Cranial Nerve Review

Cranial Nerve Review Table


Cavernous Sinus

Nerves: CN III, IV, V1, V2, VI


Vernet’s Syndrome IX, X XI Lesions in jugular foramen
Collect-Sicard Syndrome IX, X, XI, XII Lesions in retroparotid space
Vallaret’s Syndrome IX, X, XI, XII Sympatheic chain Retropharyngeal extension
Schmidt’s Syndrome occasionally VII, Intradural extension
Avellis Syndrome X, XI XI (accessory to X) Intradural extension Occasionally inferior margin of JF
Jackson’s Syndrome X, XI, XII Intracranial extension before the nerves leave the skull base
Tapia Syndrome X, XII, occasionally Lesions high in the neck
Cerebellopontine angle syndrome XI, sympathetic chain ,VII, VIII, V Extension into CP angle
Garcin's hemibase Syndrome All cranial nerves on one side (often incomplete) Infiltrative nasopharyngeal Ca.

Uncal herniation

In uncal herniation the [temporal lobe-], the [uncus-], goes by the [tentorium-] and puts pressure on the [brainstem-]. The uncus can squeeze the CN III and cause pupils to [dilate-]. Pupillary dilation often precedes a later finding of cranial nerve III compression, which is deviation of the eye to a "down and out" .

Tonsillar herniation

In tonsilar herniation the [brainstem-] moves downward through the [foramen magnum-].[^^[1]-]^^ The resulting pressure on the brainstem causes respiratory and cardiac arrest.[[3]-] Downward herniation can stretch branches of the [basilar artery-], causing them to tear and bleed, known as a Duret hemorrhage. The result is usually fatal.[[2]-]

Parinaud’s Syndrome

  • also known as Dorsal Midbrain Syndrome or Pretectal Syndrome is named for Henri Parinaud (1844-1905), considered to be the father of French ophthalmology.
  • Parinaud's syndrome is associated with increased intracranial pressure to due to compression of the Sylvian aqueduct from a pineal region tumors (ie. pinioblastoma).
  • Parinaud's syndrome is a cluster of abnormalities of eye movements and pupil dysfunction, characterized by:
  1. Paralysis of upgaze
  2. Pseudo-Argyll Robertson pupils (light-near dissociation)
  3. Convergence-Retraction
  4. Eyelid retraction (Collier’s sign)

Brain Anatomy and Function

Region Function
Fontal lobe Motor Strip
Broca's area
Temporal lobe primary auditory cortex
Wernicke’s area
Basal ganglia
Parietal lobe primary sensory cortex
Occipital lobe primary visual cortex

Foramenal Openings

Opening/ foramen CN and other structures Syndrome name
Internal auditory meatus (iam) 7 & 8 Acoustic neuroma
Jugular Foramen 9, 10 & 11 Vallaret’s Syndrome - loss of gag reflex

Pathways for referred ear pain

Origin of Pain Anterior tongue Base of tongue pharynx and larynx gag reflex
Cranial Nerve CN 5 (V3) CN 9 (IX) CN 10 (X)
Referred Pain Outer ear and temporal region. (sensory) middle ear and auditory tube (sensory) external auditory meatus (sensory)
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