Saraf Cranial

Monday, February 04, 2019

11:47 PM • The cranial nerves are a set of 12 paired nerves that arise directly from the brain.
The first two nerves (olfactory and optic) arise from the cerebrum, whereas the
remaining ten emerge from the brain stem.
• Cranial nerves III – XII arise from the brain stem. They can arise from a specific
part of the brain stem (midbrain, pons or medulla), or from a junction between two
parts
1. Midbrain – the trochlear nerve (IV) comes from the posterior side of the
midbrain. It has the longest intracranial length of all the cranial nerves.
2. Midbrain-pontine junction – oculomotor (III)
3. Pons – trigeminal (V).
4. Pontine-medulla junction – abducens, facial, vestibulocochlear (VI-VIII).
5. Medulla oblongata – posterior to the olive: glossopharyngeal, vagus,
accessory (IX-XI). Anterior to the olive: hypoglossal (XII)

Sensory (afferent) Modalities:

• General somatic sensory (GSS) – general sensation from skin.
• General visceral sensory (GVS) – general sensation from viscera.
• Special somatic sensory (SSS) – senses derived from ectoderm (e.g. sight,
sound, balance).
• Special visceral sensory (SVS) – senses derived from endoderm (e.g. taste,
smell)
Motor (efferent) Modalities:
• General somatic motor (GSM) – skeletal muscles.
• General visceral motor (GVM) – smooth muscles of gut and autonomic motor.
• Special visceral motor (SVM) – muscles derived from pharyngeal arches.

Number Name Exit Modality Function

I Olfactory Cribriform plate Sensory (SVS) Smell
II Opticus Optic canal Sensory (SSS) Vision
III Occulomotor Superior orbital fissure Motor (GSM & GVM) • GSM: 4 extrinsic eye muscles and levator palpebrae superioris
• GVM: pupillary sphincter
IV Trochlear Superior orbital fissure Motor (GSM) Superior oblique
V Trigeminal
1 Ophthalmic Superior orbital fissure GSS Scalp, forehead and nose
2 Maxillary F. rotundum GSS Cheeks, lower eye lid, nasal mucosa, upper lip, upper teeth and palate.
3 Mandibular F. ovale GSS • GSS: anterior 2/3 tongue, skin over mandible and lower teeth.
SVM • SVM: muscles of mastication.
VI Abducens Superior orbital fissure Motor (GSM) Lateral Rectus
VII Facial Internal acoustic meatus > Both: • GSS: sensation to part of ext. ear.
stylomastoid foramen GSS • SVS: taste from ant. 2/3 tongue, hard and soft palate.
SVS • SVM: muscles of facial expression.
SVM • GVM: lacrimal, submandibular, sublingual glands and mucous glands of
GVM mouth and nose.
VIII Vestibulocochlear Internal acoustic meatus SSS Hearing and balance
IX Glossopharyngeal Jugular foramen Both: • GSS: post. 1/3 tongue, ext. ear, and middle ear cavity.
GSS • GVS: carotid body and sinus.
GVS • SVS: taste from post. 1/3 tongue.
SVS • GVM: parotic gland. SVM: stylopharyngeus
GVM
SVM
X Vagus Jugular foramen Both: • GSS: ext. ear, larynx and pharynx.
GSS • GVS: larynx, pharynx and, thoracic & abdominal viscera.
GVS • SVS: taste from epiglottis region of tongue
SVS • GVM: smooth muscles of pharynx, larynx and most of the GIT.
GVM • SVM: most muscles of pharynx and larynx.
SVM
XI Accessory Jugular foramen Motor (GSM & SVM) • GSM: trapezius and sternocleidomastoid.
• SVM: a few fibres run with CNX to viscera.
XII Hypoglossal Hypoglossal canal Motor (GSM) Intrinsic and extrinsic tongue muscles (except the palatoglossus).

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 KLINIS
Fracture of ethmoid bone or lesions of olfactory fibers may result
in partial or total loss of smell, a condition known asanosmia

KLINIS
Damage to optic nerve results in blindness in eye served by nerve. Damage to visual
pathway beyond the optic chiasma results in partial visual losses. Visual defects are
called anopsias

Klinis
Trigeminal neuralgia, caused by inflammation of trigeminal
nerve, is widely considered to produce most excruciating
pain known. The stabbing pain lasts for a few seconds to a
minute, but it can be relentless, occurring a hundred times a
day. Usually provoked by some sensory stimulus, such as
brushing teeth or even a passing breeze hitting the face.
Thought to be caused by a loop of artery or vein that
compresses the trigeminal nerve near its exit from the brain
stem. Analgesics and carbamazepine (an anticonvulsant)
are only partially effective. In severe cases, surgery relieves
the agony—either by moving the compressing vessel or by
destroying the nerve. Nerve destruction results in loss of
sensation on that side of face.

Klinis
KLINIS In abducens nerve paralysis, eye cannot be moved
In oculomotor nerve paralysis, eye cannot be moved up, KLINIS laterally. At rest, eyeball rotates medially (internal
down, or inward. At rest, eye rotates laterally [external Damage to a trochlear nerve results in double vision strabismus).
strabismus (strah-biz9mus)] because the actions of the and impairs ability to rotate eye
two extrinsic eye muscles not served by cranial nerves III inferolaterally.
are unopposed. Upper eyelid droops (ptosis), and the
person has double vision and trouble focusing on close
objects

KLINIS
Bell's palsy is characterized by paralysis of facial muscles on affected side and partial loss of
taste sensation. May develop rapidly (often overnight). Caused by inflamed and swollen facial
nerve, possibly due to herpes simplex 1 viral infection. Lower eyelid droops, corner of mouth sags
(making it difficult to eat or speak normally), tears drip continuously from eye and eye cannot be
completely closed (conversely, dry-eye syndrome may occur). Treated with corticosteroids.
Recovery is complete in 70% of cases. ✚

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KLINIS
Lesions of cochlear nerve or cochlear receptors result in central, or nerve,
deafness. Damage to vestibular division produces dizziness, rapid involuntary
eye movements, loss of balance, nausea, and vomiting. KLINIS
Injured or inflamed glossopharyngeal nerves impair swallowing and taste.

KLINSI
Since laryngeal branches of the vagus innervate nearly all muscles of the larynx (“voice box”), vagal
nerve paralysis can lead to hoarseness or loss of voice.Other symptoms are difficulty swallowing and
impaired digestivesystem motility. These parasympathetic nerves are important for maintaining the
normal state of visceral organ activity. Without their influence, the sympathetic nerves, which mobilize and
acceleratevital body processes (and shut down digestion), would dominate.

KLINIS
Damage to hypoglossal nerves causes difficulties in speech and swallowing. If both nerves
are impaired, the person cannot protrude tongue. If only one side is affected, tongue
deviates (points) toward affected side; eventually paralyzed side begins to atrophy.

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