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Cranial Nerves - Physiopedia
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Purves D, ed. Neuroscience, 3rd Ed. Sinauer, Excellent text of basic neuroscience. It is somewhat deficient in neuroanatomy, but it is very clear and easy to follow. There are interesting digressions that are provided as separate short articles that are set off in boxes from the rest of the text.
Summary of the Cranial Nerves
Nolte J. Standard text of neuroscience utilized in many medical schools. It is comprehensive but not overly detailed. Principles of Neural Science. McGraw-Hill, This is the "bible" of neuroscience texts. Well-organized but quite heavy in sections. It extensively references primary sources and introduces methodology.
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This is a wonderful text for the graduate or the advanced student of neuroscience. Each section can be studied on its own by the student with a background in neuroscience. Haines DE. Nolte J and Angevine JB. Mosby, This atlas includes many illustrations that provide a 3-dimentional feel for brain structures. Neuroanatomy: Text and Atlas, 3rd ed. Atlas is incorporated in a text with more description than is found in most atlases. Figure 1. Nernst equation. At body temperature, the potassium equilibrium potential which represents the great majority of resting membrane potential is a constant times the logarithm of the ratio of concentrations of potassium outside and inside the cell.
This is similar to the Nernst equation except that it adds a factor for permeability. If an ion is impermeable, its contribution to the membrane potential V is nil. The higher the relative permeability, the closer the membrane will be to the equilibrium potential for that ion. Figure 2. Action potential. Depolarization is a graded phenomenon until threshold is reached. At that point, voltage-gated sodium channels are opened and the movement of sodium rapidly depolarizes the neuron. The voltage-gated sodium channels are then rapidly inactivated and voltage gated potassium channels are opened, which drives the cell back toward the potassium equilibrium potential near mV.
Until the cell repolarizes, the voltage-gated sodium channels are inactivated and another action potential cannot be generated absolute refractory period. Until the voltage gated potassium channels are inactivated it is harder but not impossible to generate an action potential relative refractory period. Figure 3. A myelomere of the spinal cord, and one of its two associated spinal nerves. In A: A, anterior median fissure; P, posterior median sulcus. B shows the arterial supply to the cord.
C depicts a sensory axon in the dorsal nerve root and a somatic motor axon in the ventral nerve root. Additionally, there is a sympathetic preganglionic axon arising from a neuron in the spinal cord lateral horn and this is traversing the white ramus communicans to the sympathetic gangliated chain where it is synapsing on a small postganglionic neuron. A and B by permission of R. O'Rahilly, "Basic Human Anatomy.
Figure 4. The sensory distribution of peripheral nerves. With permission of R.
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Figure 5. The approximate sensory distribution of dorsal roots after Forster. Note that there is near complete overlap between adjacent nerve roots with the exception of a small distal portion of the distribution so-called "autonomous zones". With permission from R. An unexpected error occurred. Add to Favorites Embed Share Translate text to:.
Source: Tracey A. Milligan, MD; Tamara B. The cranial nerve examination follows the mental status evaluation in a neurological exam. However, the examination begins with observations made upon greeting the patient.
For example, weakness of the facial muscles which are innervated by cranial nerve VII can be readily apparent during the first encounter with the patient. Cranial nerve VII the facial nerve also has sensory branches, which innervate the taste buds on the anterior two-thirds of the tongue and the medial aspect of the external auditory canal.
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Therefore, finding ipsilateral taste dysfunction in a patient with facial weakness confirms the involvement of cranial nerve VII. In addition, knowledge of the neuroanatomy helps the clinician to localize the level of the lesion: unilateral weakness of the lower facial muscles suggests a supranuclear lesion on the opposite side, while lesions involving the nuclear or infranuclear portion of the facial nerve manifest with an ipsilateral paralysis of all the facial muscles on the involved side.
Cranial nerve VIII the acoustic nerve has two divisions: the hearing cochlear division and the vestibular division, which innervates the semicircular canals and plays an important role in maintaining balance. During a routine neurological examination, special testing of the vestibular nerve is usually not performed.
Cranial nerve IX the glossopharyngeal nerve and cranial nerve X thevagus nerve arise from the medulla and have laryngeal and pharyngeal function; their function is tested by assessing speech and motility of the soft palate. Because cranial nerves IX and Xform the sensory and motor limbs of the gag reflex, eliciting for gag reflex can also test their function.
Cranial nerve XI the spinal accessory nerve innervates the sternocleidomastoid muscle and the upper portion of the trapezius muscle. These muscles control side-to-side turning the head and shrugging of the shoulders. The cranial nerve exam concludes by testing cranial nerve XII the hypoglossal nerve , which provides motor control of the muscles of the tongue. During the neurological assessment, the clinician should always be trying to tie together the findings of the exam to get insight into the underlying disease.
The important diagnostic clues might include signs of multiple cranial nerve involvement and unilateral vs.