Cranial Nerves

Cranial Nerves

• 12 pairs, (two are attached to the cerebrum

and 10 are attached to the brain stem

• Nine are attached to the ventral surface of

the brain stem, while one is attached to the
back of the midbrain (Trochlear).
 Cranial Nerves

Like all nerves, cranial nerves

are made up of bundles of
axons
Cranial nerves may be sensory,
or motor, or mixed, and may
contain somatic and/or
autonomic fibers.
Review… bones
Review… bones
 Foramina of Exit

NERVE FORAMEN NERVE FORAMEN

1st Cribriform plate 7th Internal acoustic meatus,
of ethmoid stylomastoid foramen
2nd Optic canal 8th Internal acoustic
meatus
3rd 9th
4th Superior orbital
5th(V1) fissure 10th
Jugular foramen
6th
5th(V2) Foramen rotundum 11th

5th(V3) Foramen ovale 12th Hypoglossal canal

 Numbers & Names
I Olfactory VII Facial
II Optic VIII Vestibulocochlear
(Statoacoustic)
III Occulomotor IX Glossopharyngeal
IV Trochlear X Vagus
V Trigeminal XI Accessory
V1: Ophthalmic
• Cranial part
V2: Maxillary
V3: Mandibular • Spinal part

VI Abducent XII Hypoglossal

Cranial Nerves
 Special Sense Nerves
 I,II,VIII
 Somatic Motor Nerves
Eye—III,IV,VI
Tongue--XII

 “Rest of body” nerves

 IX,X,XI
 Face and jaws
 VII, V

Human Anatomy, Frolich, Head/Neck IV: Cranial Nerves

 Nerve “targets” in head
 SENSORY  MOTOR
Special General Muscles Glands
Smell skin eyes salivary
Vision teeth extrinsic sweat
Hearing eye intrinsic lacrimal
tongue
jaws mucous
oral cavity
facial expression
nasal cavity
larynx
middle ear
tongue
throat
meninges
throat
ear

Human Anatomy, Frolich, Head/Neck IV: Cranial Nerves

  Head I: Skull—a framework to hang on
 Overall organization of skull
 Base of the skull—the hard part
 Developmental view
 Cranial nerves out (to “targets”)
 Head II: Throat targets
 Head III: Special Sense targets
 Head IV: Cranial nerves in depth

Human Anatomy, Frolich, Head/Neck IV: Cranial Nerves

 Base of the skull—cranial nerves out
 Ethmoid (olfactory)
I. Olfactory
 Sphenoid (optic)
II. Optic
III. Oculomotor
IV. Trochlear
VI. Abducens
 Temporal (otic)
VII. Acoustic/Auditory/
Vestibulocochlear
 Face/Jaws
V. Trigeminal
VII. Facial
 Throat (rest of body)
IX Glossopharyngeal
X. Vagus
XI. Spinal Accessory
Human Anatomy, Frolich, Head/Neck IV: Cranial Nerves XII. Hypoglosal
Cranial nerves
Cranial nerves
 Special Sense Nerves
NERVE TARGET EXIT FROM
CRANIAL CAVITY
I. Olfactory Olfactory Cribiform plate
epithelium (ethmoid)
II. Optic Retina Optic canal
(sphenoid)
VIII. Auditory Inner ear Internal auditory
meatus (temporal)

Human Anatomy, Frolich, Head/Neck IV: Cranial Nerves

 M&M, Table 14.3

Human Anatomy, Frolich, Head/Neck IV: Cranial Nerves

 Somatic Motor Nerves
(eye muscles and tongue)
NERVE TARGET EXIT CR. CAVITY
IV. Trochlear Superior oblique m. Sup. Orbital fissure
(with trochlea) (sphenoid)
VI. Abducens Lateral rectus “
III. Oculomotor •Sup.,med.,inf.rectus “
(Also parasympathetic • Inferior Oblique
to ciliary mm, constrictor
pupillae) •Levator palpebrae
superioris
XII. Hypoglossal Intrinsic, extrinsic Hypoglossal canal
mm. of tongue (occipital)

Human Anatomy, Frolich, Head/Neck IV: Cranial Nerves

Human Anatomy, Frolich, Head/Neck IV: Cranial Nerves
Human Anatomy, Frolich, Head/Neck IV: Cranial Nerves
Human Anatomy, Frolich, Head/Neck IV: Cranial Nerves
Cranial nerves
Cranial nerves
 “Rest of body” nerves
(all exit from jugular foramen)
NERVE TARGET

X: Vagus  Somatic motor to larynx/pharynx

 Parasympathetic to most of gut
 Taste to back posterior pharynx
XI: (Spinal)  Motor to traps,
Accesory sternocleidomastoid
IX: Glosso-  Sensory to carotid body/sinus
pharyngeal  Taste to posterior tongue
 Sensory to ear opening/middle
ear
 Parotid salivary gland

Human Anatomy, Frolich, Head/Neck IV: Cranial Nerves

Human Anatomy, Frolich, Head/Neck IV: Cranial Nerves
Human Anatomy, Frolich, Head/Neck IV: Cranial Nerves
Human Anatomy, Frolich, Head/Neck IV: Cranial Nerves
VII: Facial Nerve
(exits cranial cavity with VIII--internal auditory meatus)

 Facial muscles (five branches fan out over face from

stylomastoid foramen)
 Temporal
 Zygomatic
 Buccal
 Mandibular
 Cervical
 “chorda tympani” (crosses interior ear drum to join V3 )
 Taste to anterior 2/3 of tongue
 Submandibular, sublingual salivary glands
 Lacrimal glands

Human Anatomy, Frolich, Head/Neck IV: Cranial Nerves

Human Anatomy, Frolich, Head/Neck IV: Cranial Nerves
 V: Trigeminal (3 nerves in 1!)
 V1. Ophthalmic
 Exits with eye muscle group (superior orbital fissure, through orbit to
superior orbital notch/foramina)
 Sensory to forehead, nasal cavity
 V2. Maxillary
 Exits foramen rotundum through wall of maxillary sinus to inferior
orbital foramina)
 Sensory to cheek, upper lip, teeth, nasal cavity
 V3. Mandibular
 Exits foramen ovale to mandibular foramen to mental foramen
 Motor to jaw muscles--Masseter, temporalis, pterygoids, digastric
 Sensory to chin
 Sensory to tongue

Human Anatomy, Frolich, Head/Neck IV: Cranial Nerves

Human Anatomy, Frolich, Head/Neck IV: Cranial Nerves
Human Anatomy, Frolich, Head/Neck IV: Cranial Nerves
Cranial Nerves
 I: Olfactory
 II: Optic
 III: Oculomotor
 IV: Trochlear
 V: Trigeminal
 VI: Abducens
 VII: Facial
 VIII:Vestibulocochlear
 Acoustic
 IX: Glossopharyngeal
 X: Vagus
 XI: Accessory
 XII: Hypoglossal

http://www.gwc.maricopa.edu/class/bio201/cn/cranial.htm
Mnemonic
 On  Fin
 Old  And
 Olympus’  German
 Tower  Viewed
 Top  A
 A  Hop
MNEMONIC
 OLFACTORY  OH
 OPTIC  ONCE
 OCULOMOTOR  ONE
 TROCHLEAR  TAKES
 TRIGEMINAL  THE
 ABDUCENS  ANATOMY
 FACIAL  FINAL
 VESTIBULOCOCHLEAR  VERY
 GLOSSOPHARYNGEAL  GOOD
 VAGUS  VACATION
 ACCESSORY  A-HEAD
 HYPOGLOSSAL
CN I: OLFACTORY
 Cranial nerve I
 Function:
 smell
 Clinical test for
damage:
 determine whether
a person can smell
something aromatic
CN II: OPTIC
 Cranial nerve II
 Function:
 vision
 Clinical test for
damage:
 tests peripheral vision
and visual acuity
 Effects of damage:
 blindness in part or all
of the visual field
CNIII: OCULOMOTOR
 Cranial nerve III
 Function:
 eye movements, opening of

eyelid, constriction of pupil,

focusing, proprioception
 Clinical tests for injury:
 differences in pupil size;

pupillary response to light; eye

tracking
 Effects of damage
 dropping eyelid, dilated pupil,

double vision
 CNIV: TROCHLEAR
 Cranial nerve IV
 Function: eye movements
and proprioception
 Clinical test for injury: ability
to rotate eye inferolaterally
 Effects of damage – double
vision, patient tilts head
toward affected side
CN V: TRIGEMINAL
 Cranial nerve V
 Function: sensory nerve of the
face
 Clinical test for injury:
 corneal reflex; sense of

touch, pain, and

temperature; clench teeth;
move mandible side to side
 Effects of damage:
 loss of sensation and

impaired chewing
 CN VI: ABDUCENS
 Cranial Nerve VI
 Function: Eye movements
 Clinical test: lateral eye movement
 Effects of damage: inability to rotate
eye laterally; at rest – eye rotates
medially because of action of
antagonistic muscles
 CN VII: FACIAL
 Cranial Nerve VII
 Function: facial expression; sense of
taste
 Clinical test: motor functions – close
eyes, smile, whistle, frown, raise
eyebrows; taste
 Effects of damage: inability to control
facial muscles; distorted sense of taste
 Bell’s Palsy
• Damage to facial nerve results in
paralysis of facial muscles: Facial
(Bell’s palsy);lower motor neuron
lesion (whole face affected)
• NB. In upper motor neuron lesion
(upper face is intact) .
 Face is distorted: drooping of
lower eyelid, sagging of the angle
of the mouth, dribbling of saliva,
loss of facial expressions, loss of
chewing, blowing, sucking, unable
to show teeth or close the eye on
affected side
CN VIII:
VESTIBULOCOCHLEAR
 Cranial Nerve VIII
 Function: hearing and equilibrium
 Clinical tests: test hearing, balance, and
ability to walk a straight line
 Effects of damage: deafness, dizziness,
nausea, loss of balance, and nystagmus
 CN IX: GLOSSOPHARANGEAL
 Cranial Nerve IX
 Function: swallowing, salivation, gagging;
touch, pressure, taste, and pain sensations
from tongue, pharynx, and outer ear
 Clinical tests: gag reflex, swallowing, and
coughing
 Effects of damage: difficulty swallowing
 CN X: VAGUS
 Cranial Nerve X

 Function: swallowing; taste; speech;

respiratory, CV, and GI regulation; sensations
of hunger, fullness, and intestinal discomfort

 Clinical tests: test with cranial nerve IX

 Effects of damage: hoarseness or loss of

voice; impaired swallowing and GI motility
 CN XI: ACCESSORY
 Cranial Nerve XI

 Function: swallowing; head, neck, and shoulder

movements

 Clinical tests: rotate head and shrug shoulders

against resistance

 Effects of damage: impaired movement of head,

neck, and shoulders; paralysis of sternocleidomastoid
 CN XII: HYPOGLOSSAL
 Cranial Nerve XII

 Function: tongue movements of speech, food

manipulation, and swallowing

 Clinical test: tongue function

 Effects of damage: difficulty in speech and

swallowing; atrophy of tongue; inability to stick out
(protrude) tongue
 Lesion of Cranial Nerves

Causes:
 Severe head injuries, skull bone fractures or
penetrating wounds
 Brain lesions
 Compression due to raised intracranial
pressure (due to any space occupying lesion
e.g. tumor, hematoma, or CSF obstruction )
 Cavernous sinus thrombosis
Cavernous Sinus Thrombosis
 Clinical tests for Cranial Nerves

• The integrity of nerves is assessed by

examining the:
– The sensations in the area of
distribution
– Action of muscles
– Integrity of reflexes
– Secretory activity of glands
 Reflexes Related to Cranial Nerves

• Pupillary (light) CN _, _
• Accommodation CN _, _
• Corneal (Blinking) CN _,_
• Lacrimation CN _, _
• Salivation CN _, _, _, _, _
• Sneezing CN _, _, _, _, _
• Vomiting CN _, _, _, _
 Reflexes Related to Cranial Nerves

• Yawning CN _, _
• Swallowing CN _, _, _, _, _ ,_
• Jaw jerk CN _
• Stapedial CN _, _
• Cough CN _, _, _,
• Gag CN _ ,_
 Clinical Tests for Cranial Nerves

Olfactory nerve:
Ask the patient to identify items with very
specific odors,(e.g.. coffee, alcohol,
perfume), placed under the nose.
Each nostril is tested separately
Optic nerve:
Ask the patient to read an eye chart.
– Peripheral vision is tested by detecting object or
movement from corners of the eyes
Occulomotor nerve:
Note the ability to move each eye upward, downward and
inward by asking the person to follow a target moved by
the examiner.
– Also examine the constriction of pupil & accommodation
 Clinical Tests for Cranial Nerves

• Trochlear:
– Note the ability to move each eye downward and
inward
• Trigeminal nerve:
– General sensations on face are tested by using a
pin and a wisp of cotton.
– Blink reflex is tested by touching the cornea of the
eye with a cotton wisp.
– Strength and action of muscles of mastication are
tested by asking the person to clench the teeth
and open the jaw against resistance
• Abducent nerve:
– Note the ability to move each eye outward beyond
the midline
 Clinical Tests for Cranial Nerves
• Facial nerve:
– The action of muscles of face is tested by asking the
person to smile, to open the mouth, to show the
teeth, and to close the eyes tightly.
– Taste sensations from anterior 2/3 tongue is tested
using substances that are sweet, sour, salty and bitter
• Vestibulocochlear nerve:
– Hearing is tested with a tuning fork.
– Balance is tested by asking the person to walk on a
straight line.
 Clinical Tests for Cranial Nerves

• Glossopharyngeal & Vagus nerves:

• (cranial part of Accessory nerve) :
– The person is asked to swallow.
– The person is asked to say ‘ah-h-h’ to check the
movements of palate and uvula.
– The ‘gag reflex’ is tested by touching the back
of the throat by the tongue depressor.
– The person is asked to speak to check the voice
for hoarsness.
 Clinical Tests for Cranial Nerves
• Spinal part of Accessory nerve:
–The person is asked to turn the head
and to shrug the shoulders against
resistance provided by the examiner
• Hypoglossal nerve:
–The person is asked to stick out the
tongue, to observe the deviation to one
side or the other