FUNCTIONAL DIVISIONS OF NERVOUS SYSTEM

• Sensory (Afferent) Nervous System

• Motor (Efferent) Nervous System
➢ Somatic Nervous System
✓ Effector organ: Skeletal Muscle
➢ Visceral (Autonomic) Nervous System
✓ Effector organs: Smooth muscle, Cardiac muscle, Gland
➢ Parasympathetic Nervous System
• “Rest and Repair”
• CNS III, VII, IX, X & sacral region
➢ Sympathetic Nervous System
• “Fight or Flight:
• Thoracolumbar region (T1-L1-2)

DEFINITION OF TERMS
Nucleus (Nuclei)
− A mass of gray matter or group of cell bodies of neurons in the
central nervous system
− Cranial motor nuclei
• Found mostly in the brainstem

Ganglion (ganglia)
− A mass of gray matter or group of cell bodies of neurons outside
the brain or spinal cord
− Cranial motor ganglia
• are situated along the course of efferent nerve fibers of
the autonomic pathway: relay the motor impulse from
the brainstem to the effector organ

CRANIAL NERVES
12 pairs of nerves that serve mostly the head & neck
• Except Vagus - also supplies thorax & abdomen
• 10 CNs have their nuclei within the brainstem (infratentorial)
• Classified by function as:
✓ Purely sensory / afferent: I, II, VIII
✓ Purely motor / efferent: III, IV, VI, XI, XII
✓ Mixed: V, VII, IX, X
✓ Parasympathetic: III, VII, IX, X

I Olfactory Oh Sensory Some

II Optic Oh Sensory Say
III Oculomotor Oh Motor Marry
IV Trochlear To Motor Money
V Trigeminal Touch Both / Mixed But
VI Abducens And Motor My
VII Facial Feel A Both / Mixed Brother
VIII Vestibulocochlear Virgin Sensory Says
IX Glossopharyngeal Girl’s Both / Mixed Big
X Vagus Vagina Both / Mixed Boobs
XI Spinal Accessory So Motor Matter
XII Hypoglossal Heaven Motor Most

LOCATIONS OF CRANIAL MOTOR NUCLEI

Midbrain: III, IV
Pons: V, VI, VII (and VIII – sensory)
Medulla: IX, X, XI, XII

Cerebrum: I, II (SENSORY)

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 ✓ Afferent neuron (sensory neuron or N1)
✓ Association neuron (interneuron or N2)
✓ Effector neuron (motor neuron or N3)
✓ Effector organ (muscles and glands)

FUNCTIONAL COMPONENTS OF MOTOR CRANIAL NERVES

Efferent - impulses travel from CNS to periphery (processing center to
the effector organs)
Somatic
• General: skeletal muscles of myotonic origin (GSE)
✓ Sternocleidomastoid
• No special somatic efferent (SSE)
Visceral
• General: to smooth and cardiac muscles, glands (GVE)
✓ Parasympathetic
• Special: to skeletal muscles of branchiomeric origin (SVE)
o All muscles that are not myotonic in origin but are
branchiomeric in origin
o Muscles of facial expression, mastication, phonation
Significance of the pyramidal decussations: and deglutition
• Lesions above it: contralateral
• Lesions below it: ipsilateral FUNCTIONAL CLASSIFICATION
Motor Nuclei of CN III
• Edinger Westphal • Coming from the body wall, skin, skeletal
• Oculomotor nucleus Genetic muscles, tendon
Superior Salivatory Nucleus Somatic • Except for skeletal muscles for facial
• Motor nucleus of CN VII Afferent (GSA) expression, mastication, deglutition and
Inferior Salivatory Nucleus phonation
• Motor nucleus of CN IX General
Nucleus ambiguous • Coming from the reproductive tract, GIT and
Visceral
• Motor nucleus of IX, X, XI respiratory tracts
Afferent (GVA)
Special
FUNCTIONAL CLASSIFICATION OF MOTOR NEURONS Somatic • CN 2, 8 (vision & hearing)
Motor Neurons Afferent (SSA)
• send impulses towards the effector organ (muscles and glands) • Smell and taste
• Lower motor neurons Special Visceral • CN 1, 7 (ant 2/3 tongue)
• Location: brainstem nuclei and anterior horn of the spinal cord Afferent (SVA) • CN 9 (post 1/3 tongue)
(motor) • CN 10
o Posterior horn of the spinal cord – sensory General
Motor Association / Internuncial Neurons • Coming from the body wall, skin, skeletal
Somatic
• Carry impulses from one motor neuron to the other Efferent (GSE)
muscles, tendons (CNs 3, 4, 6)
• Usually found in the spinal cord General • Any secretions of the gland, contraction of the
Visceral muscles (intestines, esophagus, stomach)
PATHWAY OF A MOTOR CRANIAL NERVE Efferent (GVE) • Parasympathetic
➢ skeletal muscles for facial expression,
Special Visceral
mastication, deglutition and phonation (CN 5,
Efferent (SVE)
7, 9, 10)

CRANIAL NERVES: MOTOR NEURONS AND FUNCTIONS

WIRING OF A REFLEX
Reflex Arc
• Five Steps
✓ Arrival of stimulus and activation of receptor
✓ Activation of sensory neuron
✓ Information processing (usually in cerebral cortex)
✓ Activation of motor neuron
✓ Response by effector
• Receptor organs: sensory nerve endings
• Effector organs: Muscles & glands
• Consists of:
✓ Receptor organ (sensory nerve ending)
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 • Results from infections in the orbit, nasal sinuses and superior part
of the face
• Facial veins make clinically important connections with the
cavernous sinus through the superior ophthalmic veins
• Structures that maybe affected:
✓ CNs III, IV and VI
✓ Ophthalmic and Maxillary divisions of CN V
✓ Internal carotid artery

SAMPLE QUESTION:

Septic thrombosis of the cavernous sinus could cause secondary

injury to the following structures except:

A. Maxillary division of Trigeminal nerve

B. Mandibular division of Trigeminal nerve
C. Trochlear Nerve
D. Internal carotid artery

Test for CN V
• Ask the patient clench teeth, then palpate
masseter and temporalis muscles
• Lesions:
✓ Paralysis of muscles of mastication
✓ Deviation of jaw to weak side Atrophy of right
muscles of mastication
Right CN V affection

Test for CN VII

• Ask the patient to show the teeth by separating the lips with teeth
clenched
• Lesions:
✓ Bell’s palsy – dysfunction of the nerve
as it lies within the facial canal;
unilateral facial paralysis
✓ Facial paralysis
✓ Dry mouth
✓ Loss of lacrimation

• Facial Nerve
• Innervates the
➢ muscles of facial expressions
➢ taste buds of the anterior 2/3 of the tongue
➢ secretomotor to submandibular, sublingual and
lacrimal glands
• Exits the brainstem in cerebellopontine angle
• Enters the internal auditory meatus and exits the skull thru
stylomastoid foramen
• Branches:
➢ Geniculate ganglion
LESIONS AND COMMON CLINICAL CONDITIONS − Give rise to:
✓ Greater petrosal
Tests for CNs III, IV, VI (extraocular – muscles controlling the eyeballs) ✓ Nerve to stapedius
➢ Ask the patient to move eyes vertically & horizontally; then ✓ Chorda tympani
upward-laterally, upward-medially, downward-medially, & ✓ Post. Auricular
downward-laterally ✓ Parotid plexus
Test for CN III only
➢ Pupillary reaction is tested

• III
✓ Diplopia – patient sees double
✓ Ext. strabismus – eye looks laterally
✓ Ptosis – drooping of upper eyelid
✓ Dilated & fixed pupil
✓ Paralyzed accommodation
✓ Inferior oblique – upward gaze weakness

• IV
✓ Diplopia – extorsion of the eye
✓ Weakness of downward gaze

• VI
✓ Diplopia
✓ Int. strabismus – medial deviation

Cavernous Sinus Thrombosis

Lecturer: Dr. Gerald Dale Giron Page 3 of 4
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 ➢ Terminal branches of CN VII
from Parotid Plexus
✓ Temporal
✓ Zygomatic
✓ Buccal
✓ Mandibular
✓ Cervical

Bell’s Palsy
• Paralysis of facial muscles on the affected side
• Loss of tonus of orbicularis oculi causes eversion of lid – lacrimal
fluid is not spread over cornea – vulnerable to ulceration
• Drooping of the corner of mouth
• Weakened lip muscles affect speech
• Signs & Symptoms:
➢ Facial paralysis
➢ Loss of corneal / blink reflex
➢ Hyperacusis
➢ Dry mouth
➢ Loss of lacrimation
➢ Loss of taste – anterior 2/3 of tongue

Tests for CNs IX & X

• Gag reflex tested by touching lateral wall of pharynx with a
spatula
• IX – isolated lesions are rare, usually, also involve the vagus
nerve
➢ Dysphagia
➢ Loss of gag reflex
• X
➢ Dysphonia
➢ Dyspnea
➢ Dysarthria
➢ Dysphagia
➢ Loss of gag reflex
➢ Sagging of palatal arch; deviation of ovula

Test for CN XI
• Ask the patient to turn head to one side against resistance (test
the sternocleidomastoid); ask the patient to shrug/elevate
shoulders (test for trapezius)
• Lesions:
➢ Weakness in turning head toward opposite side & shrugging
shoulder on the same side

Test for CN XII

• Ask the patient to stick out the tongue
• Lesion:
➢ Hemiparalysis of the tongue
➢ Deviation towards the weak side

SAMPLE CASE
• During class, I asked the class to get ¼ sheet for a 10-item quiz. They
all said “NO!!!”
✓ Receptor: Organ of Corti
✓ Sensory: Cochlear
✓ Asso. Neuron: Spinal ganglion of Corti
✓ Center: Temporal lobe, brainstem
✓ Motor: Dorsal motor nucleus of vagus
✓ Effector: Muscles of phonation
✓ Special Sensory Afferent (SSA) SVE (CN10) phonation

• A medical student touched my face on right side, then I looked towards

my right side (no head turn)
✓ Receptor: Meissners corpuscles
✓ Sensory: Trigeminal nucleus of semilunar ganglion
✓ Asso. Neuron: Main principal nucleus of trigeminal nerve
✓ Center: Midpons
✓ Motor: Abducens nerve – lateral rectus
✓ Effector: Lateral rectus right eye; medial rectus left eye
✓ General Somatic Afferent (GSA) General Somatic Efferent
(GSE)

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