C.N.

TYPE CRANIAL EXIT

POINT
NUCLEUS
NAME
NUCLEUS
LOCATION
PERIPHERAL INNERVATION FUNCTION SIGN OF DAMAGE
I
Olfactory
SENSORY Cribiform plate Anterior Olfactory Olfactory Tract Mucosa of nasal cavity Smell Anosmia or dysosmia (fracture of
cribiform plate)
II
Optic

SENSORY

Optic foramen

Lateral Geniculate

Thalamus

Retina of the eye

Vision
Anopsia: visual field deficits
Loss of light reflex w/ III
Only CN affected by MS



III
Oculomotor



MOTOR



Superior
Orbital Fissure


Oculomotor



Upper Midbrain
Levator palpebrae superioris Raises eyelid Ptosis
Extraocular muscles
Superior Rectus m: SR
Medial Rectus m: MR
Inferior Rectus m: IR
Iinferior Oblique m: IO

Eye movement
MR: adduction (most
important muscle)
Diplopia
Loss of parallel gaze
External strabismus (loss of adduction)

Edinger Westphal
(Preganglionic PS)
Upper Midbrain Sphincter Pupillae Pupil constriction Midriasis
Cilliary muscle Lens accomodation Cyclopegia , loss of near response

IV
Trochlear

MOTOR

Superior
Orbital Fissure
Trochlear
Dorsal to cerebellar
peduncle, ventral to
cerebral aqueduct
Arise from the DORSAL
part , CROSS, and go
below inferior colliculus
to the ventral part.

Lower Midbrain

Superior Oblique m: SO
Downward gaze & abducts
eye
Weakness looking down (reading)
Diplopia
Intortion Tilts head AWAY from lesion










V
Trigeminal

V1: Ophtalmic
V2: Maxillary
V3: Mandibular


Corticobulbar
innervation










MIXED
(actually,
the only
one
mixed is
V3, the
rest are
sensory
only!)

V1: Superior
Orbital Fissure
Mesencephalic
Above entry point of V
Propioceptive imput
Monosynaptic reflex
Jaw jerk reflex

Motor
Point of entry of V
Medial to main sensory
nucleus
Supply muscles of
MASTICATION

Main Sensory (or
Chief or Principal)
Point of entry of V
Lateral to motor nucleus
TACTILE AFFERENTS =>
synapse 2 neuron =>
croos midline => VPM
thalamus =>
somotosensory cortex

Spinal tract & nuclei
Caudal continuation of
main sensory nucleus
Elongate nuclei
Position analogous to
dorsal horns of SC
(meaning: posteriorly
PAIN & T afferents =>
descend in spinal tract
=> reach nucleus =>
croos midline => VPM
thalamus =>
somotosensory cortex
Midbrain




Middle Pons





Middle Pons








Lower Pons to
Spinal cord
(C2)

V1:
Skin of forehead
Scalp
Cornea
V1:
General sensation (touch, pain &
T)
V1:
Loss of general sensation
Loss of blink reflex w/ VII

V2: Foramen
Rotundum
V2:
Palate
Nasal cavity
Maxillary face & teeth
V2:
General sensation


V2:
Loss of general sensation
Trigeminal Neuralgia








V3: Foramen
ovale
V3: Sensory
Anterior 2/3 of tongue
Mandibular face & teeth
V3:
General sensation
V3:
Loss of general sensation
Trigeminal Neuralgia
V3 : Motor
Muscles of mastication:
o Temporalis
o Masseter
o Medial pterygoid
o Lateral pterygoid
Anterior belly of digastric
Mylohyoid
Tensor tympani
Tensor palati



V3:
Mastication



V3:
Weakness in chewing
Jaw deviation TOWARDS weak side


Remember!!!
Complete V lesion (at entry or exit point of V) in ROSTRAL PONS, results in COMPLETE ANESTHESIA OF IPSILATERAL FACE & JAW
WEAKNESS (bc the Motor & Main Nuclei are fucked up)
Lesion in LATERAL LOWER PONS or LATERAL MEDULLA, results in COMPLETE ANESTHESIA and LOSS OF T SENSATION OF
IPSILTAREAL FACE ONLY, muscle function & tactile sensation would be intact. (bc spinal nuclei it the only one fucked up)


VI
Abducens


MOTOR


Superior
Orbital Fissure
Abducens
Found near the midline,
in the floor of the 4
th
v.
VI fibers encircled by VII
fibers (genu)


Pons


Lateral Rectus


Abduction
Diplopia
Internal Strabismus: medial eye
deviation
Loss of parellal gaze
Pseudoptosis

VII
Facial

Corticobulbar
innervations
(partially bilateral)
Bilateral upper face
innervation
Contralateral lower
face innervatoin





MIXED


Entry: Internal
Acoustic
meatus

Exit:
stylomastoid
foramen
Motor
Ventrolateral to VI
nuclei
Anterior Genu of Facial
Nerve: Fibers curve
around the posterior
side of VI nuclei, then
pass ventrolaterally
Solitary
Respond to visceral
sensation (taste,
respiratory, GI)
Superior Salivatory




Pons
Facial expression muscles
Posterior belly of digastric
Stylohyoid
Stapedius ---------------------->
Facial expression


Controls amplitude of sound
Corner mouth drops, cant close eye,
cant wrinkle forehead, no blink reflex
Hyperacusis
Submandibular & sublingual g. Salivation (preganglionic PS)
Skin behind ear Pain behind ear
Anterior 2/3 tongue palate Taste Ageusia (loss of taste), disgeusia
Lacrimal gland Tears (preganglionic PS) Dry, red eye. Loss of lacrimation, complete
VII lesion
Right Corticobulbar fibers ( UMN Lesion) Left lower face weakness= mouth droops (pt CAN blink, wrinkle
forehead, bc pt still have the left corticobulbar fibers innervating the upper face)
Left LMN lesion(VII) Complete left face weakness = Bell Palsy


VIII
Vestibulocochlear



SENSORY


Internal
Acoustic
Meatus

Vestibular
Posterior surface of
Pons

Cochlear
Dorsal & Ventral

Pons
Medulla

Ponto-
medullary
junction


Inner ear laberynth structures
Semicircular canal
Cochlear apparatus

Hearing
Balance
Angular acceleration (head
turning)
Linear acceleration (gravity)
Sensorineural hearing loss
Profound & unilateral lesion is in
cochlear nuclei or cochlear part of VIII
Slight bilateral hearing loss & decrease
ability to localize sound lesion above
superior olivary nucleus
Loss of balance
Nystagmus

IX
Glossopharyngeal


MIXED

Jugular
Foramen
Ambiguus
LMN muscles
Behind inferior ollive
Solitary
Same as X
Inferior Salivatory


Medulla
Stylopharyngeus Elevation of pharynx

Loss of Gag reflex with X
Oropharynx Sensation
Carotid sinus/body Chemoreceptor
Parotid gland Salivation
Posterior 1/3 tongue Taste





X
Vagus

Corticobulbar
innervation







MIXED






Jugular
Foramen
Ambiguus
LMN skeletal
muscles
Behind inferior ollive
Dorsal Motor Vagal
Major
Parasympathetic
nuclei preganglionic
fibers to thorax and GI
(foregut & midgut)
Lateral to XII nucleus,
in the floor of 4
th
v.
Solitary
Respond to visceral
sensation (taste,
respiratory, GI)
Imput of carotid sinus
and body







Medulla

Muscles of palate and
pharynx; except tensor palate
(V) and stylopharyngeous (IX)

Swallowing


Dysphagia
Palate droop (ipsilateral paralysis of
soft palate Uvula pointing AWAY
from lesion
Nasal regurgitation
Larynx muscles
(recurrent laryngeal)

Fonation
Nasal speech
Hoarseness
Fixed vocal cord

Larynx and Laryngopharynx
Sensory Loss of gag reflex w/ IX
Loss of cough reflex
Delayed gastric emptying
GI tract & GI smooth muscle &
glands (foregut & midgut)
Sensory
PS
Delayed gastric emptying


Carotid sinus/body

Chemoreceptor

XI
Accesory
Corticobulbar inn.

MOTOR
Jugular
Foramen

Spinal Accesory
Cervical spinal
cord
Sternocleidomastoid Head rotation to opposite side Weakness turning chin to opposite side
Trapezius Elevates and rotates scapula Shoulder droop
Remember: Intramedullary lesions DONT affect this CN!!!
XII
Hypoglossal
Corticobulbar inn.

MOTOR
Hypoglossal
canal

Hypoglossal

Medulla
Styloglossus
Hypoglossus
Genioglossus
Intrinsic tongue muscles
(except palatoglossus by X)

Tongue movement
Tongue pointing TOWARDS affected side
on protrusion