Brain stem and Cranial

Nerves

.
 Cranial Nerves
 There are 12 pairs of
cranial nerves
 Leave the cranium
by passing through
named openings at
the base of the skull
 Some motor, sensory
or mixed
 CN I: Olfactory
 Functions in smell
 Collection of sensory nerves that extends down from
olfactory bulb and pass through openings of the cribriform
plate in the ethmoid bone
 Specialized sensory receptive parts of olfactory nerve
located in olfactory mucosa of upper parts of nasal cavity
 CN I. Olfactory – four respects

1. The somas of the primary

afferent neurons occupy a
surface of epithelium.
2. The axons of the primary
afferents enter the cerebral
cortex directly.
3. The primary afferent neurons
undergo continuous turnover,
being replaced from basal stem
cells.
4. The pathway to the highest
cortical centers (in the frontal
lobe) is entirely ipsilateral.
 Olfactory

Unilateral Anosmia Frontal Meningioma

ANOSMIA

Bilateral Anosmia Head Trauma

Especially
with leakage
of
cerebrospinal
fluid
 CN. II: Optic
 Sensory
 Arises from the retina
 Enters the cranial cavity
through optic canal and form
optic chiasm and tract
 Major function: carries visual
sensations to the brain for
perception and discrimination
 Symptoms of dysfunction:
loss of vision
Visual Pathway

Retina

N. II

OpticalChiasma

Optical Tract

CGL

Opt. Radiation

Primary
Visual Cortex
 Lesions of the visual pathways
Lesions Field defects
Partial CN. II. Ipsilateral scotoma.
Complete CN. II. Blindness in that eye.
Optic chiasm. Bitemporal hemianopia
Optic tract. Homonymous
hemianopia.
Meyers loop Homonymous upper
quadrant anopia.
Optic radiation Homonymous
hemianopia.
Visual cortex Homonymous
hemianopia.
Bilateral macular Bilateral sentral
cortex scotomas
 CN. III (Oculomotor) , CN. IV (Trochlear) &
CN. VI (Abducen)

 Motor nerves that innervate muscles

of eye and orbit
 Leave cranial cavity by passing
through superior orbital fissure to
enter orbit
 Supply total of 9 muscles of the eye
that include 6 skeletal muscles
arising from the walls of the orbit
and attaching to the eye, 2 smooth
muscles within eye and 1 skeletal
muscle of upper eyelid
Function of CN III, IV, VI
(SO4RL6)3
 CN. III: Oculomotor
Major functions: innervates all extraocular muscles -
except superior oblique and lateral rectus – and
striated muscles of eyelid
Motor: eye movements – elevation (superior rectus
when the eye is abducted and inferior oblique when
adducted), depression (inferior rectus when eye is
abducted), adduction and elevates upper eyelid
Parasympathetic: pupillary constriction in response to
light; increases convexity of lens for near vision
Symptoms of dysfunction: double vision, drooping
eyelid, deviation of eye outward, uneven dilation of
pupils
 CN. IV: Trochlear CN. VI: Abducens

 Motor  Motor
 Innervates superior  Innervates lateral rectus
oblique muscle muscle
 Depresses the adducted  Major function in eye
eye movement – abduction
 Symptoms of of eye
dysfunction: double  Symptoms of
vision dysfunction: double
vision and inward
deviation of eye
Complete left III
Complete left
Nerve paralysis
VI nerve
paralysis

Lateral Gaze Paralysis

 CN. V: Trigeminal
 Mixed motor and sensory
 Has small motor root and large
sensory root; extends from brain stem
to sensory ganglion (trigeminal
ganglion) found in apex of petrous
temporal bone
 Nerve divides into 3 branches beyond
ganglion: V1(Opthalmic), V2
(Maxillary) and V3 (Mandibular)
 Sensory fibers enter each of
divisions, motor fibers only enter V3
(only one mixed)
 CN. V: Trigeminal
 V1 enters orbit through superior orbit
fissure
 V2 enters pterygopalatine fossa through

foramen rotundum
 V3 exits through foramen ovale to reach
infratemporal fossa
 Major functions:

-V1 – innervate structures of the orbit,

nose and forehead and scalp back to
vertex of skull
-V2 – provide sensation from the skin over
the cheek and to upper portion of oral
cavity
 CN. V: Trigeminal
- V3 – supplies sensation from
the skin over the jaw , the area
over the ear and the lower part
of the oral cavity, including
tongue (supplies muscles of
mastication)
Symptoms of dysfunction:
numbness in face, weakness
and wasting of jaw muscles,
brief attacks of severe pain,
asymmetric chewing
Trigeminal Neuralgia
(tic douloureux)
- excruciating episodic pain
in the area supplied by
trigeminal nerve, especially
second and third division
- trigger point
- intense pain makes the
patient grimace (tic)
- antiepileptic drug (phenytoin,
carbamazepine) is effective
- surgical treatment
 CN. VII: Facial
 Mixed
 Also parasympathetic and
preganglion fibers
 Leaves cranial cavity by
passing through internal
auditory meatus where
sensory ganglion is located;
then runs in a bony facial
canal in the temporal bone
and exits the base of the skull
through stylomastoid
foramen; divides into
terminal branches on face
 CN. VII: Facial
 Major functions:
sensory – supply taste buds in anterior two-thirds of
tongue
motor – innervates muscles of facial expression
(smiling, frowning, whistling)
 Parasympathetic – innervates salivary glands
except parotid, as well as lacrimal glands and
cerebral vasculature
 Symptoms of dysfunction: facial paralysis, loss of
taste over anterior two-thirds of tongue
VII. Facial Nerve

1. Facial Motor Nucleus

2. Superior Salivatory Nucleus

3. Nucleus Tractus Solitarius

4. Spinal Tract Nucleus of V

VI. Abducens Nerve

5. Abducens Nucleus
Facial Palsy (Bell’s Palsy)

Right facial paralysis

 CN. VIII: Vestibulocochlear
 Sensory
 Two components: cochlear and vestibular
 Leaves cranial cavity by entering internal auditory meatus;
ends in specialized receptors of the inner ear located in the
petrous temporal lobe
 Major functions: vestibular nerve conveys information
regarding changes in position and movements of head
needed to maintain equilibrium; cochlear aids in hearing
 Symptoms of dysfunction: deafness, feeling of distortion in
space, dysequilibrium
 CN. IX: Glossopharyngeal
 Mixed, with large sensory and small motor components, also
parasympathetic and preganglion fibers
 Leaves cranial cavity by passing through jugular foramen in
company of nerves X & XI to reach lateral aspect of pharynx
 Major functions:

Sensory – supplies mucosa of posterior tongue and pharynx

including tonsillar area, so branches convey sensation and
taste; provide sensory supply to specialized receptors in
carotid body and sinus for reflex regulation of of blood
pressure and respiration
 CN. IX: Glossopharyngeal
 Motor – supplied one
muscle of pharynx, the
stylopharyngus; aids in
swallowing
 Parasympathetic –
innervates parotid gland;
essential for secretion of
saliva
 Symptoms of dysfunction:
spasms of pain in posterior
pharynx, maybe in fall of
blood pressure
 CN. X: Vagus
 Mixed and has additional large
parasympathetic portion
 Leaves cranial cavity by passing
through jugular foramen, along with IX
& XI to reach lateral aspect of pharynx
and larynx
 Major functions:

Motor – supplies skeletal muscles of

pharynx, larynx and soft plate
(important in swallowing)
Sensory – mediates sensation from
posterior pharynx, visceral sensation
from pharynx, larynx, thoracic and
abdominal organs
 CN. X: Vagus

Parasympathetic – innervates smooth muscle

and glands of gastrointestinal, pulmonary,
cardiovascular systems in neck, thorax and
abdomen
 Symptoms of dysfunction: hoarseness, poor

swallowing, loss of gag reflex

 CN. XI: Spinal Accessory
 Motor
 Arises from upper cervical spinal
cord and enters cranial cavity through
foramen magnum; leaves via jugular
foramen
 Major function: innervates trapezius
and sternocleidomastoid muscles
 Symptoms of dysfunction: inability to
shrug, wasting of neck with
weakened rotation
 CN. XII: Hypoglossal
 Motor
 Leaves cranial cavity
through hypoglossal
(anterior condylar) canal
 Major function: innervates
muscles of tongue
 Symptoms of dysfunction:
wasting of tongue with
deviation to side of lesion
on protrusion