Adobe Systems Cranial nerves Adobe Systems Zápatí prezentace 2 Cranial nerves -twelve pairs of cranial nerves -the exception is I. and II. cranial nerve, which are the protruding parts of the telencephalon and diencephalon -generally named according to their structure or function -numbered based on their position (rostral-caudal) -the innervation area, as the name suggests, is the head and neck -the exception is the X. cranial nerve, which extends into the abdominal cavity Adobe Systems Zápatí prezentace 3 Olfactory nerve (n. I) •part of the telencephalon, not really a cranial nerve in the conventional sense •humans have a poor sense of smell compared to animals (dogs) •olfactory area is approximately 5 cm2 (107 olfactory cells) •(olfactory area in dogs up to 170 cm2 ) •humans can distinguish around 10 000 smells •the olfactory neurons can regenerate • sensory nerve fibers extend from the olfactory epithelium through the many openings of the cribriform plate to reach the olfactory bulb The specialized olfactory receptor neurons of the olfactory nerve are located in the olfactory mucosa of the upper parts of the nasal cavity. Adobe Systems Zápatí prezentace 4 Olfactory pathway 1st. neuron - neuroepithelial cell of the olfactory epithelium of the upper parts of the nasal cavity (pars olfactoria cavitatis nasi) 2nd. neuron - mitral cell in the olfactory bulb - axons continue further along the olfactory tract to the trigonum olfactorium - the olfactory tract on both sides divides into medial and lateral olfactory striae - the medial stria projects to the to contralateral olfactory structures -the lateral stria continues on to structures associated with the olfactory cortex in the temporal lobe - The olfactory pathway connects to parts of the brain that control emotional responses - associating different smells with our feelings, sexual attraction and also serves asthe warning system that provides us with information about the outside world (if something stinks its probably dangerous for the body) Adobe Systems Zápatí prezentace 5 SYMPTOMS OF OLFACTORY NERVE LESIONS hyposmia/mikrosmia (impaired sense of smell) Anosmia (loss of sense of smell) parosmia (cacosmia) (normal fragrances stink, the fragrance of the flowers stink) uncinate seizure (a form of epileptic seizure with olfactory hallucinations, evoked from the area of ​​the hippocampal gyrus) - seizures often originates from temporal lobe Obsah obrázku text Popis byl vytvořen automaticky Adobe Systems Zápatí prezentace 6 Optic nerve (n.II) - part of the diencephalon, not really a cranial nerve in the conventional sense - doesn´t regenerate after injury - formed from the central processes of the ganglionic cells (3th neuron of the optic pathway) - contains approximately 1,2 milions of the afferent fibers - 80% fibers ends in the lateral geniculate nucleus, remain fibers leads to the mesencephalon and hypothalamus - 4th neurons are the cells of the lateral geniculate nucleus, their axons constitutes the optic radiation that ends in the occipital cortex - neurons of the occipital cortex create a so-called cortical image of the external world loss of left visual field Adobe Systems Zápatí prezentace 7 Branches of the optic tract - composed of approximately 10-20% fibers - branch to area pretectalis - pupillary reflex -branch to the hypothalamus - control of vegetative functions and control of circadian rhythms (the sleep-wake cycle). Adobe Systems Zápatí prezentace 8 SYMPTOMS OF OPTIC NERVE LESIONS amaurosis – vision loss hemianopsia – loss of vision or blindness (anopsia) in half of the field of vision, usually on one side of the vertical midline (cannoot see the right or left side of the field of vision) quadrantopsia - loss of vision in one quarter (one-fourth) of the field of vision scotoma - blind spot in your field of vision (temporary or permanent) phosphene - images of light or color that you can see while your eye is closed Adobe Systems Zápatí prezentace 9 Obsah obrázku lampa, oranžová Popis byl vytvořen automaticky Obsah obrázku zavřít Popis byl vytvořen automaticky edema of the eye papilla - occurs when intracranial pressure rises, which leads to compression of nerve fibers due to increased intracranial pressure in the subarachnoid space around the optic nerve suspicion of increased intracranial pressure - fundoscopic examination is a visualization of the retina using an ophthalmoscop Adobe Systems Zápatí prezentace 10 Oculomotor nerve (n.III) - arises from the interpeduncular fossa (sulcus nervi oculomotorii) of the midbrain - innervates all of the extraocular muscles except superior obliquus muscle and lateral rectus muscle - brings preganglionic parasympathetic fibers from the parasympathetic nucleus III (Edinger-Westphali), which, after interpolation in the ciliary ganglion, innervate the pupillary sphincter muscle (miosis, constriction of the pupil) and ciliary muscle (accommodation – increasing the curvature of the lens) Adobe Systems Zápatí prezentace 11 miosis (narrowed pupil) mydriasis (dilated pupil) accommodation – increasing the curvature of the lens when the ciliary muscle is contracted, the lens becomes more spherical – and has increased focussing power Adobe Systems Zápatí prezentace 12 •passes through subarachnoid space (interpeduncular cistern) lateral to the posterior communicating artery •pierces dura mater lateral from the posterior clinoid process a enters the cavernous sinus CAVE: oculomotor nerve palsy caused by posterior communicating artery aneurysm! Oculomotor nerve Adobe Systems Zápatí prezentace 13 - oculomotor nerve is located uppermost, above the trochlear nerve in the lateral wall of the cavernous - In the cavernous sinus: receives sympathetic branches from internal carotid plexus for innervation of superior tarsal muscle (ncl. intermediolateralis Th1-Th5 → ganglion cervicale superius → n. caroticus internus → plexus caroticus internus) Obsah obrázku text Popis byl vytvořen automaticky Adobe Systems Zápatí prezentace 14 SYMPTOMS OF OCULOMOTOR NERVE LESION - ptosis (drooping or falling of the upper eyelid, weakening of the levator palpebrae superioris muscle) - strabismus (eyes do not line up in the same direction) - diplopia (double vision) - miosis (constriction of the pupil) - mydriasis (dilation of the pupil) Obsah obrázku oranžová, zavřít, kosmetické, oči Popis byl vytvořen automaticky Adobe Systems Zápatí prezentace 15 Trochlear nerve (n.IV) - the trochlear motor nucleus in the midbrain - fibers decussate within the brainstem - arises as only cranial nerve from the dorsal aspect of the brainstem - innervates the superior oblique muscle Adobe Systems Zápatí prezentace 16 SYMPTOMS OF TROCHLEAR NERVE LESION - inability to move the eye down and laterally – paresis of the superior oblique muscle (the eye is moved medially) - diplopia (double vision) Adobe Systems Zápatí prezentace 17 Trigeminal nerve (n.V) - the biggest cranial nerve - mixed nerve with large nuclear complex 1. Motor nucleus of trigeminal nerve (masticatory) •branchiomotor nucleus supplies muscules derived from 1th pharyngeal arch (muscles of mastication, m. mylohyoideus, venter anterior m. digastrici, m. tensor tympani, m. tensor veli palatini) 2. Principal sensory nucleus of trigeminal nerve (pontine) •somatosensory nucleus, receives discriminative sensations, proprioception, light touch and vibration in areas of face and mouth 3. Spinal nucleus of trigeminal nerve •somatosensory nucleus for perception of cold, heat, pain (pain in or around your teeth and jaws) and partial proprioception from n. V, VII, IX, X 4. Mesencephalic nucleus of trigeminal nerve •ganglion with pseudounipolar neurons, receives proprioception (the sense that lets us perceive the location, movement, and action of parts of the body) from periodontium - group of tissues that together facilitate the anchorage of teeth in jaws, hard palate, temporomandibular joint and from extraocular, masticatory, mimic and lingual muscles too Adobe Systems Zápatí prezentace 18 Trigeminal nerve •arises from the middle part of pons •enters the trigeminal cave (Meckel´s cave), a dura mater pouch containing trigeminal ganglion (semilunare, Gasseri) •motor root (portio minor trigemini) underruns the ganglion and joins the mandibular nerve directly Adobe Systems Zápatí prezentace 19 Ophthalmic nerve •1th branch of the trigeminal nerve •counts approx. 26 000 myelinated fibers •the most medial branch of the trigeminal ganglion •passes through the lateral wall of cavernous sinus •supplies (somatosensory): Øorbit with periosteum, ocular bulb, lacrimal gland Øconjunctiva of the upper eyelid Øskin of nasal dorsum and tip, upper eyelid and forehead to the interauricular line Øethmoidal cells mucosa, sphenoid sinus and ventral part of nasal cavity Obsah obrázku text Popis byl vytvořen automaticky Adobe Systems Zápatí prezentace 20 Ophthalmic nerve •divides in superior ophthalmic fissure to: Ønervus frontalis Ønervus lacrimalis Ønervus nasociliaris Nervus frontalis •n. supraorbitalis → r. medialis → r. lateralis •n. supratrochlearis Nervus lacrimalis •r. communicans cum nervo zygomatico Nervus nasociliaris •r. communicans cum ganglio ciliari •nn. ciliares longi •n. ethmoidalis posterior •n. ethmoidalis anterior → rr. nasales → r. nasalis externus Innervates the mucosa of the upper part of the nasal cavity • • Ø Adobe Systems Zápatí prezentace 21 The corneal reflex The corneal reflex is mediated by the reflex arc, which consists of corneal roreceptors, the afferent ophthalmic nerve (1st branch of the nerve) and the efferent VII nerve innervating the orbicularis oculi muscle (leads to tighteninig of the eyelids) hypo/areflexia (loss of reflex): indicated mesencephalon or pons damage also known as the blink reflex or eyelid reflex - blinking of the eyelids elicited by stimulation of the cornea (such as by touching Adobe Systems Zápatí prezentace 22 Herpes Zoster Ophthalmicus - a viral disease characterized by a unilateral painful skin rash or blisters in distributions of the fifth cranial nerve (opthalmic nerve) - travel along neurons to the sensory axons of the skin to form vesicular lesions - occurs after reactivation of latent varicella-zoster virus (VZV) present within the cerebral ganglia antiviral drugs, corticoids, ATB for bacterial infection…. the risk of brain damage in patients with weakened immunity !!! > Obsah obrázku osoba, zavřít Popis byl vytvořen automaticky Adobe Systems Zápatí prezentace 23 Maxillary nerve - 2nd branch of the trigeminal nerve - supplies (somatosensory): dura mater in the middle cranial fossa cheek skin between the palpebral and oral fissure mucosa of the upper cheeks mucosa of the maxillary sinus and posterior 2/3 of the nasal cavity mucosa of the palate, nasopharynx and adjacent part of the Eustachian tube, maxilla and upper teeth Adobe Systems Zápatí prezentace 24 Maxillary nerve - passes through the lateral wall of cavernous sinus, - enters pterygopalatine fossa through the foramen rotundum - enters the orbit through the inferior orbital fissure and runs forward on the floor of the orbit - emerges on the face through the infraorbital foramen - terminates by dividing into inferior palpebral, lateral nasal and superior labial branches Adobe Systems Zápatí prezentace 25 Mandibular nerve •3th branch of the trigeminal nerve •counts approx. 26 000 myelinated fibers •supplies (somatosensory): Ødura mater near the posterior branches of middle meningeal artery Øskin of temporal region and around mandibula Ømucosa of the lower cheeks, isthmus faucium, palatine tonsil and the floor of the oral cavity Ømandible and lower teeth •innervates (branchiomotor): Ømasticatory muscles (m. masseter, m. temporalis, m. pterygoideus medialis et lateralis) Øm. mylohyoideus, venter anterior m. digastrici Øm. tensor tympani, m. tensor veli palatini Adobe Systems Zápatí prezentace 26 Mandibular nerve •the most lateral branch of the trigeminal ganglion •receives motor root •enters to the infratemporal fossa through the foramen ovale •enter the mandibular canal, a narrow tunnel running through the mandible, within this canal, the nerve provides branches to the mandibular teeth and emerges as the mental nerve (provides feeling of lower lip, the front of your chin, and a portion of your gums) Adobe Systems Zápatí prezentace 27 Chorda tympani Chorda tympani branches off the facial nerve (within the facial canal) and enters the lateral wall of the tympanic cavity - exits the skull by descending through the petrotympanic fissure into the infratemporal fossa and joins the lingual nerve, a branch of the mandibular nerve - fibers of chorda tympani enter the sublingual space to reach the anterior 2/3 of the tongue and submandibular ganglion which innervate the submandibular and sublingual salivary glands Adobe Systems Zápatí prezentace 28 Jaw jerk (masseter) reflex The mandible (lower jaw) is tapped at a downward angle just below the lips at the chin while the mouth is held slightly open In a healthy patient, the answer is the closing of the lower jaw, which is caused by the contraction of the masseter muscle we can test for damage to the trigeminal nerve using the masseter reflex Adobe Systems Zápatí prezentace 29 Trigeminal neuralgia type of chronic pain disorder that involves sudden attacks of severe facial pain similar to an electric shock on one side of the face - most commonly affects the 2nd and 3rd branches of the trigeminal nerve - usually the pain is triggered by touching the trigger zone (trigger point) for example touching the face, gums, chewing, brushing teeth, talking, cold or touch stimulus of the face - Inflammation in the oral cavity can mimic the trigeminal neuralgia by irritation of the mandibular nerve! - Adobe Systems Zápatí prezentace 30 Trigeminal neuralgia the most common cause of trigeminal neuralgia is compression of the trigeminal nerve at the point of exit from the brainstem by a vessel exit point of the nerve from the brainstem Adobe Systems Zápatí prezentace 31 Trigeminal neuralgia treatment – surgical - microvascular decompression and inserting a special material between the vessel and the nerve - - the goal is to reduce the transmission of pulsations from the vessel to the nerve Adobe Systems Zápatí prezentace 32 Abducens nerve (n.VI) •the abducens motor nucleus in the pons •arises from the bulbopontine groove medial to the n. VII •innervates the lateral rectus muscle Adobe Systems Zápatí prezentace 33 Abducens nerve (n.VI) - runs along the clivus forward and laterally - in the cavernous sinus runs laterocaudally from the internal carotid artery – mobile and more vulnerrable - through the superior orbital fissure into the orbit Obsah obrázku text Popis byl vytvořen automaticky thin and mobile -can be injured by stretching or compression Adobe Systems Zápatí prezentace 34 SYMPTOMS OF ABDUCENS NERVE LESION - lateral limitation of eye movement (the lateral rectus muscle does not work) - diplopia (double vision) - Etiology: - trauma - compression by the tumor - arteriovenous fistula of the sinus cavernosus - intracranial hypertension - Adobe Systems 35 Facial nerve (n.VII) Arising of the n. VII arises from the bulbopontine groove lateral from the abducent nerve) - travels from the pons through the facial canal in the temporal bone - exits the skull at the stylomastoid foramen - enters the parotid gland posteriorly and forms the parotid plexus - branches for facial muscles arise from the parotid plexus Zápatí prezentace Adobe Systems Zápatí prezentace 36 Facial nerve (n.VII) - enters the pyramid through the fundus of internal acustic meatus (area nervi facialis, ventrocranial part) - before entering the pyramid, it connects with the n. intermedius, part of the facial nerve - contains the sensory fibers for taste from the front two-thirds of the tongue and parasympathetic fibers for the sublingual and submandibular salivary gland Obsah obrázku jídlo Popis byl vytvořen automaticky Adobe Systems Zápatí prezentace 37 1. Temporal branches - muscles of the frontal and temporal region - 2. Zygomatic branches - m. orbicularis oculi, mm. zygomatici and muscles of the nose 3. Buccal branches - muscles of the upper lip and buccal region - 4. Marginal mandibular branches - muscles of the chin and lower lip - 5. Cervical branches - m. platysma after exiting the parotid plexus it has 5 branches for mimic muscles… Adobe Systems Zápatí prezentace 38 Symptoms of facial nerve lesion •mimic muscles palsy (drooping of the corner of the mouth) •lagophthalmos (inability to close the eyelids completely - leads to corneal drying and ulceration) •ageusia (loss of taste functions of the tongue) •hyposecretion of saliva Obrys plačícího obličeje se souvislou výplní Čokoláda se souvislou výplní Obrys zmateného obličeje se souvislou výplní Adobe Systems Zápatí prezentace 39 Vestibulocochlear nerve (n.VIII) - emerges from the brain at the cerebellopontine angle and exits the cranium via the internal acoustic meatus of the temporal bone - splits to form the vestibular nerve and the cochlear nerve - vestibular nerve innervates the vestibular system of the inner ear, which is responsible for detecting balance - cochlear nerve travels to cochlea of the inner ear, forming the spiral ganglion which serve the sense of hearing arises from the bulbopontine groove medial to the n. VII Adobe Systems Zápatí prezentace 40 Symptoms from damage to the vestibular system - vertigo (the feeling of spinning) - nystagmus (rhythmic, abnormal eye movements) - nausea (the feeling that you are going to vomit) - vomitus (vomiting) - Adobe Systems Zápatí prezentace 41 Symptoms from damage to the auditory system - hypacsis (partial hearing loss) - - anacusis (the total loss of hearing) - - tinnitus (the sensation of hearing, commonly described as a ringing sound, noise in the aer) Adobe Systems Zápatí prezentace 42 Vestibular schwannoma - benign tumor from the Schwann´s cells - develops on the vestibular nerve - arise at the junction of central myelin produced by oligodendrocytes and peripheral myelin from Schwann cells (Obersteiner-Redlich zone) Adobe Systems Zápatí prezentace 43 Vestibular schwannoma Symptoms from vestibulocochlear nerve compression: - one-sided hearing loss - noise in the ear (Tinnitus) - balance problems and vertigo Treatment -observations -radiation -surgical removal - Obsah obrázku text, různé, řetěz Popis byl vytvořen automaticky Adobe Systems Zápatí prezentace 44 Glossopharyngeal nerve (n.IX) - nerve with motor, sensitive and parasympathetic (gl. parotis, parotid salivary gland) component - sensory function - for taste perception from dorsal 1/3 of the tongue (n.VII - taste perception from the front two thirds of the tongue) - leaves the brainstem in a form of the several rootlets from the posterolateral sulcus - Adobe Systems Zápatí prezentace 45 Glossopharyngeal nerve - leaves the cranium through the jugular foramen - descends forward and inferiorly, aiming to the root of the tongue innervation of the muscles - muscles of the pharynx, soft palate except of m. tensor veli palatini parasympathetic innervation of the parotide gland taste perception from dorsal 1/3 of the tongue somatosensory information (pain, temperature, touch) from the pharynx, palatine tonsil, dorsal 1/3 of the tongue, tympanic cavity and adjacent part of the Eustachian tube Obsah obrázku text Popis byl vytvořen automaticky Adobe Systems Zápatí prezentace 46 Vagus nerve (n.X) - contains parasympathetic fibres to control heart, lungs, and digestive tract - extends through the jugular foramen, then passes into the carotid sheath between the internal carotid artery and the internal jugular vein down to the neck, chest, and abdomen Adobe Systems Zápatí prezentace 47 Drug-resistant epilepsy Treatment of drug-resistant epilepsy - implantation of electrodes to stimulate the vagus nerve with electrical impulses connection of subcutaneous electrodes to a generator implanted below the clavicle Adobe Systems Zápatí prezentace 48 Accessory nerv (n.XI) - essential for neck and shoulder movement - innervation of the sternocleidomastoid and trapezius muscles - palsy of the accessory nerve is most often manifested as the inability to rotate the head to the healthy side - the arm on the affected side is lowered Adobe Systems Zápatí prezentace 49 Hypoglossal nerve (n.XII) innervates all muscles of the tongue, except for the palatoglossus which is innervated by the vagus nerve - exits the cranium via the hypoglossal canal of the occipital bone - passes inferiorly to the angle of the mandible and moving in an anterior direction to enter the tongue Adobe Systems Zápatí prezentace 50 Symptom of hypoglossal nerve lesion Unilateral damage to the hypoglossal nerve hemiglossoplegia (paralysis of half of the tongue) - the affected side of the tongue is atrophic, fasciculations (muscle twitching) appear - the tongue rolls on affected side - Bilateral damage to the hypoglossal nerve - paralysis of both halves of the tongue, (glossoplegia) – cannot crawl out, speech is impaired (dysarthria) - Adobe Systems Zápatí prezentace 51 References: HOMBACH-KLONISCH, S., T. KLONISCH and J. PEELER. Sobotta: Clinical Atlas of Human Anatomy. Munich, Germany: Elsevier Science, 2019, 680 s. ISBN 978-0-7020-5273-6. STANDRING, S, et al. Gray's Anatomy: The Anatomical Basis of Clinical Practice. 41st. Philadelphia: Elsevier, 2016, 1562 s. ISBN 978-0-7020-5230-9. DRAKE, R. L., A. WAYNE VOGL and A. W. M. MITCHELL. Gray's Anatomy for Students. 4th. Philadelphia: Elsevier, 2020. ISBN 978-0-323-39304-1. DRAKE, R. L., A. WAYNE VOGL, A. W. M. MITCHELL, R. M. TIBBITTS and P. E. RICHARDSON. Gray's Atlas of Anatomy. 2. Philadelphia: Churchill Livingstone, 2015, 648 s. ISBN 978-1-4557-4802-0. VILENSKY, J. A., W. M. ROBERTSON and C. A. SUÁREZ-QUIAN. The Clinical Anatomy of the Cranial Nerves: The Nerves of "On Old Olympus Towering Top. Wiley-Blackwell, 2015, 336 s. ISBN 978-1-1184-9201-7. NETTER, F. H. Atlas of Human Anatomy. 6. Philadelphia: Saunders, 2014, 624 s. ISBN 978-1-4557-0418-7. ELLIS, H. and V. MAHADEVAN. 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CHROBOK, V., J. DRŠATA, M. JANOUCH, P. KOMÍNEK, et al. Příručka pro praxi: Screening sluchu novorozenců [online]. Praha: Česká společnost otorinolaryngologie a chirurgie hlavy a krku ČLS JEP, 2019 [cit. 2022-03-21]. Dostupné z: https://www.otorinolaryngologie.cz/content/uploads/2020/02/ppp-screening-sluchu-novorozencu.pdf ČIHÁK, Radomír. Anatomie 3. Třetí, upravené a doplněné vydání. Praha: Grada, 2016, 832 s. ISBN 978-802-4756-363. PARENT, A. and M. B. CARPENTER. Carpenter's Human Neuroanatomy. 9th Edition. Providence: Williams & Wilkins, 1996. ISBN 0-683-06752-4. AUGUSTINE, J. R. Human Neuroanatomy. 2nd Edition. New Jersey: Wiley-Blackwell, 2017. ISBN 978‐0‐4709‐6161‐2. STRASSMAN, A. M., Y. MINETA and B. P. VOS. Distribution of fos-like immunoreactivity in the medullary and upper cervical dorsal horn produced by stimulation of dural blood vessels in the rat. The Journal of Neuroscience. 1994, 14(6), 3725-3735. ISSN 0270-6474. DOI:10.1523/JNEUROSCI.14-06-03725.1994 BURSTEIN, R., P. BLAKE, A. SCHAIN and C. PERRY. Extracranial origin of headache. Current Opinion in Neurology. 2017, 30(3), 263-271. ISSN 1350-7540. DOI:10.1097/WCO.0000000000000437 Adobe Systems Zápatí prezentace 52 Thank you for your attentioon Adobe Systems