Evon Chai -ME216-

CN Nuclei Course Function

I Bipolar neurons > cribiform plate > olfactory SVA: smell
bulb > olfactory tract > olfactory area-temporal *Ant cranial fossa → anosmia, CSF rhinorrhea

II Ganglion cells (retina) > optic nerve > optic
chiasm > optic tract >
- lat geniculate body (thalamus) > optic tract >
visual area (occipital lobe)
- pretectal nuclei > EW (pupillary reflex)
SSA: vision
*Blindness
*before optic chiasm: Tunnel vision (Increased CSF)
*after optic chiasm: Homonymous hemianopia (stroke)

III Midbrain Midbrain > lat wall cavernous sinus > divides GSE: Extra ocular muscle (LPS, SR, IR, MR, IO)
periaqueductal into sup & inf div > sup orbital fissure > m/s *ptosis, squint, diplopia, [mydriasis, loss of accommodation &
Motor light reflex – sphincter pupillae & ciliary m/s]
*Eye: downwards & lateral

EW nucleus EW nucleus > CN3 > ciliary ganglion > short GVE: (EW nucleus) [Ciliary ganglion] Pupillary reflex
ciliary nerve > sphincter pupillae *ICP (extradural haemorrhage) → light reflex lost

IV Midbrain Dorsal midbrain > lat wall cavernous sinus > sup GSE: Superior oblique
orbital fissure *Diplopia (looking down) Eye: upwards & medial; head tilts

V Mesencephalic Trigeminal ganglion (petrous temporal bone) > GSA: touch, pain from skin of face
(Midbrain) V1 Ophthalmic – lat wall CS > sup orbital fissure V1 – ant scalp, forehead, ext nose, upper eyelid, frontal sinus,
proprioception > Frontal, lacrimal, nasociliary (3 branches) eye, cornea, ciliary body (Iris-corneal reflex)
from muscles of *Headache d/t common cold, eye inflammation
mastication V2 Maxillary – lat wall CS > F. rotundum >
pterygopalatine fossa > infraorbital foramen V2 – lower eyelid, cheek, ala of nose, upper lip, upper jaw
General Sense (teeth & gum), maxillary sinus
(Upper pons) V3 Mandibular – F. ovale >
touch, pressure, Short trunk V3 –
proprioception Anterior part Short trunk: -
*Trigeminal Posterior part Anterior part: Buccal N – cheek, gums of 3 lower molar
lemniscus > Auriculotemporal Posterior part:
VPM thalamus Inf alveolar N > F. mandibular > F. mental > i. Auriculotemporal – parotid gland, outer surface tympanic
(come out as MENTAL NERVE: chin) membrane, ext acoustic meatus, tragus, pre-auricular
Spinal nucleus Lingual N (branch of CN7) ii. Inf alveolar N – lower jaw (teeth & gum)
(Pons → C2) iii. Lingual N – ant 2/3 tongue, floor of mouth (joined by
Pain and chorda tympani CN7)
temperature *Trigeminal neuralgia

Motor SVE: 1st branchial arch (m/s of mastication) V3 –

(Upper pons) Short trunk: Medial pterygoid
Ant: Lat pterygoid, temporalis, masseter
Post: (Inf alveolar N) Mylohyoid, ant belly digastric

VI Facial colliculus Inf pons > cavernous sinus > sup orbital fissure GSE: Lateral rectus
(inf pons) *Medial deviation of eye

VII Spinal nucleus V Pons > loops around CN6 nucleus > facial GSA: Touch, temperature, pain (outer surface tympanic
(Pons-C2) colliculus > exit > membrane, ext auditory meatus)

Nucleus of Intracranial (middle ear) SVA: Taste (Ant 2/3 tongue) CHORDA TYMPANI
solitary tract Post cranial fossa > Int acoustic meatus (+8)>
geniculate (sensory) ganglion > facial canal
Motor (petrous temporal bone) > F. stylomastoid > SVE: 2nd branchial arch (m/s of facial expression, post belly
(lower pons) Branches: G. petrosal, stapedius, c. tympani digastric, stylohyoid, auricular m/s)
Geniculate ganglia: GSA, SVA
Sup salivatory GVE: [pterygopalatine ganglion] lacrimal gland (G. Petrosal N);
(lower pons) Extracranial [submandibular ganglion] submandibular & sublingual salivary
Parotid gland > SVE gland (via chorda tympani N)
Branches: temporal, zygomatic, buccal x2,
mandibular, cervical *UMN – opposite lower face (stroke)
(loss of nasolabial fold, drooping of mouth angle, slurring)
→ Smiling usually preserved
*LMN – same side, upper & lower face (Bell’s palsy)
(loss of forehead wrinkles, nasolabial fold, drooping of mouth
angle, eye open, corneal reflex lost, slurring of speech)
 Evon Chai -ME216-

VIII Vestibular (4) Hearing: Organ of corti > cochlear nerve SSA: Hearing (pitch-cochlear nuclei, auditory cortex; loudness-
Lat, med, sup, Equilibrium: Vestibular apparatus > vestibular N cochlear cells; localisation-sup olivary nuclei)
inf SSA: Equilibrium (vestibule-ocular reflex)
Vestibular & cochlear ganglion > Int acoustic
Cochlear meatus (+7) > lower pons *Conduction deafness (Rinne’s –ve)
*Sensorineuronal deafness (Rinne’s +ve AC > BC; Weber’s
lateralise to opposite side)
*Central vertigo – MS, neurosyphilis, vetebrobasilar ischemia,
acoustic neuroma, trauma
*peripheral vertigo – labyrinthitis, vestibular neuritis, BPPV,
Meniere’s syndrome

IX Spinal nucleus V Medulla (btw olive & inf cerebellar peduncle) > GSA: Touch, temperature, pain (Middle ear, tonsils),
(pons-C2) jugular foramen > sup & inf ganglia > btw int & pharyngeal plexus (palate, pharynx mucosa),
ext carotid artery lingual (post 1/3 tongue, circumvallate papillae)

Nucleus of SVA: Taste (post 1/3 tongue, circumvallate papillae)

solitary tract
GVA: Palate, pharynx, carotid sinus baroreceptor
*vasovagal syncope by CN X

N. ambiguus SVE: 3rd branchial arch (Stylopharyngeus) Swallowing 2nd stage

Inf Salivatory GVE: [Otic ganglion] Parotid gland salivation (via L. Petrosal N)

*Surgical, gunshot, tumour compression → Loss of gag reflex

(afferent limb), loss of carotid sinus reflex, loss of taste (post
1/3), loss of salivation, dysarthria (slurring) in bulbar palsy

X Spinal nucleus V Medulla (btw olive & inf cerebellar peduncle) > GSA: Touch, temperature, pain (medial auricle, ext auditory
(pons-C2) jugular foramen > sup & inf ganglia meatus, outer surface tympanic membrane;
dura of PCF, larynx mucosa)
+ cranial CN 11 > carotid sheath btw ICA & IJV >
Nucleus of Branches: SVA: Taste (most posterior part – vallecular)
solitary tract
(lower medulla) Meningeal: dura of post cranial fossa GVA: Inf pharynx, larynx, trachea, oesophagus (inf ganglion of
Auricular vagus), aortic body chemoreceptor
Sup laryngeal: ELN (cricothyroid), ILN (laryngeal *loss of cough reflex (anaesthesia of larynx)
mucosa sensory – cough reflex)
N. ambiguus Recurrent laryngeal – m/s larynx, mucosa SVE: 4th and 6th branchial arch (soft palate, pharynx, larynx via
(medulla) Cardiac: sup, inf neck combined CN11 & CN10), heart rate
Pulmonary plexus *uvula deviation to normal side, regurgitation of food via nose
Oesophageal plexus – Lt (ant gastric), Rt (post) *dysphagia, loss of gag reflex (efferent limb)
Abdomen – celiac, SM plexus, IM plexus *hoarseness, dysphonia, dysarthria, aphonia (if both sides)

Dorsal nucleus GVE: Parasympathetic fibres to GI, respiratory tracts

(medulla) *Parkinson’s disease (injury to dorsal nuclei)

XI N. ambiguus Cranial root – btw olive & Inf CP SVE:

(medulla) Spinal root – lat ventral horn C1-C5 (C6) >
foramen magnum > join cranial root at lateral
aspect of medulla
> leaves cranium via jugular foramen
Cranial root – Joins Vagus (soft palate, pharynx, larynx)
GSE:
Spinal root – SCM, trapezius
*LN removal surgery: trapezius paralysis (dropped shoulder)

XII Hypoglossal Ventral medulla > hypoglossal trigone at floor GSE: tongue muscles except palatoglossus (by CN X)
nucleus of 4th ventricle > medulla (btw pyramid & olive) *XII palsy → tongue deviated to side of lesion, dysarthria
(ventral
medulla) > exits skull via hypoglossal canal > **Ansa cevicalis C1 (via CN12) Geniohyoid and thyrohyoid

btw jugular vein & carotid artery > loops

around ECA below occipital A
(Runs on hyoglossus muscle)
 Evon Chai -ME216-

Reflexes
Afferent Efferent
Light pupillary reflex CN II CN III
Corneal reflex CN V1 CN VII
Vestibulo-ocular reflex CN VIII CN III
Gag reflex CN IX CN V – jaw open
CN X – pharynx constrict
CN XII – tongue thrust
Carotid sinus reflex CN IX CN X
Aortic body reflex CN X CN X
Cough reflex CN X CN X

Swallowing CN IX, CN X
Speech (consonant) CN VII, CN IX, CN X, CN XII
Speech (vowel) CN X