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Figure 13.5b
Clinical notes
Smells and the responses they can provoke Evidence of olfactory connections to the limbic system are: smells can trigger memories; smells can provoke emotional responses; smells have a role in sexual arousal. Anosmia Head injuries which fracture the cribriform plate may tear olfactory nerves resulting in post-traumatic anosmia. Anosmia can also be caused by blockage of the nasal cavities, for example a nasal polyp or malignancy.
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Inspection
Ptosis (absent/present) Squit(absent/ present) unilateral./ bilateral Exopthalmos (thyrotoxicosis, hydrocephalus, craniosyostosis) Enophthalmos (horners syndrome) Conjuctival hemorrhage(cranial trauma, subarachnoid haemorrhage) Telengiectases(louis bar syndrome) Color of the eyes(vascular disease)
Pupil size, shape equality, regularity of the pupil. Constricted pupil sympathetic dilator muscle(hypothalamus, brainstem sympathetic chain, pericarotid plexus,pontine tumor) Dilated pupil parasympathetic fibers pretectal nuclei, edinger westphal nucleus
Occular movement
Internal rectus Superior rectus Inferior oblique Inferior rectus Superior oblique External rectus
Central nystagmus occurs as a result of either normal or abnormal processes not related to the vestibular organ. For example, lesions of the midbrain or cerebellum can result in up- and downbeat nystagmus. Peripheral nystagmus occurs as a result of either normal or diseased functional states of the vestibular system and may combine a rotational component with vertical or horizontal eye movements and may be spontaneous, positional, or evoked.
Gaze Induced nystagmus occurs or is exacerbated as a result of changing one's gaze toward or away from a particular side which has an affected vestibular apparatus. Positional nystagmus occurs when a person's head is in a specific position.An example of disease state in which this occurs is Benign paroxysmal positional vertigo(BPPV) Post rotational nystagmus occurs after an imbalance is created between a normal side and a diseased side by stimulation of the vestibular system by rapid shaking or rotation of the head. Spontaneous nystagmus is nystagmus that occurs randomly, regardless of the position of the patient's head.
5th nerve
Root pattern Brainstem pattern
8th nerve
Cochlear component: Whispering numbers to each ear.
Rinnnes test? Conductive deafness bone conduction > nerve conduction Perceptive deafnessbone and air conduction impaired
Temporal lobe epilepsy Diseases such as epilepsy in the areas to which the olfactory impulses project (e.g. the temporal lobe) may cause olfactory hallucinations. The smells which are experienced are usually unpleasant and are often accompanied by pseudopurposeful movements associated with tasting such as licking the lips