Cranial Nerves

Thereare12pairsofcranialnervesandbecausetheyarenerves,theyareconsideredtobeapartofthe
peripheralnervoussystem(PNS).Conventionally,eachofthe12pairsofnervesisnamedusingaRoman
numeral(IthroughXII)togetherwiththedescriptivenameforthenerve.

IOlfactoryNerveisasensorynerve(anervecarryingsensationinformationtothebrain)thatarisesin
thenasalmucosa(upthroughtheolfactoryforaminaofthecribriformplate)andconveysimpulsesforthe
senseofsmelltothebrain.Sensory.
CLINICAL APPLICATIONS

Anosmiareferstopartialortotallossoftheabilitytosmell.Thismayresultfromafractureofthe
ethmoidoralesionofolfactoryfibers.
IIOpticNervearisesfromtheretinaoftheeyeandtravelsthroughtheopticforamenoforbittodeliver
imagesofsighttothebrain.Partialcrossoveroffibersoccursattheopticchiasmandcontinuesthrough
thethalamus.Thalamicfibersthenruntothevisualcortexintheoccipitallobe.Sensory.
CLINICAL APPLICATIONS

Damage to an optic nerve results in blindness in the eye serviced by that nerve. Damage to visual
pathwaysdistaltotheopticchiasmresultsinpartialvisuallosses.Visualdefectsarecalledanopsias.

IIIOculomotorNerveisamotornerve(anervehavingonlyfiberstravelingtomusclestocausetheir
movement)andrunsfromthemidbrainthroughthesuperiororbitalfissurestoeye.Controlsfourofthe
sixextrinsicmusclesoftheeye(inferioroblique,superior,inferiorandmedialrectus)tomovetheeye
upward,downwardandmedially.Parasympatheticmotorfibersgotomuscleswithintheiristhatare
responsibleforconstrictionofthepupil.Finally,italsotravelstothelevatorpalpebraesuperiorismuscle,
whichactstoraisetheuppereyelid.Motor.
CLINICAL APPLICATIONS

Inoculomotornerveparalysis,theeyecannotbemoveduporinward,andatrest,theeyeturnslaterally
(externalstrabismus),astheactionsofthetworemainingeyemuscleareunopposed.Also,theupper
eyeliddroops(ptosis)andthepersonwillhavedoublevisionanddifficultyfocusingoncloseobjects.If
themedialrectushasbecomeweakened,theeyewilltendtodriftlaterally,sometimestermeda'lazyeye'.
Acommontreatmentforthisistoplaceaneyepatchonthestronger(dominant)eyeinordertostrengthen
theweakermusclesoftheaffectedeye.
IVTrochlearNervealsoarisesinthemidbrainandgoesthroughthesuperiororbitalfissures.Itisthe
smallestofthecranialnerves.Trochleameans"pulley"andthisnerveinnervatesanextrinsiceyemuscle
calledthe superioroblique thathooksthroughapulleyshapedligament(calledthetrochlea)onthe
medialaspectoftheorbit.Itcausestheeyetomovedownandoutward(inferolaterally).Motor.
CLINICAL APPLICATIONS

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Traumatoorparalysisofatrochlearnerveresultsindoublevisionandreducedabilitytorotateeye
inferolaterally.Thisnervecanalsobeaffectionatelycalledthecheatersnerve,asitisresponsibleforthe
downandoutglanceoftheeyewhenwewanttocheckonourneighborsanswer.
VTrigeminalNerveisamixednerve(anervehavingbothsensoryandmotorfibers),itariseswithin
thePonsandtravelstothejaw'smusclestopowerchewing.Thenervealsocontainsfibersbringing
sensationfromthefacetothePons.Itisthelargestofthecranialnervesandformsthreedivisions:
Opthalmic division (V1) from skin of anterior scalp, upper eyelid, nose, nasal cavity mucosa and
lacrimalglandthroughsuperiororbitalfissure.Maxillary

division(V2)fromlowereyelid,palate,upper
teeth, skin of cheek and upper lip through the foramen rotundum. Mandibular

division (V3) from

anteriortongue,lowerteeth,skinofchin,temporalregionofscalpthroughtheforamenovale.Dentist
desensitizeupperandlowerjawsbyinjectinglocalanestheticintoalveolarbranchesofmaxillaryand
mandibulardivisionrespectively.MixedorBoth.
CLINICAL APPLICATIONS

Inflammationofthetrigeminalnervecancauseticdouloureuxortrigeminalneuralgia.Thiscondition
causesexcruciatingpainthatonlylastsforafewsecondstominutesbutoccursrelentlessly.Theactual
causeisunknownbutmaybeduetopressureonthetrigeminalnerveroot.Sensorystimuluslikebrushing
theteethorairhittingthefacecantriggeranepisode.Somerespondtoanalgesicsbutseverecasesmay
requirecauterization,poisoningorseveringofnerveproximaltotrigeminalganglion.

VIAbducensNerve fibersleavetheinferiorPonsandentertheorbitviathesuperiororbitalfissure
(alongwiththeoculomotorIIIandtrochlearIVnerves),goingtotheextrinsiceyemusclethe lateral
rectus.Thelateralrectusisresponsibleforrotatingtheeyeoutward(laterally).Thenerveissonamed
becauseitabductstheeyeball(turnstheeyelaterally,awayfrommidline).Motor.
CLINICAL APPLICATIONS

Inabducensnerveparalysis,theeyecannotbemovedlaterally;atrest,theaffectedeyeballturnsmedially
(internalstrabismus),givingapersona'crosseyed'condition.

VIIFacialNervearisingfromthePonsandinnervates(givesnervesupplyto)themusclesoffacial
expression,theeyelids,aswellassomeofthemuscleswhichassistsspeechandmastication.Italsois
involvedinthecontrolofsalivasecretion.Thenervealsocontainsfibersthatbringtastesensationfrom
anteriortwothirdsoftonguetothebrainstem.MixedorBoth.
CLINICAL APPLICATIONS

Bell'spalsyiscausedbytheherpessimplexvirusandischaracterizedbyparalysisoffacialmuscleson
theaffectedsideandpartiallossoftastesensation.Thevirusproducesaninflammationofthefacialnerve
and can occur rapidly (often overnight). Symptoms include lower eyelid drooping, corner of mouth
sagging(difficultyineatingandspeaking),constantteardrippingandaninabilitytocompletelycloseeye.
Canresolvespontaneouslywithouttreatment.

VIIIVestibulocochlearNervearisesintheinnerearandpassesthroughtheinternalauditorymeatusto
enterbrainstematthePons.Itisreallytwonerves(thevestibularn.andthecochlearn.)housedtogether.

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Thevestibularcomponentconveysequilibriumandpositionsenseandcoordinatesmovementofheadand
neck.Thecochlearcomponentcoveyssoundwavesandisresponsibleforhearing.Sensory.
CLINICAL APPLICATIONS

Lesionsofthecochlearnerveorcochlearreceptorsresultincentralornervedeafness,whereasdamageto
the vestibular division produces disturbances associated with equilibrium, such as dizziness, rapid
involuntaryeyemovements,lossofbalance,nauseaandvomiting.
IXGlossopharyngealNerve bringssensationfromthe pharynx (backofthethroat),sensesblood
pressureandO2 andCO2 contentfromthecarotidartery,delivers tastesensationfromposteriorone
thirdoftonguetotheMedulla.Parasympatheticmotorfibersactivateparotidsalivarygland.Italsosends
motornervefiberstothetoelevatethepharynxwhenswallowing.MixedorBoth.
CLINICAL APPLICATIONS

Injuryorinflammationtotheglossopharyngealnervesimpairsswallowingandtasteontheposteriorthird
ofthetongue,particularlyforsourandbittertastingsubstances.

XTheVagusNerveistheonlycranialnervetoextendbeyondtheneckregion.Itsmotorfiberscome
fromthemedullathroughthejugularforamenanddescendtotheneck,thoraxandabdomen.Involvedin
swallowing,controllingmuscleoflarynx;parasympatheticmotorfibersregulatecardiac,pulmonary,and
partofgastrointestinalactivities.Itbringssensationfromthegastrointestinaltractbacktothemedullaas
wellasinformationforbloodpressure(carotidsinus)andchemistry(carotidandaorticbodies).Mixed
CLINICAL APPLICATIONS

Vagus nerve paralysis can lead to hoarseness or loss of voice; other symptoms include difficulty
swallowing,impaireddigestivesystemmotility.Totaldestructionofbothvagusnervesisincompatible
withlife,astheparasympatheticfibersarecrucialinmaintainingnormalvisceralactivity.

XIAccessoryNerveformsfromaunionofcranialandspinalroots.Itemergesfromthemedullaand
exitsthroughthejugularforamentosupplymotorfiberstothe sternocleidomastoidandthe trapezius
thatcontributetoelevatetheshoulderasoccurswitha"shrug".Alsosuppliesmotorfiberstothelarynx,
pharynxandsoftpalate.Motor.
CLINICAL APPLICATIONS

Injurytothespinalrootoftheaccessorynervecausesheadtoturntowardinjuredsideasaresultof
paralysisofthesternocleidomastoid.Shruggingofthatshoulderbecomesdifficult(trapezius).

XIIHypoglossalNerveisamotornervethatcomesfromthemedullaandgoesthroughthehypoglossal
canal to the intrinsic and extrinsic muscles of the tongue. Its concerned with food mixing and
manipulationandalsoformovementsofthetongueinvolvedinspeechandswallowing.Motor.
CLINICAL APPLICATIONS

Damage to the hypoglossal nerve causes difficulties in speech and swallowing; if both nerves are
impaired,thepersoncannotprotrudethetongue;ifonlyonesideisaffected,thetonguedeviates(leans)

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towardaffectedside.Eventuallytheparalyzedsideofthetonguebeginstoatrophy(getsmaller)fromlack
ofuse.