CRANIAL NERVES

BY

Dr. S. Irwansyah, Sp S.

Origin of Cranial Nerve Fibers

12 pairs refer to by either name or
Roman numeral
N I & N II : fiber tracts of the brain
(not true nerves)
N XI : derived, in part, from the upper
cervical segment of spinal cord.
The remaining nine pairs : relate to the
Brain Stem

N I, II, VIII special sensory input

N III, IV, VI control eye
movements & pupillary constriction
N XI and XII : pure motor ( N XII :
sternocl mastoid and Trapezius ; XII
muscles of tongue
N V, VII, IX and X : mixed
N III, VII, IX, and X : carry
parasympathetic fibers

Functional Components of the

Cranial Nerves

1.
2.
3.
4.
5.
6.

Conveyed from or to the brain stem by 6

types of nerve fibres:
Somatic efferent fibers
Somatic afferents fibers
Visceral eff fbrs
Visceral aff fbrs
Branchial eff fibers
Special sensory fibers
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Sensory ganglia:
Semilunar (Gasserian) ganglion (N V)
Geniculate ganglion (NVII)
Cochlear & Vestibular ganglia (N VIII)
Inf & Sup glossopharyngeal ganglia
(N IX)
Sup vagal ganglion (N X)
Inf vagal (Nodose) ganglion (N X)

Ganglia of cranial parasympathetic

division of autonomic nervous
system:
ciliary ganglion (N III)
Pterygopalatine & submandibular
ganglia (N VIII)
Otic ganglion (N IX)
Intramural ganglion (N X)

Anatomic Relationships of the Cranial

Nerves

Cranial Nerve I : Olfactory Nerve

- Function : Smell
The true N I : short connect. from
olfactory mucosa (nose) & olfactory
bulb (cranial cavity)
9 15 of these nerves on each side of
the brain
Lie just above cribiform plate and
below the frontal lobe

Axons from olfac bulb run within olfact stalk

- synapse: in ant olfact nucleus ;
- terminate : in primary olfactory cortex
(pyriform cortex),entorhinal cortex and
amygdala.
Clinical Correlation :
- Anosmia = absence of the sense of smell
frontal lobe tumor & olfact groove
meningioma compress olfact bulb & stalk.
Head trauma injured olfact nerves & bulb

CRANIAL NERVE II : OPTIC

NERVE

Function : Vision
Arises from gangl cells in the retina
passes through optic papilla to the orbit
(contained within meningeal sheaths). Its
name changes to optic tract when the
fibers passed thrgh optic chiasm.
Optic tracts axons project to Sup Coll &
lat geniculate (relays visual information to
the cortex)
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CRANIAL NERVE III: OCULOMOTOR

NERVE
N III, IV and VI : Control eye movements
(In addition: N III controls pupillary constrict)
N III contain axons that arise in oculomotor
nucl innerv all of oculomotor m (except:
Sup oblique & Lat rectus) and
Edinger-Westphal nucl sends
parasympathetic axons to the ciliary
ganglion.
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somatic efferent portion of the N III

innerv muscles: Levator Palp Sup ; Sup,
Med & Inf rectus and Inf Oblique.
Visceral eff portion of the N III innerv
m ciliary and constrictor pupillae.

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CRANIAL NERVE IV : TROCHLEAR N.

- Originates from the trochlear nucleus

located just caudal to oculomotor nucl

within lower midbrain.
Its axons cross within midbrain
emerge contralaterally on the dorsal
surface of the brain stem curves
ventrally between Post.cerebral and
Sup Cerebellar a. (Lateral to N III)
anteriorly in the lateral wall of
cavernous sinus via Sup orbital
fissure enters the Orbit

Innerv : Superior oblique muscle

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CRANIAL NERVE VI: ABDUCENS N

Innervates : Lateral rectus muscle

Its long intracranial course vulnerable
to pathologic processes in Posterior &
midle Cranial fossa.
Arises from neurons of abducens nucl
within dorsomed tegmentum (caudal
pons) axons project thrgh the body of
the Pons pontomedullary fissure
cavernous sinus close to internal carotid
exits from Cr Cavity via the sup orbital
fissure.
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Note : m. Levator palpebrae Sup has no

action on the eye ball, but lifts the
upper eye lid when contracted
Closing the eyelids by contrct of
orbicular muscle of the eye (innervated
by N VII)

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Both eyes move in the same direction to

follow an object in space, but they move by
simultaneously contracting and relaxing
different muscles (called : conjugate gaze
movement)
Pupillary diameter => affected by
parasympathetic eff fibr in the N III and
Sympathetic fibr from Sup cervical
Ganglion.
Constriction (Miosis) : caused by
stimulation of parasymphathetic fibr &
Dilation (mydriasis) : by symphathetic
activation
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The Pupillary light reflex : constrict of both

eyes in response to a bright light. (Even if
the light hits only one eye both pupils
usually constrict = a Consensual response).
Clinical Correlation :
Strabismus : deviation of one or both eyes
Diplopia (double vision) : by misalignment of
visual axes
Ptosis (Lid drop) : by weakness or paralysis
of lev palp sup m.

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Ophthalmoplegia:
a. Oculomotor (N III) paralysis.
- External opth : -Divergent strabismus,
diplopia and ptosis.(The eyes deviate
downward and outward).
- Internal opth : dilated pupil, light reflex
(-) and accomodation reflex (-)

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b. Trochlear (N IV) paralysis: characrerized

by slight convergent strabismus and
diplopia on looking downward.
(cannot look downward & inward
difficulty in descending stairs tilted the
head as a compensatory adjustment)
c. Abducens (N VI) paralysis : the most
common eye palsy (owing to the long
course of N VI).
Charact: convergent strabismus and
diplopia.
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CRANIAL NERVE V : TRIGEMINAL

NERVE

large sensory root carries sensation

from the skin & mucosa of most of the
head
smaller motor root innerv most of
the chewing muscl (massetter,
temporalis, pterygoids, mylohyoid) and
tensor tympani muscle of middle ear.

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Sensory root (the main portion of the

nerve) arise from cells in the semilunar
ganglion (Gasserian, Trigeminal) in a
pocket of dura lateral to cavern sinus
passes posteriorly btwn Sup petrosal
sinus in the tentorium & the skull base
enters the Pons.

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3 division :
Fibers of Opthalmic div cranial cav
through Sup Orbit Fissure
Fibr of maxillary div : through For
Rotundum
Fibr of mandibular div : thrgh For Ovale
( Sensory fibr & motor fibr involved
in mastication

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* Corneal Reflex:
aff axons are carried in opth branch =>
synapse in the spinal tract & nucl N V
=> impuls relayed to facial nucl (VII),
where motor neuron that project to m.
orbic oculi are activated ( eff = N VII)
* Jaw jerk Reflex : Its aff & eff run in N V.

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Clinical Correlation
loss of sensation 1 sensory modalities
paralysis m tensor tympani => impaired
hearing
Paralysis muscl of mastication =>
mandibular dev to the affected side
Loss of reflex (cornea, jaw jerk, sneeze)
Trismus (lock jaw)
Tonic spasm of the muscles of mastication
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Tic douloureux (Trigeminal neuralgia) :

severe pain in distr of 1 branch of N V ;
paroxysmal pain of short duration can be
caused by pressure from a small vessel on
the root entry zone of the nerve.
may follow irritation of the trigger zone, a
point on the lip, face, or tongue that is
sensitive to cold, pressure, or blast of air.
usually: unilateral

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CRANIAL NERVE VII : FACIAL

NERVE
Consist of: facial nerve proper &
nervus intermedius
pass trough
internal auditory meatus (where the
geniculate ggln components lies)
* Fac nerv proper axons arise in facial nucleus
The nerve exit through For stylomast
innerv muscl of facial expression,
m.platysma, m stapedius in the inner ear.
* N. Intermed sends parasymph pregangl fibr
to the pterygopalatine ggln => innerv
lacrimal gld and,

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Via chorda tympani nerve to the

submaxillary & sublingual ggln in the
mouth => innerv salivary gld
Visceral aff of n. Intermed => carries
taste sensation from 2/3 ant of the
tongue, via chorda tympani to solitary
tract and nucleus.
Clinical correlation
Facial nucl receives crossed & uncrossed fibr
by way of corticobulbar (corticonuclear)
tract.

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M frontalis & orbic ocule receives bilat

cortical innerv = > not paralyzed by lesion
in one motor cortex or its corticobulbar
pathway
Peripheral facial paralysis (Bells palsy) =>
attempt to close the eyelid the eye ball
may turn upward (=bells phenomenon).
Symptoms & signs depend on the location
of the lesion : Lesion in or outside the For
stylomast flaccid paralysis of facial
expression m in the affected side.
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Lesion in the facial canal involving

chorda tympani nerve reduced
salivation and loss of taste sensation
of 2/3 ant ipsilat of the tongue.
Lesion higher up in the canal
paralyze m stapedius.

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Cranial Nerve VIII :

Vestibulocochlear nerve

Is a double nerve
Arise from spiral and vestibular ganglia
in the labyrinth of the inner ear.
Passes into cranial cav via internal
acoustic meatus the brain stem
Cochlear nerve hearing (audition)
Vestibular nerve part of equilibrium
(position sense)

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CRANIAL NERVE IX :
GLOSSOPHARYNGEAL NERVE

Contains several types of fibers

Branchial efff fibr from nucl ambiguous
pass to m. Stylopharyngeus
Visceral eff fibr from nucl salivatory Inf
pass trough tympanic plexus & petrosal
nerve to the otic ggln
Visceral aff fibr arise from unipolar cell in
the Inferior ganglia
Centrally : terminate in solitary tract and
its nucleus project to thalamus
cortex
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Peripherally: visceral aff axons of N IX

supply general sensation to the pharynx,
soft palate, 1/3 post of the tongue, tonsil,
auditory tube, and tympanic cavity.
N IX supply special receptor in the carotid
body and carotid sinus control of
respiration, blood pressure and heart rate.
Note : 3 cranial nerves contain taste fibers
( N VII for 1/3 ant tongue ; N IX for 1/3
postof tongue; N X for epiglottis.

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Clinical correlation
Pharyngeal (gag) reflex depends on N IX
for its sensory components (N X innerv
motor component).
Carotid sinus reflex depends on N IX for
its sensory comp.
Pressure over the sinus => slowing of
Heart rate and fall in BP.

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CRANIAL NERVE X: VAGUS NERVE

* Branchial eff fibr from nucl ambiguous pass
to the muscle of soft palate and pharynx
via recurrent laryngeal nerve to intrinsic
muscl of larynx
* Visceral eff fibr from dorsal motor nucleus of
the vagus => to thoracic & abdominal
viscera
* Somatic aff fibr of unipolar cells in Superior
ganglion send peripheral branch via auricular
branch of n X to the Ext auditory meatus &
part of the earlobe.
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Visceral aff fibr of unipolar celss in Inferior

ganglion send peripheral branch to the
pharynx, larynx, trachea, esophagus, and
thoracic & abdominal viscera.
Clinical correlation
Complete bilateral transection of vagus :
Fatal
Weakness / paralysis of vocal cord =>
difficulty in swallowing and cardia
arrhythmias.

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CRANIAL NERVE XI : ACCESSORY

NERVE
2 components : 1. Cranial component
2. Spinal component
Cranial components :
Branchial eff fibrs (from ambiguous nucl to
the intrinsic m of larynx) join the N XI
inside the skull but are part of the vagus
outside the skull
Spinal components :
Branchial eff fibrs suply m sternocl mast &
partly supply m trapezius.

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Clinical correlation
interruption of spinal comp
m sternocl mast paralsysis =>
inability to rotate the head to the
contralateral side.
paralysis of upper portion of m.
trapezius = > wing-like scapula and
inability to shrug ipsilateral shoulder

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CRANIAL NERVE XII:

HYPOGLOSSAL NERVE
Somatic eff fibr from hypoglossal nucl in the
ventromedian portion of graymatter of
medulla emerge between pyramid and
Olive to form Hypoglossal nerve.
N XII leaves the skull through hypoglossal
canal passes to the muscles of the
tongue
Clinical Correlation :
- Pheripheral lesion usually : mechanical
causes
- Nuclear and Supranuclear lesion (tumors,
bleeding,demyelination)

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TERIMA KASIH

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