Cranial Nerves

Dr. Badrah Alghamdi

Nervous
system
Central Nervous
Peripheral
system (CNS)

Nervous system
Spina
l
nerve
s

Somatic
(voluntar
y)

Cranial
nerves
(except CN
II)

Autonomi Somatic
(voluntar
c
y)

Brai
n

Autonomi
c

Spinal
cord

1. Olfactory
Nerve
Smell

Senso
ry

Pathway:
Olfactory nerve arise
from the olfactory
receptor nerve cells in
the olfactory mucous
membrane in the
upper part of the
nasal cavity. Fibers
pass through the
opening of cribriform
plate of ethmoid bone
to enter the olfactory
bulb. Olfactory nerve
fibers runs from the
posterior end of
olfactory bulb to end
up in olfactory

Olfactory nerve
Lesion:

Unilate
Caused by lesion in olfactory
ral:
nerve, bulb, or tract:

1.Traumatic: e.g. fracture in

cribriform plate as in fracture base
of skull or fracture of anterior
cranial fossa.
2. Neoplastic: cerebral tumors of
frontal lobes or meningiomas of
Anosmia: loss of
the anterior cranial fossa can
sense of smell.
produce anosmia by pressing on
the Caused
olfactory
or tract.
bybulb
common
cold,
3. Inflammatory:
basal of
allergy, or any disease
meningitis.
olfactory mucous
Lesion in one side of olfactory
membrane.
cortex is unlikely to produce

Bilatera
l:

complete anosmia.
Why??

Olfactory nerve
Lesion:

Commonest
cause is Posttraumatic.

Parosmia: unpleasant
perception of an odour.

2. Optic Nerve
Sens
ory

vision

Pathw
ay:

Rods and Cones are

specialized receptor neurons
in retina which are
connected to the ganglion
cells by bipolar neurons.
Optic nerve is made up by
the axons of cells in
ganglionic layer of the
retina. It leaves the the
orbital cavity through the
optic canal and join the optic
nerve of the opposite side in
optic chiasma. In optic
chiasma, fibers from the
nasal (medial) half of each
retina cross the midline and
enter the optic tract of the
opposite side, while fibers
from the temporal (lateral)
half of each retina pass in
the optic tract of the same

Optic Nerve
Lesion
a. Total blindness of one
eye
b. Bitemporal Hemianopia
c. Nasal
Hemianopia.
d. Contralateral
Homonymous Hemianopia.
e. Quadrantanopia
(Quadrantic Hemianopia).
f. Contralateral Homonymous
Hemianopia.

Contralateral
Homonymous
Hemianopia with
macular sparing.

Optic nerve lesions:

Complete section of one optic nerve

Ipisilateral loss of vision + Loss of direct and consensual
light reflex.
Sagittal section of optic chiasma
Bitemporal hemianopi + Loss of direct and consensual
light reflex: commonly caused by a tumor of the pituitary
gland.
. Partial lesion of the optic chiasma on its lateral
side
Nasal Hemianopia.
. Lesion in Optic tract, Optic radiation
Contralateral Homonymous Hemianopia. Light reflex is
preserved in optic radiation lesions but not in optic tract
lesion.
. Lesion in visual cortex
Contralateral
Homonymous Hemianopia with or without macular

Light Reflex:
Exposure of one eye to bright light
leads to pupillary constriction of
the same eye (direct light reflex)
and of the opposite side
(consensual light reflex).

Pathway:
1.Exposure of the eye to bright
light send impulses along the optic
nerve (CN II), optic chiasma, and
optic tract.
2. The fibers do not reach the
lateral geniculate body but leave
optic tract to relay in pretectal
nucleus in the midbrain.
3. Then fibers pass to EdingerWestphal nucleus (CN III nucleus)
of both sides.
4. Preganglionic fibers arise from
EW nucleus and pass through the
oculomotor nerve (CN III) to relay in

Accommodation (Near)
Reflex:
when the eye is directed from a
distant to a near object:
1. Convergence of the eyes due to
contraction of both medial recti
muscles.
2. Thickening of the lens: to
increase its refractive power by
contraction of the ciliary muscle.
3. Miosis (constriction of pupils):
Ciliary
due
to contraction of theCiliary
superior
muscle
muscle
pupillae
contracte muscles. Pupils constrict
tod restrict the light waves to the
thickest part of the lens.

Pathway:
1. Afferent impulses travel
through the optic nerve,
the optic chiasma, the
optic tract, the lateral
geniculate body, and
the optic radiation to
the visual cortex in the
occipital lobe.
2. Cortical fibers descend
to the oculomotor
nuclei of both sides in
the midbrain.
3. Efferent fibers
(oculomotor nerve)
pass to the eye to
supply medial recti

3.
Oculomotor

Motor
(GSE,GV
E)

Upwa
rd
Medial

Up
and

In

Downwa
rd

The oculomotor nerve has 2

motor nuclei located in
midbrain:
1. The main motor nucleus:
which supply the majority
of the extrinsic muscles
of the eye (the levator
palpebrae superioris,
superior rectus, medial
rectus, inferior rectus, and
inferior oblique)
2. The parasympathetic
nucleus (EdingerWestphal nucleus) located
posterior to the main motor
nucleus: Preganglionic axons
synapse in ciliary ganglion
and postganglionic fibers
supplies the intrinsic
muscles of the eye (the

Oculomotor nerve is entirely motor and is

responsible for lifting the upper eye lid
(levator palpebrae superioris), turning the eye
upward (superior rectus), downward (inferior
rectus), and medially (inferior oblique),
constricting the pupil (constrictor pupillae of
iris)
Inand
oculomotor
nerve lesion:
accommodating
the eye (ciliary
1.muscles).
The eye can not be moved upward,
downward, or inward. At rest, the
eye looks laterally (external
strabismus) and that is due to
unopposed action of superior oblique
and lateral rectus. This condition is
associated with double vision
(diplopia).
2. There is drooping of the upper eyelid

4.

Trochlear

Dow
an
d
n
In

Mot
or
(GS
E)

Pathway:
The trochlear nucleus which
located in midbrain, received
corticonuclear fibers from both
cerebral hemispheres. The
nerve fiber leaves the nucleus
on the posterior surface of the
brain stem and immediately
decussates with the nerve of
the opposite side. The trochlear
nerve is entirely motor and
supplies
Lesion: the superior oblique
muscle
responsible
Doublewhich
visionison
looking for
turning
thedownward
eye downward
and
straight
e.g. when
medially.
reading or descending the
stairs.
Limitation of movement of
the affected eye on looking
inwards and downwards.

5.
Trigeminal

Sensory
(GSA)
Motor
(SVE)

Trigeminal nerve carries

both sensory and
motor fibers. It has 4
nuclei:
1. The main sensory
nucleus in pons.
2. Spinal nucleus which
is continuous with
main sensory nucleus
superiorly and extend
inferiorly through the
whole length of the
medulla oblongata.
3. Mesencephalic
nucleus located
around the cerebral
aqueduct in the

Motor
nucleus

Trigeminal nerve
branches:
Trigeminal nerve leaves
the pons as a small motor
root and a large sensory
root. The sensory root
expands to form the
crescent-shaped
trigeminal ganglion which
gives rise the ophthalmic,
maxillary, and mandibular
branches. Both ophthalmic
and maxillary nerves are
entirely sensory nerves
while mandibular contains

Sensory
Sensations from the skin of
the face (Except the angle of
the mandible), the anterior
2/3 of the tongue and the
buccal cavity

Motor
supply the muscles of
mastication (temporalis,
masseter, lateral and medial
pterygoids), the tensor
tympani, the tensor veli
palatini, the mylohyid, and the
anterior belly of the digastric
muscle.

Trigeminal nerve lesion:

1. Loss of sensations on the same side of the face (sparing the
angle of the mandible) including all the area supplied by the
affected branch.
2. Weakness of the muscles of mastication in case of mandibular
branch lesion and that is associated with deviation of the jaw
to the affected side due to the unopposed action of the
pterygoid muscles of the healthy side.
3. Ipsilateral loss of the corneal reflex (afferent CN 5, efferent CN
7) and palate reflex (afferent CN 5, efferent CN 10).

Trigeminal neuralgia:
Sever, stabbing pain over
one side of the face along
one or more of the sensory
branches of the trigeminal
nerve, usually mandibular
and maxillary of unknown
cause.

6.
Abducent

Looki
ng
side
to

Mot
or
(GS
E)

Pathway:
The nucleus of the abducent
nerve lies in the lower part of the
pons. It receives corticonuclear
fibers from both cerebral
hemispheres. Abducent nerve
emerge in the groove between
the lower border of the pons and
the medulla oblongata. It pass
forward to supply lateral rectus
muscle which moves the eye
outwards (laterally).

Lesion:
1. Limitation of movement of the
affected eye on looking
laterally.
2. Internal strabismus:
because unopposed medial

7.
Facial

Motor (SVE,
GVE)
Sensory (SVA)

Smile
and
Taste
for the
anterior
2l3 of

Facial Nerve Nuclei:

1. Main motor nucleus: Facial nerve has five terminal
branches (temporal, zygomatic, buccal, mandibular, and
cervical) which supplies the muscles of facial
expression. .
2. Parasympathetic nucleus: near to the main motor nuclei
and they are:
submandibular and sublingual salivary glands.
The lacrimal nuclei: receive afferent fibers from the
hypothalamus for emotional responses. It supplies the
lacrimal glands.
3. Sensory nucleus: receive taste fibers from the anterior
two-thirds of the tongue, the floor of the mouth, and
the palate.
Parasympathetic
nucleus

sensory
nucleus

Muscles of
the upper
half of the
face receives
corticonuclea
r fibers from
both
cerebral
hemisphere
s while
muscles of
the lower
half of the
face receives
corticonuclea
r fibers from

Lesions:
Upper motor neuron lesion (UMNL): damage affecting the
descending tract above the facial main motor nucleus.
Lower motor neuron lesion (LMNL): damage affecting the facial
motor nucleus or the nerve itself.

UMNL

LMNL

Lesion affecting tract above

facial nucleus.

Lesion affecting facial motor

nucleus or the nerve it self.

Paralysis of the muscles of the

lower half of the face on the
contralateral (opposite) side
of the lesion.

Paralysis of the muscles of the

upper and lower halves of the
face on the ipisilateral (same)
side of the lesion.

Paralysis is associated with

hypertonia and
hyperreflexia.

Paralysis is associated with

hypotonia and hyporeflexia.

Associated hemiplagia on the

same side of the facial
paralysis.

Associated hemiplagia on the

opposite side of the facial
paralysis.

Corneal
Reflex
Light touch of the cornea
of conjunctiva results in blinking of
the eyelids.
Afferent impulses: ophthalmic division of trigeminal nerve
to the sensory nucleus of trigeminal nerve.
Efferent impulses: travel through facial nerve to both
orbicularis oculi muscles which causes closure of the
eyelids.

8.
Sens
vestibulocochlearory
Heari
ng
and

balan
ce

(SSA)

The vestibulocochlear nerve consists of two distinct

parts: the vestibular and the cochlear nerve which
concerned with the transmission of information from
the internal ear to the CNS.
Vestibular nerve:
Vestibular nerve has four nuclei (lateral, superior, medial, and
inferior vestibular nuclei). They receive signals from:
The utricle and saccule
The semicircular canals
Cerebellum: concerned with equilibrium.
Fibers of oculomotor, trochlear, and abducent nerve.
NOTE: These connections enable the movements of the head
and the eyes to be coordinated. In addition, information
received from the internal ear can assist in maintaining
balance by influencing the muscle tone of the limbs and trunk.
Lesion:
1. Vertigo.
2. Ipisilateral incoordination.
3. Nystagmus.

Cochlear nerve:
Cochlear nerve has 2 nuclei (anterior and posterior
neucli). Cochlear nerve conducts nerve impulses
concerned with sound from the organ of Corti in the
cochlea to the primary auditory cortex (area 41 and 42).
Lesion:
1. Tinnitus.
2. Deafness.

9.
Glossopharyngeal
Motor (SVE)
Poster
ior 1/3
of the
tongu
e

Sensory (SVA, GVA,

GSA)

Speech

This is a mixed nerve

carrying motor, sensory
and autonomic
(parasympathetic) fibers.
Motor fibers:
Stylopharyngeus
Constrictors of the
pharynx.
Sensory fibers:
General sensations from
the posterior 1/3 of the
tongue, pharynx and
tonsils.
Taste sensation from the
posterior 1/3 of tongue.
Parasympathetic fibers:
To the parotid gland.
Lesion:
1. Ipisilateral loss of taste
and general sensations

10. Vagus
Motor (GVE,
SVE)
Sensory
(SVA, GVA,
GSA)

This is a mixed nerve carrying

motor, sensory, and autonomic
(parasympathetic fibers).
Motor fibers:
To the soft palate, pharynx, and
larynx.
Sensory fibers: from
The skin over the external
auditory meatus.
The thoracic and abdominal
viscera.
Autonomic fibers:
Parasympathetic fibers to the
heart, GIT, the bronchial tree.
Lesion:
1. palato-pharyngeo-laryngeal
paralysis resulting in True
Bulbar Palsy manifisted by:
Bulbar symptoms:

The gag (pharyngeal) reflex:

Stimulus: touching the posterior pharyngeal wall.
Response: elevation of the soft palate and bilateral contraction
of pharyngeal muscles. It is tested on the left and the right sides
and the reflex response should be consensual (i.e., the elevation
of the soft palate should be symmetrical regardless of the side
touched).
Afferent (sensory): CN IX (glossopharyngeal)
Efferent (motor): CN X (Vagus)

Touching the soft palate can lead to a similar reflex response.

However, in this case, the sensory limb of the reflex is the
trigeminal nerve.

Lesion:
In glossopharyngeal nerve lesion: there will be no response when
touching the affected side.
With vagal nerve damage: the soft palate will elevate and pull
toward the intact side regardless of the side of the pharynx that is
touched
If both CN IX and X are damaged on one side (not uncommon),
stimulation of the normal side elicits only a unilateral response,
with deviation of the soft palate to that side; no consensual
response is seen. Touching the damaged side produces no response
at all

11.
Accessory
Should
er
shrug

Moto
r
(SVE)

The nerve is purely

motor and has 2
parts:
1. Cranial: it arises in
the medulla and
runs with the vagus
nerve to share in
the motor
innervation of the
soft palate and
pharynx.
2. Spinal: supplies
sternomastoid and
trapezius muscles.
Lesion: ipisilateral

12.
Hypoglossal

Mot
or
(GSE
)

Tongue
movem
ent

Hypoglossal nerve is
entirely motor and supplies
the intrinsic muscle of the
tongue as well as
genioglossus, styloglossus,
and hypoglossus to control its
movements and shape.
Greater part of the
hypoglossal nucleus receives
corticonuclear fibers from
both cerebral hemispheres.
However, the cells in
hypoglossal nucleus
responsible for supplying the
genioglossus muscle (muscle
that pulls the tongue
forward) only receive
corticonuclear fibers from the
opposite cerebral
hemisphere.

Summary

Cranial
nerve

Branche
s

Compon
ent

Function

(I)
Olfactory

Sensory

Smell

(II) Optic

Sensory

Vision

Motor

Raises upper eyelid, turns eyeball upward,

downward, and medially. (accommodation
reflex)

Parasymp
athetic

Constricts pupil.

motor

Turn eyeball downward and laterally

(III)
Oculomot
or

(IV)
Trochlear
(V)

Trigeminal
:

Ophtha
lmic

Sensory

Cornea, skin of forehead, scalp, eyelids, and

nose.

Maxilla
ry

Sensory

Skin of face over maxilla, teeth of upper jaw.

Mandib
ular

Sensory

Skin of cheek, skin over mandible and side of

head, teeth of lower jaw.

Motor

Muscles of mastication.

Motor

Turn eyeball laterally

Motor

Muscles of facial expression

(VI)
Abducent
(VII)

(VIII)
Vestibulococ
hlear

(IX)
Glossophary
ngeal

(X) Vagus

(XI)
Accessory

(XII)

Vestibu
lar

Cochlea Sensory
r

Sensory

Position and movement of the head

hearing

Motor

Stylopharyngeus muscle - assists swallowing

Parasymp
athetic

Parotid salivary gland

Sensory

General sensation and taste from the

posterior 1/3 of the tongue and pharynx

Motor

Heart, Blood vessels, trachea, bronchi,

oesophagus, stomach, intestine and
Palatoglossus.

Sensory

Taste from epiglottus, visceral sensation

from pharynx, larynx, thorax, and abdomen.

Cranial

Motor

Muscles of soft palate (except tensor

veli), pharynx (except
stylopharyngeus), and larynx (except
cricothyroid).

Spinal

Motor

Sternocleidomastoid and trapezius

muscles.

Motor

Muscles of the tongue (except