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TABLE OF CONTENTS

Cranial Nerves 1. Overview and CN I & II

2. CN III, IV, & VI
3. CN V, VII, & VIII
4. CN IX, X, XI & XII
5. Summary and Practice Questions
REVIEW OUTLINE

● CN I - Olfactory n.
Cranial ○ Olfactory bulb
● CN II - Optic n.
Nerves ○ Optic tract
○ Optic chiasm
● CN III - Oculomotor n.
● CN IV - Trochlear n.
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● CN V - Trigeminal n.
● CN VI - Abducens n.
● CN VII - Facial n.
● CN VIII - Vestibulocochlear n.
● CN IX - Glossopharyngeal n.
● CN X - Vagus n.
● CN XI - Accessory n.
● CN XII - Hypoglossal n.
 AfraTafreeh.com
Clinical Case Study Bootcamp.com

A 42 year patient presents complaining of

blurriness in his peripheral vision. After performing
blood work you notice that his GH and IGF-1 levels
are through the roof. You then order and MRI to
confirm your initial diagnosis.

https://commons.wikimedia.org/wiki/File:Acromegaly.jpg
Learning Outcomes Bootcamp.com

By the end of this lesson, students should be able to:

1. Name and identify the 12 pairs of cranial nerves
2. List the individual functions of each cranial nerve
3. Diagnose cranial nerve damage based on symptoms
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 AfraTafreeh.com
Cranial Nerve Overview Bootcamp.com

● 12 pairs of cranial nerves

● Emerge from ventral surface
● Number 1-12 from rostral to
caudal (I-XII)
● All innervate the head and neck
(except Vagus)
● 2 emerge from Forebrain
● 10 emerge from Brainstem

https://commons.wikimedia.org/wiki/File:1320_The_Cranial_Nerves.jp
g
 CN I Olfactory Tract/ Bulb/ Nerve Bootcamp.com

Origin/Pathway:
● olfactory receptor cells → olfactory
bulb → olfactory tract → primary
olfactory cortex
● Pass through the cribriform plate
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Function:
● Smell (olfaction)

https://commons.wikimedia.org/wiki/File:Head_Olfactory_Nerve_Labeled.png
 AfraTafreeh.com
CN II Optic Nerve Bootcamp.com

Origin/ Pathway:
● Retina → Optic Nerve → Optic
Chiasm → Optic Tracts → LGN →
Primary Visual Cortex
● Passes through optic canal
Function:
● Sight (vision)

Optic Chiasm

Pituitary
Gland
Optic Nerve Lesion Bootcamp.com

● Damage to the left optic nerve will cause

loss in left peripheral visual field

● Optic nerve damage = Monocular blindness

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(ipsilateral peripheral vision loss)
 AfraTafreeh.com
Optic Chiasm Lesion Bootcamp.com

● Damage to optic chiasm will cause loss in

both peripheral fields

● Optic chiasm damage = Bitemporal

Hemianopia (bilateral peripheral vision loss)
Optic Tract Lesion Bootcamp.com

● Damage to left optic tract will cause loss

of vision in right visual field

● Optic tract damage = Right homonymous

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hemianopia (contralateral visual field
loss)
 AfraTafreeh.com
Clinical Case Study Bootcamp.com

A 42 year patient presents complaining of blurriness in his

peripheral vision. After performing blood work you notice that his
GH and IGF-1 levels are through the roof. You then order and MRI
to confirm your initial diagnosis.

Diagnosis:
● Pituitary adenoma compressing optic chiasm

Optic
Chiasm

Pituitary
Gland

https://commons.wikimedia.org/wiki/File:Acromegaly_treatment_diagram.JPEG https://commons.wikimedia.org/wiki/File:Acromegaly.jpg
 CN III Oculomotor Nerve Bootcamp.com

Origin/ Pathway:
● ventral midbrain → superior orbital fissure
(SOF) → eye muscles
Function:
● Motor: Med., Inf., and Sup. Recti, Inf.
Oblique, and Levator Palpebrae muscles
● Parasymp: pupillary constriction and lens
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focusing

Oculomotor n.

https://commons.wikimedia.org/wiki/File:Eye_orbit_anterior_(modified).jpg
 AfraTafreeh.com
CN IV Trochlear Nerve Bootcamp.com

Origin/ Pathway:
● dorsal midbrain → SOF → eye muscle
● (*Only CN that emerges from dorsal
brainstem)
Function:
● Motor to the superior oblique muscle
● Rotates eyes inferolateral (downwards
and outwards)

Trochlear n.

ANTERIOR POSTERIOR https://commons.wikimedia.org/wiki/File:Eye_orbit_anterior_(modified).jpg

 CN VI Abducens Nerve Bootcamp.com

Origin/ Pathway:
● Pontomedullary junct. → SOF → lateral
rectus (eye muscle)
Function:
● Motor to lateral rectus muscle
● Abduction of eyes
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Abducens n.

https://commons.wikimedia.org/wiki/File:Eye_orbit_anterior_(modified).jpg
 AfraTafreeh.com
Eye Movements Bootcamp.com

Muscle Action Cranial nerve

Lateral Rectus CN VI

Medial Rectus CN III

Superior Rectus CN III

Inferior Rectus CN III

Inferior Oblique CN III

Superior Oblique CN IV

https://commons.wikimedia.org/wiki/File:Eye_orbit_anatomy_superior.jpg
 Clinical Case Study Bootcamp.com

Patient presents with a “droopy”

left side of face and cannot
control facial expression on that
side. However, he has no problems
with chewing on the left side.
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● What is your diagnosis

https://commons.wikimedia.org/wiki/File:Bellspalsy-neurology.jpg
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CN V Trigeminal Nerve Bootcamp.com

Origin/ Pathway:
● Pons →
● Ophthalmic (V1) → SOF
● Maxillary (V2) → F. Rotundum
● Mandibular (V3) → F. Ovale
Trigeminal n.

Function:
● Sensory to face
● Motor to muscles of
mastication

https://commons.wikimedia.org/wiki/File:1108_Muscle_that_Move_the_Lower_Jaw.jpg

https://commons.wikimedia.org/wiki/File:Trigeminal_Nerve.png
CN VII Facial Nerve Bootcamp.com

Origin/ Pathway
● Medulla → Internal acoustic meatus
(IAM) → stylomastoid foramen
Function
● Motor: facial expression
○ Temporal, Zygomatic, Buccal,
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Mandibular, Cervical branches
● Special Sensory: Taste to Ant. ⅔
tongue
● Parasymp: lacrimal gland, sublingual
and submandibular glands

Facial n.

https://www.flickr.com/photos/dundeetilt/24400618511
 AfraTafreeh.com
CN VIII Vestibulocochlear Nerve Bootcamp.com

Origin/ Pathway
● Medulla → IAM →
cochlear or
vestibular apparatus
Function
● Cochlear: Hearing
● Vestibular: Balance

Vestibulocochlear n.

https://courses.lumenlearning.com/nemcc-ap/chapter/special-senses-hearing-audition-and-balance/
 Clinical Case Study Bootcamp.com

Patient presents with a “droopy” left side

of face and cannot control facial
expression on that side. However, he has no
problems with chewing on the left side.

What is your diagnosis?

● Left facial nerve damage AfraTafreeh.com

https://commons.wikimedia.org/wiki/File:Bellspalsy-neurology.jpg
 AfraTafreeh.com
Clinical Case Study Bootcamp.com

Patient presents with difficulty balancing, facial muscle weakness,

worsening hoarseness, difficulty swallowing, reduction in taste
sensation, decreased parotid salivation, difficulty turning head to
left and atrophy of left trapezius and SCM muscles. An X-Ray
reveals a Tumor compressing the brainstem.

What cranial nerves are

involved and responsible
for which symptoms?

https://commons.wikimedia.org/wiki/File:Large_Acoustic_Neuroma_coronal_MRI.jpg
https://commons.wikimedia.org/wiki/File:Vestibular-schwannoma-003.jpg
 CN IX Glossopharyngeal Bootcamp.com

Origin/Pathway:
● Medulla → jugular foramen → pharynx & tongue
Function:
● Motor: Stylopharyngeus muscle
● Parasympathetic: Salivation (Parotid gland)
● Sensory:
○ General sensory to post 1/3 tongue
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○ Pharyngeal mucosa
○ Blood Pressure (Carotid Sinus and Body)
● Special sensory: Taste to post. 1/3 tongue

Glossopharyngeal n.

https://commons.wikimedia.org/wiki/File:1109_Muscles_that_Move_the_Tongue_Palatoglossus_and_surface.png
 AfraTafreeh.com
CN X Vagus nerve Bootcamp.com

Origin/Pathway:
● Medulla → Jugular foramen →
Thorax → Abdomen
Function:
● Motor: pharynx and larynx
(swallowing and speech
production)
● Sensory: mucosal of pharynx
and larynx

Vagus n.

https://commons.wikimedia.org/wiki/File:Recurrent_laryngeal_nerve.svg
 CN X Vagus nerve Bootcamp.com

Function:
● Special Sensory: taste sensation from epiglottis
● Parasympathetic: motor impulses to heart,
lungs, and abdominal viscera (regulate heart
rate, breathing and digestion)
● General Visceral Sensory: thoracic and
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abdominal viscera

https://commons.wikimedia.org/wiki/File:Recurrent_laryngeal_nerve.svg
https://pixabay.com/illustrations/abdomen-intestine-large-small-1698565/
 AfraTafreeh.com
CN XI Spinal Accessory Nerve Bootcamp.com

Origin/Pathway:
● Ventral rootlets of C1-C5 → foramen magnum →
jugular foramen → muscle
Function:
● Motor: to Sternocleidomastoid and Trapezius
(move head & neck)

Spinal accessory n.

https://commons.wikimedia.org/wiki/File:1610_Muscles_Controlled_by_the_Accessory_Nerve-02.jpg
 CN XII Hypoglossal Nerve Bootcamp.com

Origin/Pathway:
● Medulla → Hypoglossal canal → Tongue
Function:
● Motor to the extrinsic and intrinsic
muscles of the tongue
Normal AfraTafreeh.com
L. hypoglossal nerve lesion

Hypoglossal n.

https://commons.wikimedia.org/wiki/File:Person_with_tongue_sticking_out.jpg
https://commons.wikimedia.org/wiki/File:Unilateral_hypoglossal_nerve_injury.jpeg
 AfraTafreeh.com
Clinical Case Study Bootcamp.com

What cranial nerves are involved and responsible for which symptoms?
–CN_____ facial muscle weakness and reduction in taste (anterior ⅔)
-CN______ difficulty balancing
-CN______ reduction in taste (posterior ⅓) and parotid salivation
–CN_____ hoarseness, difficulty swallowing, reduction in taste (epiglottis)
–CN_____ difficulty turning head to left & atrophy

https://commons.wikimedia.org/wiki/File:Large_Acoustic_Neuroma_coronal_MRI.jpg
https://commons.wikimedia.org/wiki/File:Blausen_0009_AcousticNeuroma.png https://commons.wikimedia.org/wiki/File:Vestibular-schwannoma-003.jpg
Tongue Sensation Overview Bootcamp.com

Motor:
● Hypoglossal (CN XII)
Gen Sensory:
● Ant 2/3 – Trigeminal (CN V3)
● Post 1/3 – Glossopharyngeal (CN IX)
● Epiglottis – Vagus (CV X)
Taste Sensory:
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● Ant 2/3 – Facial (CN VII)
● Post 1/3 – Glossopharyngeal (CN IX)
● Epiglottis – Vagus (CN X)

https://commons.wikimedia.org/wiki/File:1109_Muscles_that_Move_the_Tongue_P
alatoglossus_and_surface.png
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Practice Questions Bootcamp.com

1. Identify cranial nerve A, what it innervates, and the

functional deficit it would cause if damaged.

2. Identify cranial nerve B, what it innervates, and the

functional deficit it would cause if damaged.
Summary Bootcamp.com

By the end of this lesson, students should be able to:

1. Name and identify the 12 pairs of cranial nerves
2. List the individual functions of each cranial nerve
3. Diagnose cranial nerve damage based on symptoms
AfraTafreeh.com
 AfraTafreeh.com
REVIEW OUTLINE

● CN I - Olfactory n.
Cranial ○ Olfactory bulb
● CN II - Optic n.
Nerves ○ Optic tract
○ Optic chiasm
● CN III - Oculomotor n.
● CN IV - Trochlear n.
● CN V - Trigeminal n.
● CN VI - Abducens n.
● CN VII - Facial n.
● CN VIII - Vestibulocochlear n.
● CN IX - Glossopharyngeal n.
● CN X - Vagus n.
● CN XI - Accessory n.
● CN XII - Hypoglossal n.