Cranial Nerves

Overview

image 2022 09 12T125553.997

Illustration by Ava Yap

Snapshot

  • A 35-year-old woman presents to the emergency department with left eye vision loss and headache. She was in her usual state of health until 3 hours prior to presentation, when she developed vision loss and eye pain that worsened with eye movement. She reports that approximately 8 months ago she had left arm numbness that self resolved. On physical exam, her visual acuity is 20/185, and a sluggish response to light on the left eye with the swinging flash-light test is noted. (Optic neuritis likely secondary to multiple sclerosis.)

Introduction

Cranial Nerves
Cranial NerveTypeFunctionCranial ExitNotes
Olfactory nerve (I)SensoryOlfactionCribiform plate Only CN without thalamic relay to the cortex  Cribiform plate fracture can lead to anosmia                        
Optic nerve (II)SensoryVisionOptic canal
Oculomotor nerve (III)MotorEye movement via thesuperior, inferior, and medial rectusinferior oblique musclePupillary constrictionAccomodationEyelid opening via innervation of thelevator palpebrae muscleSuperior orbital fissueCenter contains output to ocular muscles which is affected primarily 1st by vascular diseasePeriphery contains parasympathetic output which is affected 1st by compression
Trochlear nerve (IV)MotorEye movement via innervation of thesuperior oblique muscleSuperior orbital fissue
Trigeminal nerve (V)Motor and sensoryMastication via the mandibular nerve (V3) Facial sensation via the ophthalmic nerve (V1)maxillary nerve (V2)mandibular (V3)Ophthalmic nerve (V1)superior orbital fissureMaxillary nerve (V2)foramen rotundum Mandibular nerve (V3)foramen ovale Mediates the jaw jerk reflex  
Abducens nerve (VI)MotorEye movement via innervation of thelateral rectus Superior orbital fissure
Facial nerve (VII)Motor and sensoryFacial movementTaste from the anterior 2/3 of tongueLacrimationSalivation via innervation of thesubmandibular glandsublingual glandEyelid closing via innervation of the orbicularis oculi muscleStapedius dampens excessive sound Internal auditory meatus Visceral sensation recieved by nucleus solitarius
Vestibulocochlear nerve (VIII)SensoryHearingBalanceInternal auditory meatus 
Glossopharyngeal nerve (IX)Motor and sensoryTaste from posterior 1/3 of tongueSwallowingSalivation parotid glandMonitoring carotid body and sinus chemo- and baroreceptorsStylopharngeuselevates pharynx and larynxJugular foramenMotor output orginates in nucleus ambiguusVisceral sensation recieved by nucleus solitarius
Vagus nerve (X) Motor and sensoryTaste from epiglottic regionSwallowingPalate elevationMidline uvulaTalkingCoughingThoracoabdominal visceraMonitoring aortic arch chemo- and baroreceptorsCan cause vasovagal syncope in response to an emotional stimulus Jugular foramen Motor output orginates in nucleus ambiguusVisceral sensation recieved by nucleus solitariusParasympathetic fibers to heart, lungs, and upper GI orginates from dorsal motor nucleusGives recurrent laryngeal nerve which innervates all laryngeal muscles except cricothyroid
Accessory nerve (XI)MotorHead turning and shoulder shruggingsternocleidomastoid muscletrapeziusJugular foramenMotor output orginates in nucleus ambiguus
Hypoglossal nerve (XII)MotorTongue movementHypoglossal canal