 Sudden bilateral blindness: bilateral occipital ischaemia (pupil reflexes preserved), trauma, meths, functional Gradual bilateral blindness: cataracts, glaucoma, diabetes, chiasmal / optic nerve compression Sudden unilateral blindness: anterior to optic chiasm; retinal artery / vein thrombosis; temporal arteritis; glaucoma; papilloedema; chorioretinitis; migraineBitemporal hemianopia: optic chiasm; may have RAPDHomonymous hemianopia: on contralateral side to lesion; posterior to optic chiasm (may be macular sparing if in radiation, in tract complete); light reflex gone, accommodation intactCentral scotoma: multiple sclerosis; meths; ETOH; optic gliomaPapilloedema: blurred pink disc; engored retinal veins; filled optic cup; haemorrhages; takes >6hrs Caused by space occupying lesions, hydrocephalus, intracranial HTN, HTN, central retinal vein thrombosis 00 Sudden bilateral blindness: bilateral occipital ischaemia (pupil reflexes preserved), trauma, meths, functional Gradual bilateral blindness: cataracts, glaucoma, diabetes, chiasmal / optic nerve compression Sudden unilateral blindness: anterior to optic chiasm; retinal artery / vein thrombosis; temporal arteritis; glaucoma; papilloedema; chorioretinitis; migraineBitemporal hemianopia: optic chiasm; may have RAPDHomonymous hemianopia: on contralateral side to lesion; posterior to optic chiasm (may be macular sparing if in radiation, in tract complete); light reflex gone, accommodation intactCentral scotoma: multiple sclerosis; meths; ETOH; optic gliomaPapilloedema: blurred pink disc; engored retinal veins; filled optic cup; haemorrhages; takes >6hrs Caused by space occupying lesions, hydrocephalus, intracranial HTN, HTN, central retinal vein thrombosis 1127125359537019202403249295VA; visual fields; direct and consensual pupil reflex; pupil sizes; fundoscopy00VA; visual fields; direct and consensual pupil reflex; pupil sizes; fundoscopy11271253249295Exam00Exam11271252623185Course00Course19202402626995Optic foramen optic chiasma in pituitary fossa optic tract lateral geniculate body optic radiation (connect with oculomotor nerve via superior colliculus) internal capsule temporal lobe (lower quads), parietal lobe (upper quads) occipital cortex00Optic foramen optic chiasma in pituitary fossa optic tract lateral geniculate body optic radiation (connect with oculomotor nerve via superior colliculus) internal capsule temporal lobe (lower quads), parietal lobe (upper quads) occipital cortex19202402298700Eye00Eye11271252298065Origin00Origin245110965200IOlfactory00IOlfactory19202401951990Meningioma, ethmoid tumour, basal skull fracture, pituitary surgery00Meningioma, ethmoid tumour, basal skull fracture, pituitary surgery19202401622425Anosmia00Anosmia19202401294130Cribiform plate of ethmoid bone00Cribiform plate of ethmoid bone1920240965200Inferior frontal lobe, primary olfactory cortex00Inferior frontal lobe, primary olfactory cortex11271251951990Aetiology00Aetiology11271251622425Symptoms00Symptoms1127125964565Origin00Origin11271251289685Course00Course246380330200Cranial Nerves00Cranial Nerves19196059666605Sensory: lower face and anterior head; mucous membranes of nose / sinuses / mouth / anterior 2/3 of tongue / orbit / dura / cornea; test corneal reflex; facial sensationMotor: muscles of mastication; mylohyoid; anterior belly digastric; tensor palate / tympani; buccinators; test muscles of mastication and jaw jerk00Sensory: lower face and anterior head; mucous membranes of nose / sinuses / mouth / anterior 2/3 of tongue / orbit / dura / cornea; test corneal reflex; facial sensationMotor: muscles of mastication; mylohyoid; anterior belly digastric; tensor palate / tympani; buccinators; test muscles of mastication and jaw jerk11283959666605Symptoms00Symptoms19196057798435Posterior cranial fossa over petrous temporal bone middle cranial fossa (trigeminal ganglion beside greater wing of sphenoid) lateral wall of cavernous sinusV1 = ophthalmic = sensory Nasociliary orbit through head of LR infratrochlear, anterior ethmoid Lacrimal orbit above LR Frontal orbit above LR supraorbital, supratrochlear If opthalmic only lost = cavernous sinus; if all lost = centralV2 = maxillary = sensory through foramen rotundum pterygomaxillary fissure infraorbital groove meningeal, infraorbital, post sup /ant sup alveolar nerve, zygomaticofacial/temporalV3 = mandibular = sensory + motor through foramen ovale meningeal, medial / lateral pterygoid, buccal, deep temporal, masseter, auriculotemporal, inferior alveolar, lingual00Posterior cranial fossa over petrous temporal bone middle cranial fossa (trigeminal ganglion beside greater wing of sphenoid) lateral wall of cavernous sinusV1 = ophthalmic = sensory Nasociliary orbit through head of LR infratrochlear, anterior ethmoid Lacrimal orbit above LR Frontal orbit above LR supraorbital, supratrochlear If opthalmic only lost = cavernous sinus; if all lost = centralV2 = maxillary = sensory through foramen rotundum pterygomaxillary fissure infraorbital groove meningeal, infraorbital, post sup /ant sup alveolar nerve, zygomaticofacial/temporalV3 = mandibular = sensory + motor through foramen ovale meningeal, medial / lateral pterygoid, buccal, deep temporal, masseter, auriculotemporal, inferior alveolar, lingual2444757471410VTri-geminal00VTri-geminal332105828992511264907795895Course00Course11264907470775Origin00Origin19196057471410Pons00Pons2463802185035PupilProblems00PupilProblems11264906162675Other00Other19812006163310Diencephalic: Mid position pupilsReactiveMidbrain: Mid position pupilsNon-reactivePontine: PinpointReactiveLook away from side of lesionMedulla: LargeNon-reactiveMetabolic: Small ReactiveUncal herniation: unilateral dilated non-reactive (medial temporal lobe herniates III compression)00Diencephalic: Mid position pupilsReactiveMidbrain: Mid position pupilsNon-reactivePontine: PinpointReactiveLook away from side of lesionMedulla: LargeNon-reactiveMetabolic: Small ReactiveUncal herniation: unilateral dilated non-reactive (medial temporal lobe herniates III compression)11264903921760Miosis00Miosis30714954551046Sympathetic nerve supply damage (ie. Opposite of Holmes Adie Pupil)Lesion in medulla if IX, X, XI involved; lesion middle cranial fossa if V involvedAetiology: CVA, aneurysm, cavernous sinus thrombosis (if III, IV, VI involved), carotid dissection, cancer (brain, lung, pancoast, thyroid, cervical, jugular foramen), glioma, encephalitis, infection, sinusitis, multiple sclerosis, syringomyelia, trauma (thyroid, laryngeal surgery, stab wound), basal skull fracture)Symptoms: miosis; ptosis; enopthalmus; anhydrosis (if present = central / preganglionic)00Sympathetic nerve supply damage (ie. Opposite of Holmes Adie Pupil)Lesion in medulla if IX, X, XI involved; lesion middle cranial fossa if V involvedAetiology: CVA, aneurysm, cavernous sinus thrombosis (if III, IV, VI involved), carotid dissection, cancer (brain, lung, pancoast, thyroid, cervical, jugular foramen), glioma, encephalitis, infection, sinusitis, multiple sclerosis, syringomyelia, trauma (thyroid, laryngeal surgery, stab wound), basal skull fracture)Symptoms: miosis; ptosis; enopthalmus; anhydrosis (if present = central / preganglionic)1971040535686029870403916680Lesion of iridodilator fibres in midbrainAetiology: diabetes, syphilis, alcoholic neuropathy, midbrain lesionsSymptoms: will accommodate; won’t react to direct / consensual light00Lesion of iridodilator fibres in midbrainAetiology: diabetes, syphilis, alcoholic neuropathy, midbrain lesionsSymptoms: will accommodate; won’t react to direct / consensual light19812003916045Argyl Robertson Pupil00Argyl Robertson Pupil19812004550410Horner’s Syndrome00Horner’s Syndrome11283952183130Mydriasis00Mydriasis19710403612515Also: III palsy; drugs (anticholinergics, TCA’s)00Also: III palsy; drugs (anticholinergics, TCA’s)19723102800350Marcus Gunn Pupil00Marcus Gunn Pupil29781502800985Lesion of afferent pathwayAetiology: multiple sclerosisSymptoms: RAPD; will react to consensual light, not to direct light (so dilates when you shine your light on it with swinging light test)00Lesion of afferent pathwayAetiology: multiple sclerosisSymptoms: RAPD; will react to consensual light, not to direct light (so dilates when you shine your light on it with swinging light test)19723102165985Holmes AdiePupil00Holmes AdiePupil29781512166620Lesion of parasympathetic nerve supply (ie. Opposite of Horner’s)Aetiology: usually secondary to bacterial / viral infectionSymptoms: slow accommodate; won’t react to direct / consensual light00Lesion of parasympathetic nerve supply (ie. Opposite of Horner’s)Aetiology: usually secondary to bacterial / viral infectionSymptoms: slow accommodate; won’t react to direct / consensual light246380432435VIAbducensLR 600VIAbducensLR 611283951667510Aetiology00Aetiology19723101667510Wernicke’s encephalopathy; mononeuritis multiplex; multiple sclerosis; GBS; increased intracranial pressure; diphtheria; botulism00Wernicke’s encephalopathy; mononeuritis multiplex; multiple sclerosis; GBS; increased intracranial pressure; diphtheria; botulism29787851318895Can’t look out; convergent strabismus00Can’t look out; convergent strabismus21348701318895Symptoms00Symptoms2134870788035Course00Course2978150791845Over petrous temporal bone in cavernous sinus (anterior to ICA, inferior and medial to III) superior orbital fissure between 2 heads of LR LR00Over petrous temporal bone in cavernous sinus (anterior to ICA, inferior and medial to III) superior orbital fissure between 2 heads of LR LR11569704324352134870462915Origin00Origin2978150462915Pons00Pons19812009248140To all except palatoglossus; tongue deviates to side of lesion00To all except palatoglossus; tongue deviates to side of lesion19913608902065Hypoglossal canal00Hypoglossal canal12052309248140Symptoms00Symptoms12058658902700Course00Course12001508573135Origin00Origin19812008577580Medulla00Medulla3340108566785XIIHypo-glossal00XIIHypo-glossal3340107521575XIAccessory00XIAccessory12052308202930Symptoms00Symptoms19812008202930Drooping of shoulder; downward rotation and protraction of scapula; wasting of trapezius00Drooping of shoulder; downward rotation and protraction of scapula; wasting of trapezius12058657857490Course00Course19913607856855Foramen magnum spinal root and cranial root00Foramen magnum spinal root and cranial root12001507527925Origin00Origin19812007532370Pons00Pons3340106055360XVagus00XVagus12052306866890Symptoms00Symptoms19812006866255Mengingeal, auricular (tympanic membrane), pharyngeal, superior laryngeal (mucous membranes above cords), recurrent laryngeal (mucous membranes below cords), cardiac, visceralUvula deviation away, absent gag, hoarseness, bovine cough00Mengingeal, auricular (tympanic membrane), pharyngeal, superior laryngeal (mucous membranes above cords), recurrent laryngeal (mucous membranes below cords), cardiac, visceralUvula deviation away, absent gag, hoarseness, bovine cough12058656391275Course00Course19913606390640Jugular foramen in carotid sheath anterior to subclavian artery, posterior to brachiocephalic artery00Jugular foramen in carotid sheath anterior to subclavian artery, posterior to brachiocephalic artery12001506061710Origin00Origin19812006066155Medulla00Medulla3340104733925IXGlosso-pharyn-geal00IXGlosso-pharyn-geal12052305391785Symptoms00Symptoms19913605391785Tympanic (mucous membrane of middle ear and auditory tube, parotid), stylopharyngeus, pharyngeal sensation, carotid sinus; taste and sensation to posterior 1/3 of tongue, tonsils, posterior 1/3 palate, anterior epiglottis00Tympanic (mucous membrane of middle ear and auditory tube, parotid), stylopharyngeus, pharyngeal sensation, carotid sinus; taste and sensation to posterior 1/3 of tongue, tonsils, posterior 1/3 palate, anterior epiglottis19812004744085Medulla00Medulla12001504739640Origin00Origin12058655069205Course00Course19913605069205Jugular foramen between IJV and ICA between ICA and ECA into pharynx and tongue00Jugular foramen between IJV and ICA between ICA and ECA into pharynx and tongue3340103102610VIIIVestibulo-cochlear00VIIIVestibulo-cochlear12058654262755Aetiology00Aetiology19913604262121Acoustic neuroma, TORCH, # petrous temporal bone, aspirin, gentamicin, brainstem disease, vascular, conductive00Acoustic neuroma, TORCH, # petrous temporal bone, aspirin, gentamicin, brainstem disease, vascular, conductive12052303761105Symptoms00Symptoms19913603760470Whispering test, Rinne’s (behind ear, air should be > bone, if not = conductive deafness), Webers (forehead; conductive localises to affected side, sensory to opposite), Hallpike00Whispering test, Rinne’s (behind ear, air should be > bone, if not = conductive deafness), Webers (forehead; conductive localises to affected side, sensory to opposite), Hallpike19913603437890Int auditory meatus cochlear and vestibular branches00Int auditory meatus cochlear and vestibular branches12058653437890Course00Course12001503108325Origin00Origin19812003112770Pons00Pons334010690245VIIFacial00VIIFacial12058652303145Aetiology00Aetiology19913602302510UMN: cancer, vascularLMN: cancer, vascular; acoustic neuroma, Bell’s palsy (HSV 1), multiple sclerosis, Ramsay Hunt syndrome, parotid, basal skull fracture, meningitis, otitis media, diphtheria, sarcoidosis (tends to be bilateral not unilateral)00UMN: cancer, vascularLMN: cancer, vascular; acoustic neuroma, Bell’s palsy (HSV 1), multiple sclerosis, Ramsay Hunt syndrome, parotid, basal skull fracture, meningitis, otitis media, diphtheria, sarcoidosis (tends to be bilateral not unilateral)12052301348740Symptoms00Symptoms19913601348105Chorda tympani: sensory, parasympathetic; submandibular and sublingual glands, taste anterior 2/3 tongueMuscular: temporal, zygomatic, buccal, mandibular, cervical, posterior belly digastric, stylohyoid; facial expression (LMN involves occipitofrontalis)Post auricular, meningeal; hyperacusis00Chorda tympani: sensory, parasympathetic; submandibular and sublingual glands, taste anterior 2/3 tongueMuscular: temporal, zygomatic, buccal, mandibular, cervical, posterior belly digastric, stylohyoid; facial expression (LMN involves occipitofrontalis)Post auricular, meningeal; hyperacusis19913601025525Int auditory meatus stylomastoid foramen postmedial parotid gland00Int auditory meatus stylomastoid foramen postmedial parotid gland12058651025525Course00Course1981200700405Pons00Pons1200150695960Origin00Origin ................
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