Neuroanatomy summary – Cranial nerves

By : Manar Bawaqnah
Dr: Mohammed Abuawad
 First order neuron Second order neuron
Neuron CN1: olfactory neuron Cell body Olfactory bulb
bipolar neuron
Receptor Radiated cilia in mucus Neuron cell 1- Mitral cell
2- tufted cell
Cell body Olfactory epithelium in superior Axons -Olfactory tract
nasal concha *medial stria : synapse with anterior
Axons inter the Cribriform plate of ethmoidal olfactory nucleus and cross to the
skull through bone contralateral olfactory bulb through
anterior commissure
**lateral stria : stay in the same side
Synapse with Olfactory bulb : glomerulus Cerebral cortex Primary cortex: piriform or
second order In temporal periamgdaloid area
neuron in lobe Secondary cortex: entorhinal cortex
(28)
Type of neuron Type C : unmyelinated Type of neuron Myelinated fibers

*lesion in one side of olfactory nerve don`t cause lose of olfactory sensation

* lesion in both of olfactory nerve cause lose of olfactory sensation (ansomnia)

CN2: optic nerve

First order neuron Second order third order neuron
neuron
receptor Cons Bipolar cell cell Ganglion cell
-7 million in fova centralis axons Form the optic nerve, CN2
-high visual acuity & color Consist from:
-synapse with one bipolar neuron - temporal hemiretina fiber
Rods -nasal hemiretina fiber
-100 million outside fova centralis
in macula leutea Cortex: Primary visual cortex (17) =
-detect the shape and movement occipital striate cortex
10-20 rods synapse with one Secondary visual cortex (18 &
bipolar neuron 19) = extrastriate cortex

Visual reflex Afferent limb nucleus Efferent limb note

Direct and Epsilateral - Midbrain, -preganglionic -test: direct a light toward one eye
consensual optic nerve pretectal nucleus, parasympathetic fiber of -normal results: bilateral constriction
light reflex CN2 epsilateal oculomotor nerve CV3 Lesion
- If in the CN2: lose of direct (epsi)
-synapse with ciliary
-and then to EWN, and indirect (contra) light reflex
ganglion
bilateral when U direct the light toward the
-postganglionic affected eye
parasympathetic that - If in CN3 or EWN: lose of direct eye
innervate ciliary muscle reflex when U direct the light
and pupil sphenctor toward the affected eye & lose of
muscle( short ciliary indirect eye reflex when U direct the
nerve) light toward the normal eye
Visual reflex Afferent limb nucleus Efferent limb note
Accommodaton optic nerve 1- superior 1-CN3 nad EWN as mentioned -normal results bilateral pupil
refex CN2 colliculus and then above. constriction + increase
to EWN, bilateral curvature of muscle & both
2- viscual eye filed 2- through UMN to eyes move medially by medial
cortex(area 8) occulomotor nuclei in midbrain rectus muscle
In frontal lobe (pure motor) eyes move medially Lesion: no accommodation reflex
Corneal reflex Opthalmic -Trigeminal CN6: facial nerve , innervate -test: touch the cornea
branch (V1) ganglion and then orbicularis oculi and cause -normal result: bilateral
of CN5 spinal trigeminal blinking blinking by orbicularis oculi
nucleus (bilateral)
-then, facial nuclei
Visual body Superior coilliculus Tectospinal tract : innervate The reflex: Moving your head
reflex splenius capitis muscle and neck with an object that U
Tectobulber: facial and see
oculomotor muscles
Pupillary skin -Thalamus -Hypothalamospinal tract -> The reflex: Mild pain (pinching)
reflex ciliospinal center of budg, stimulate muscles of head,
(ciliospinal -Superioe cervical pregnaglionic sympathetic neck & trunk and epsilateral
reflex) sympathetic ganglion (epsilateral) pupil dilatation
-postganglionic sympathetic
(long ciliary nerve)  pupil
dilator muscle

Structure Content Lesion

Optic nerve Epsilateral temporal and nasal hemiretinal Lose of visual filed in the epsilateral eye
fiber = total blindness of the epsilateral eye

-if the lesion in the temporal fiber of one eye:

epsilateral nasal hemianopsia
Optic chiasm -Bilateral nasal hemiretinal fiber Lose of Rt visual field of Rt eye & Lose of Lt
-decussate in it visual field of Lt eye
= Bilateral heteronymous (temporal)
hemianopsia
Optic tract or geniculate - Epsilateral temporal hemiretinal fiber Lose of contralateral visual field of both eyes
nucleus or optic - contralateral nasal hemiretinal fiber = contralateral homonymous hemianopsia
radiation (whole of it) - responsible for the contralateral visual
Superior optic radiation Inferior contralateral visual field fiber Lose of Inferior contralateral visual field
(posterior stream) remember: Rt visual filed = Rt visual filed = contralateral inferior homonymous
paraital lobe of Rt + Rt visual filed of Lt quadranopsia
Inferior optic radiation superior contralateral visual field fiber Lose of superior contralateral visual field
(ventral stream) = contralateral superior homonymous
temporal lobe quadranopsia
Note Optic tract & geniculate nucleus & optic radiation are responsible for the contralateral visual
filed
- Rt visual filed = Rt visual filed of Rt + Rt visual filed of Lt
Cerebral cortex OR post. contralateral homonymous hemianopsia with
cerebral artery macular sparing in both eyes (bilateral)
CN3: oculomotor nerve
Nuclei Edinger westphal nuclei Pure motor nuclei
type Preganglionic parasympathetic Motor
Location Midbrain, more posteriorly Midbrain
Innervate 1- constrictor pupillae muscles. 1- levator palperae muscle
2- ciliary muscles. 2- superior rectus muscle
3- inferior rectus muscle
4- medial rectus muscle
5- inferior oblique muscle
Emerge from Interpeduncular fossa Interpeduncular fossa
Lesion of CN3 CN3 Palsy:
1- flaccid paralysis of extraocular muscle
2- ptosis
3- eyeball move outward downward (laterally and inferiorly)
4- pupil dilatation

note Edinger westphal branch extend with the pure motor fiber, and when the pure
motor divided into superior and inferior branches, it extend with the inferior
branch, and then with the branch that innervate the inferior oblique muscle.

CN4: Trochlear nerve

Name Trochlear nerve
Nucleus + location Trochlear Abducent in the mid brain, at the level of inferior colliculus
Emerge from The dorsal surface of midbrain
Innervate Superior oblique muscle, move the eye downward + laterally (outward
and internal rotation)
lesion Eye ball move medially and superiorly
falling during going down the stairs
Note The Rt Trochlear nucleus give the Lt trochlear nerve, and so on.

CN6: Abducent nerve

Name Abducent nerve
Nucleus + location Abducent Abducent in pons
Emerge from Pontomedullary junction
innervate Lateral rectus muscle
lesion Medial strabismus and enotropia
 CN5: Trigeminal nerve
Name Trigeminal nerve : psudounipolar neurons
Divisions Ophthalmic (V1) Sensation from frontal sculp, upper eye lid, conjunctiva, cornia,
upper nose
Maxillary (v2) Nasal cavity, upper lip, upper oral cavity, upper teeth
Zygomatic and temporal region
Mandibular (V3) Lower lip, jaw, external ear
nuclei Spinal trigeminal nucleus -Pain and temperature sensation from the epsi lateral
side of face
- found in: caudal pons (laterally) & medulla
-cell body found in the trigeminal ganglion
chief sensory or principal -TPDT and pressure sensation from the face
nucleus - middle pons ; laterally
-cell body found in the trigeminal ganglion
mesencephalic nuclei -proprioception from masseter muscle and
temporomandibular joint
- upper pons (Laterally) & midbrain
- cell body found mesencephalic nuclei (CNS not PNS)
motor nuclei of trigeminal - middle pons ; medially
-cell body found in the trigeminal ganglion
Innervated muscles: 1-lateral pterygoid muscle 1- anterior belly of digastric muscle
Muscles of 2- medial pterygoid muscle 2- tensor tympani muscle
mastication 3- temporalis muscle 3- Veli palatine muscle
4- masseter muscle 4- mylohyoid muscle
lesion 1-lose of sensation of pain and temperature, pressure, TPDT from the epsilateral side
of the face + lose of general (not taste) sensation from the anterior 2/3 of the tongue
2- lose of corneal reflex
3- paralysis of muscles of mastication
Trigeminal neuralgia Symptoms:
Or tic douloureux Recurring intense stabbing & shooting pain that continue for 10 min and then stop
(has gab or free period), usually occur in mandibular division
More common in female and people older than 50
Reason:
1- vascular compression 2- tumer or multiplesclerosis 3- idiopathic
Treatment:
Antiseizure drugs + antidepressant drugs : gapapentin or phenytoin
Surgery in case of tumor(remove it) or vascular compression (relieve the nerve)
 CN7 : Facial nerve
Nuclei Emerge Extend through Notes Innervate or sensation
from brain
stem
Facial motor Branches: -Muscles of face except:
nuclei 1- temporal branch muscles of mastication
2- buccal br. -Innervate: cervical platysma
Facial canal: 3- mandibular br. Muscle of mandible, zugomatic,
b/w Internal 4- zygomatic br. temporal
Internal acoustic 5- cervical br. -give a branch before it exit
acoustic meiatus & from stylomastoid foramin
meiatus stylomastoid innervate stapedius muscle
Superior salivary foramen Preganglionic Parasympathetic The postganglionic
gland neuron extend through cordi Parasympathetic fibers
tympani nerve, then synapse innervate : submandibular and
with the autonomic ganglion sublingual gland
(submandibular ganglion)
Nucleus The cell body neuron that trans Trans taste sensation from the
solitaries the taste sensation found in the anterior 2/3 of the tongue
geniculate ganglion and the *special sensory
central process extend toward *cordi tympani nerve
Nucleus solitaries
*pressure Sensations from :
- middle ear
-Tempanic membrane
-external acoustic meatus
*general sensation
*general sensation from soft
palat and ovula
Spinal nucleus Pain and temperature
of trigeminal Sensations from :
nerve - middle ear
-Tempanic membrane
-external acoustic meatus
**greator petrosal nerve: branch from Preganglionic Parasympathetic of Superior salivary
gland (after it emerge from Internal acoustic meiatus) and emerge through the foramen
lacerum and don`t extend through the facial canal , synapse with ptyregopalatine ganglion

Innervate: lacrimal gland and mucus gland of nasal cavity

Lesion in Symptoms
LMN or facial nerve (bell`s Flaccid paralysis muscle face, epsilateral half
palsy) Ptosis, no wrinkling of upper eye lid, deviation of the angle of the mouth
Upper motor neuron lesion Lesion in the epsilateral (to the lesion) superior and inferior cerebral motor
cortex (lesion in Lt UMN: lesion in Lt superior and inferior ….)
*Contralateral spastic paralysis in the lower quadrant of the face
*The upper epsilateral quadrant isn`t affected, it`s still innervated by the
epsilateral cerebral motor cortex
 CN8 : Vevtibulocochlear nerve
Receptors Ganglion Emerge Second order neuron
through
Vestibular Semicircular Vestibular Internal Cell body: vestibular nuclei in
br. canal ganglion acoustic the lower part of pons and
(cell body of meiatus medulla (epsilateral), fibers go
first order to :
neuron) 1- thalamus-> cerebrum
2- spinal cord (vestibuospinal
tract)
3- cerebellum (ICP)
4- brain stem (MLF) control eye
movement

Cochlear Organ of Spiral Internal Cell body: in ant. and post. Third order neuron
br. corti ganglion acoustic Cochlear nuclei in medulla
(cell body of meiatus (epsilateral) Cell body: in the
first order -extend to the contralateral thalamus(medial
neuron) lateral lemnissci and then to the geniculate nuclei)
thalamus -extend to the
auditory cortex (41,
temporal lobe)

Lesion in Symptoms
In the pathway from cochlear receptor to Spsilateral hearing lose
ant. and post. Cochlear nuclei
Vestibular branch Lose of balance, vertigo, nausea and some
ataxia

CN9: Glossopharyngial nerve

Nuclei Emerge from Note Innervate/ sensation
brain stem from
Nucleus ambiguus and innervate
stylopharyngous
muscle in the pharynx
Inferior salivary Preganglionic Parasympathetic neuron , the innervate parotid gland
gland last part of it called lesser petrosal nerve,
Internal jugular synapse with otic ganglion
foramen - the The postganglionic Parasympathetic
fibers innervate parotid gland
 Nucleus solitaries Trans taste sensation
Pass through inferior ganglion and then from the posterior 1/3
superior ganglion in its way toward the of the tongue
brain stem *special sensory
-epsilateral

*General sensation
(not pain or
temperature) from
nose, nasal and oral
cavity, pharynx

Spinal nucleus of Pass through inferior ganglion and then *General sensation
trigeminal nerve superior ganglion in its way toward the (pain and temperature)
brain stem from nose, nasal and
oral cavity, pharynx

CN10: vagus nerve

Nuclei Emerge from brain Innervate/ sensation from
stem
Nucleus ambiguus Pharynx , larynx soft palat
muscles except
stylopharyngous muscle
Dorsal motor nuclei Preganglionic innervate heart, lung, GI
Parasympathetic neuron
Internal jugular ,synapse with enteric
foramen ganglion

- the The postganglionic

Parasympathetic fibers
innervate heart, lung, GI
Nucleus solitaries Pass through inferior Special taste sensation from
ganglion and then epiglottis and the region
superior ganglion in its posterior to the tongue
way toward the brain
stem(Nucleus solitaries) -General sensation from
viscera and larynx
Spinal nucleus of trigeminal Pass through inferior Pain and temperature
nerve ganglion and then sensation from larynx
superior ganglion in its
way toward the brain
stem
** any lesion in CN9 OR CN10 or Nucleus ambiguous  no gag reflex

** lesion in CN10  Horsness of voice and dysphagia

 CN11: accessory nerve
Divided into notes lesion
Cranial part Nucleus ambiguous in medulla Symptoms like in CN10 lesion
Extend with the vagus nerve
Spinal part Anterior gray horn C1-C5 - dropping of the shoulder,
Inter the skull through foramrn magnum epsilaterally
Innervate:
1- sternocleidomastoid  rotate the head -diffeculty in rotation of the head
2- trapezius muscle  move the shoulder to the contralateral side
superiorly

CN12: hypoglossal nerve

Type Pure motor
innervate Extrinsic and intrinsic muscles of the tongue
lesion *epsilateral flaccid paralysis of the tongue and atrophy
*difficulty in speeching and chewing
*deviation of the tongue to the epsilateral side when the patient try to
protrude it

"".. ‫"أيخاف قلبك وﷲ مأمنه‬

By: Manar BQ