Cranial nerves, I - olfactory nerve and disorders

Olfactory nerves that subserve the sense of smell have their source cells in the mucous membrane of the top and back part of the nasal cavity. Bipolar sensory cells, the distal portions of which consists in ciliates processes are of penetrating the mucous membrane in the upper part of the nasal cavity. The core processes of these nerves, approximately twenty each side, passing through ethmoid cells, which form the brush as olfactory glomeruli terminals dendrites cribiform plate. Axons mitral cells enter the olfactory Groove frontal bones to the brain. Subsequently, the olfactory tract divided into olfactory medial and lateral grooves. The medial straie becomes the opposite of the previous commisure. Lateral stretch fibers emerge from distribution to previous perforated substance and end up in the complex prepiriform and medial and cortical nuclei of the amygdaloid area. The latter represents the main olfactory cortex.

Testing: before assessing olfactory sensations, one must determine that the nasal passages are not blocked. Local allergic rhinitis, the plyps and sinusitis that undermine smell injuries must be excluded. The test substance should be non-irritating and volatile. Fresh ground coffee, asafoetida, eucalyptus oul power oil or lemon are some of the common test substances used. Substances such as chloroform that can stimulate the gustative final-organos or peripheral nerves trigeminal neuralgia in nasal instead of stimulating olfactory nerves, mucosal endings must be avoided. Each ditch should be evaluated separately with another grave be masked.The patient must be ordered to inhaled and identify the substance of ensayo.La odor perception is more important than the identification.

Smell disorders

1 Quantitative: Loss (anosmia) reduction (hyposmia) or greater acuity (which).

2 Qualitative: Distortion of smell (dysosmia or parosmia)

3 Delusions and hallucinations of smell.

Anosmia occurs only if the disease is bilateral.La head injuries, olfactory groove meningiomas and aneurysms of previous previous or brain communicates artery are some of the causes of the unilateral anosmia.Hyperosmia tends to be a feature of neurotic patients.Dysosmia or parosmia can occur with local abnormalities in the nose.Olfactory hallucinations and delusions usually suggest psychiatric disorders.However, it can be associated with uncinadas where olfactory experience is brief and accompanied by an alteration of consciousness and other phenomena epileptic seizures.

The olfactory nerve is one of the twelve cranial nerves in the human body and is very important if your function and disorders are known.

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The accessory nerve (eleventh cranial nerve) and hypoglossal nerve (12th cranial nerve)

The accessory nerve (eleventh cranial nerve) is a purely motor nerve and has two roots cranial and spinal column. Hypoglossal nerve is also a pure motor nerve and provides intrinsic muscles of the tongue.

The accessory nerve

This is a purely motor nerve. It has two roots-cranial and spinal column. Spinal root stems from the previous five upper cervical segments horn cells and enters the skull of the foramen magnum. These fibres are joined by the cranial root that emerges from the part flow together and ambiguous kernel leave the skull of the hole jugular with the vague.Into the hole jugular, cranial root fibres bind the vague to be distributed together with the vague pharynx and laringe.Esta fibres part of nerve cannot test separately. The part of the spinal column supplies the esternocleidomastoideo and the top of the Trapeze.

Testing: This is limited to the assessment of the esternocleidomastoideo engine power and the sternocleidomastoid trapecio.El is evaluated by the inspection and palpation while patient turns his head against the muscular paralysis resistencia.La is flat and not prominently highlighted on the head to the opposite side. Trapeze is tried asking the patient to tap or shrugging.

Hypoglossal nerve (12th cranial nerve)

This is also a pure motor nerve and supplies the intrinsic muscles of the tongue. Arises from a series of rootlets cord between pyramid and inferior olive and arises skull through hypoglosal hole of providing language.

Tests: You must ask the patient to open the mouth without stick out tongue. In unilaterla paraysis, the language for the healthy side curves sliughtly.The protruding tongue, is diverted to the paralysed side.Look for any loss or the lengua.Esto fibrillations should always be reviewed without protrusion of the tongue and indicates a lower motor neuron nerve injury XII.In injuries to the upper motor neuron, the language is short and speastic.

Bulbar paralysis: this is a syndrome characterized by weakness or paralysis of the muscles supplied by lower brianstem motor cores i.e. the motor nerves in ninth to twelfth cores.Acute injuries as siphetheria or polio, no time for muscle atrophy.Chronic as paralysis bulbar progressice or brain stem tumors are marked wasting and atrophy of the mouth, tongue and the sternocleidomastoids.Esto shapes must be differentiated from pseudobulbar palsy is caused by the paralysis of upper motor neuron muscles bulbar in vascular lesions of the upper brainstem and motor neuron disease.

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Ocular nerves - Oculomotor, trochlear and Abducens nerve

Ocular nerves are oculomotor, the trochlear and Abducens nerve. Work together in the regulation of eye movements, they are considered as ocular nerves and discussed together.

The (cranial nerve III) oculomotor nerve
Oculomotor nucleus consist of several peer groups of adjacent to average, ventral line to the aqueduct of sylvius in upper colliculi nerve cells. A central group of nerve cells, Edinger-Westphal nucleus innervate pupillary sphincter and ciliary bodies. Situated more dorsally and constitutes the parasympathetic nerve part oculomotor.Nerve cells that mediate the action of eye muscles show definitive topographical representation of back-ventral.El course of nerve fibers previously through the midbrain, medial tot he red core, the substantia nigra and cerebral peduncle. Nerve follows the previous appearance of just mid-brain's pons, between superior cerebellar and later cerebral arteries.

Penetrates the Dura side and prior to the subsequent clinoid process and enters the side wall breast cavernoso.Desde there, enter orbit of supplied and superior orbital fissure lift palpaebrae superioris, inferior oblique and straight top, medial and bottom muscles. The preganglionic parasympathetic fibers from the Edinger-Westphal nucleus passed to ciliary ganglion, whence postganglionic fibers provide pupillary constrictores and ciliary muscles which function in accommodation.

The trochlear nerve (4th cranial nerve)
This is the smallest of the cranial nerves and is situated just prior to the aqueduct in the midbrain immediately above the curve fibres pons.Las and with the aqueduct later and decussate in previous Medullary veil. Penetrates hard posterolateral clinoid later process into the cavernous sinus where is lateral and lower third nerve. On the superior orbital fissure enters orbit to provide superior oblique muscle. This nerve palsy causes weakness movement down and to outside eyes and extorsion (eyeball outward rotation).

Abducens nerve (cranial nerve VI) (Abducent nerve)
This nerve emerges from the bottom of the pons on the fourth floor ventriculo.El nerve follows the brain stem in the pontomedullary junction. It has the longest intracranial course between the cranial nerves and lies between the bridge Pons and the clivus. Drilled in the back between the subsequent clinoid and apex of the petrous bone sellae Dura into the cavernous sinus inferomedial 3rd nerve.Enters orbit through superior orbital fissure to supply the rectus (lateral) external.

Medial longitudinal fasciculus: This fiber tract une 3rd cores, 4, 5, 6, 7, 8, 11 and cranial nerve XII and cervical nerves motor kernels higher.Due to this interconnection isolated eye movements are not posibles.Visual, auditory, sensory, vestibular and other stimuli produces conjugated deviation of eyes and head.

Sympathetic innervation: sympathetic fibers that control the action of oculopupillary originate from the eighth cervical and first thoracic spinal segments.Preganglionic fibers will lower sympathetic ganglia, middle and upper neck.Postganglionic fibres follow the course of the internal carotid artery and travel Division of Ophthalmology fifth nerve in orbit.On the nerves for a long ciliary time, supplying the dilators tarsal muscles pupilar.Los and orbital muscle Muller.

Cortical control: the back of the second and third front convolutions are evolutionary cortical control eye movements conjugados.Un Pontine for lateral eye Center also has been described in the vicinity of the Abducens - the center of gaze of parapontine nerve.

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Glossopharyngeal nerve and vagus nerve (9th and 10th cranial nerve) and its disorders

Since these two cranial nerves intimately connected described here together. Glossopharyngeal nerve has a sensory component and speedboat. Motor fibres originate the nucleus ambiguus, located on the side of the spinal cord. Along with the vagus, and accessory nerves, leave the skull of the hole jugular. Muscle stylopharyngeus whose function is to provide the elevate the pharynx. Autonomic efferent fibers of the glossopharyngeal nerve arise from the inferior salivatory nucleus. Preganglionic fibers become otic ganglion of less superficial petrosal nerve. and postganglionic fibres pass through the auriculotemporal nerve fifth branch to reach the Parotid gland. The nuclei of the glossopharyngeal nerve sensory fibres are located in petrous found in petrous below of the hole bone jugular ganglion and also the upper ganglion, which is small. Exteroceptive fibres supplied faucial tonsils, the rear wall of the pharynx, part of the soft palate and sensations of taste of the rear third of the language.

The vague: this is the longest among all the cranial nerves. Motor fibres originate the ambiguous nucleu and supply of all the muscles in the throat, the soft palate and larynx, with the exception of tensor veli palati and stylopharyngeus. Parasympathetic fibers emerge from the dorsal efferent kernel and left cord as preganglionic fibers part craniosacral autonomous nervous system. These fibres end nodes close to the viscera supplying post-ganglionic fibers. Is parasympatahetic function. Therefore, vagal stimulation produces bronchial constriction, bradycardia, secretion of the gastric and pancreatic juice and greater peristalsis.Sensory part of the vague has their nuclei in the jugular in ganglion and ganglion vague nodoso.El sensations from the subsequent appearance of the external auditory meatus and adjacent pinna and the sensation of pain from the duramater lining the posterior cranial fossa.

Testing: It's better to test features of nerve IX and x together as they are affected usually together. Consult for symptoms such as dysphagia, dysarthria, nasal regurgitation of fluids and hoarseness of voice. Part of engine is tested by examining the uvula when the patient is made to open the mouth.The uvula is usually unilateral vague media.Paralisis online, palatal arc is flattened and dropped from ipsilaterally. The phonation the uvula is diverted to the normal side.

Gag reflex or pharyngeal reflex occurs through the application of a stimulus, such as a bucket of cotton to the wall of pharynx psoterior or squeezes region or language.If the mirror is present, there will be accompanied by retraction of the tongue pharyngeal muscles contraction and elevation.This reflex afferent arc is favoured by the glossopharyngeal, while the efferent is through the vago.Este reflection is lost in both nerve injury 9 or 10.Comprobar General sensation on the posterior wall of pharynx, soft palate, tonsils faucial and taste on the third back of the tongue. These are problems in glossopharyngeal paralysis.

Disorders of nerve functions of the ninth and tenth

Isolated from any nerve involvement is rare and usually involved together, often the nerves of the 11th and 12th centuries also may be affected. The glossopharyngeal neuralgia resembles the trigeminal neuralgia, but is much less common. It is presented as a paroxysmal pain originating from the throat of tonsillar fossa.It may be associated with bradycardia and in such cases is called neuralgia vegoglossopharyngeal.Una trial of phenytoin or carbamazepine is effective for pain relief.Brain stem as a disease of motor neuron, vascular lesions as lateral Medullary infarction or bulbar poliomyelitis injuries can affect these together resulting in bulbar paralysis nerves.Basal meningitis and posterior Fossa tumors can involve these nerves outside the brain stem.Complete bilateral paralysis of vague is incompatible with life.Especially on the left recurrent laryngeal nerve, participation occurs in thoracic injury and this produces only hoarseness of voice without dysphagia.

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