OLFACTORY NERVE

INTRODUCTION
• Cranial nerve I is the olfactory
nerve. As one of the five major
senses, olfaction allows us the
sense of smell. The olfactory
pathway connects small nerve
cells detecting particles in the
air to the cerebral cortex
 OLFACTORY NERVE CELLS
• The olfactory nerve cells are short
receptor ‘hair’ cells (6) that penetrate
through the cribriform plate of
the ethmoid bone (3) and pass between
the pseudostratified ciliated columnar
(sustentacular and basal) cells of the
superior nasal mucosa (4). This
penetration allows the hair cells to sample
air particles in the nasal cavity, sending
action potentials to the olfactory bulb.
Sustentacular cells provide structural support to the
nasal mucosa and secrete an aqueous liquid to
maintain moisture in the nasal cavity. Lying on the
basal surface of the sustentacular cells are basal cells,
which can regenerate olfactory nerve cells when they
become damaged
 Olfactory bulb
• The olfactory bulb is the thickened
structure seen lying in the olfactory groove
of the anterior cranial fossa. It contains
the olfactory ganglion where hair cells
synapse with mitral and tufted cells before
projecting to the brain in the olfactory
tract. These cells are interspersed
with Bowman’s glands, which secrete an
immunoglobulin A (IgA)-enriched mucin
protective layer into the nasal cavity.
Mitral cells receive the axons of multiple olfactory
receptor hair cells and synapse this information in a
structure known as a glomerulus . Tufted cells synapse on
mitral cell dendrites. Tufted and olfactory hair cells both
excite mitral cells and promote the transmission of action
potentials from mitral cells.
 Olfactory tract and cortical connection

• The olfactory tract is a bundle

of afferent nerve fibres that run under
and adjacent to the olfactory sulcus in the
frontal lobe. When this posteriorly
travelling tract reaches the anterior
perforated substance, it divides into the
medial and lateral striae.
• The medial stria conveys axons to the
subcallosal gyrus. This is important for
the emotional integration of smell.
The lateral stria conveys axons to the primary olfactory
cortex in uncus of the parahippocampal gyrus in the temporal
lobe. This is important for the integration of smell with
memory encoding and retrieval.
These cortical regions then synapse in a complex neural
network involving the occipital, frontal, temporal and parietal
lobes, as well as deep diencephalic nuclei. At this time, this
integration is poorly understood.
 Terminologies used

• Anosmia - Absence of smell sensation

• Hyposmia - Decreased sensation
• Hyperosmia- Overly acute sense of smell
• Dysosmia – Impairment or defect in sense of smell
• Cacosmia - Sensation of a bad or foul smell
• Coprosmia- cacosmia with fecal odour
• Parosmia – Perversion or distortion of smell
• Phantosmia- Perception of an odour that is not real
• Olfactory agnosia- Inability to identify detected odours
 Clinical relevance
1. examination of cranial nerve I
• Examining cranial nerve I is an oft-forgotten part of the 
cranial nerve exam, as it rarely brings to light clinically significant
information. Patients should be screened for changes to smell (and taste,
as this is often more helpful) with a simple question: “have you noticed
any change to your smell or taste?”
 2. ANOSMIA

• Anosmia refers to the loss of smell. This is a common phenomenon in elderly life

known as presbyosmia (similar to the presbycusis of hearing loss). In younger patients,
there are three common causes of anosmia (in order of decreasing prevalence):
• Severe upper respiratory tract infection: inflammatory damage to both olfactory
nerve cells and regenerative basal cells leading to loss of smell
• Trauma: the brain moves relative to a stationary ethmoid bone, shearing olfactory
nerve cells
• Chronic rhinosinusitis: chronic inflammatory damage to the basal cells leading to
loss of regenerative capability
 Neurologic causes of anosmia
• Lesions of the orbital surface of brain- Sphenoid ridge/ olfactory groove
meningiomas Frontal lobe gliomas
• Cranio-cerebral trauma with damage to the cribriform plate
• Damage due to excessive retraction of frontal lobes
• Temporal lobectomies
• Foster-Kennedy syndrome
 Other causes
• Drugs- Antihistamines/ propylthiouracil/antibiotics
• Toxins-cadmium/toulene
• Vit def- A,B6,B12
• Alzheimer ’ s/ Parkinson ’ s disease/ Multiple sclerosis
• Conversion disorder
• Kallman Syndrome- Hereditary disorder (X-linked) Hypogonadism + anosmia.
 3. Parkinson’s disease
Parkinson's disease is a neurological disorder that affects the central
nervous system. It has been found that people with Parkinson's disease often
have a reduced sense of smell due to damage to the olfactory nerve.
 4. Odor identification
The olfactory nerve is responsible for identifying different odors, and any
damage to the nerve can affect the ability to distinguish between different
smells.
 Limbic system
The olfactory cortex is connected to the limbic system, which is involved in
emotions and memory. The olfactory nerve plays an important role in
triggering emotional responses and memories associated with certain smell
 Olfactory hallucinations

• Psychosis
• Lesion of central olfactory system-neoplastic/ vascular
• Uncinate fits- Complex partial/ temporal lobe seizures Usually preceded
by an olfactory/gustatory area that is often disagreeable Often
accompanied by chewing movements Seizure focus- MEDIAL
TEMPORAL LOBE No objective loss of smell interictally
 Testing of the function
• NEVER USE IRRITANT ODOURS- such as ammonia, as it stimulates the V th nerve instead of I cr n
• Make sure that nasal passages are open and pt doesn ’ t have local nasal pathology
• Patient must close his eyes and asked to smell through one nostril after another
• Points to note- Whether he can detect any odour/not Whether he can identify the correct odour Is the
intensity symmetrical on both sides
• Perception more important than identification Perception indicates continuity of olfactory pathways
Identification indicates intact cortical function as well
• Lesion central to the decussation never causes anosmia such as lesion of olfactory cortex
• Appreciation of presence of smell is enough for exclusion of anosmia.
 GROUP 8

BMS/2021/40119 NASBIT OSORO

BMS/2021/94571 ODINDO FRANKLINE
BMS/2021/95856 ALLAN OMABENE
BMS/2022/31014 PONI JOVIA
BMS/2022/56495 FAITH KOECH
BMS/2022/58355 JOYCE MBURU
BMS/2022/57868 LIZ MOURED
BMS/2022/58296 MILLY NAFULA
BMS/2022/57929 SHARON KEMBOI