1. NEUROANATOMY Lecture : 8 Peripheral Nervous System Anatomy of the Cranial Nerves (I, II, III, IV, & VI) Prepared and presented by: Dr. Iyad Mousa Hussein, MD, Ph.D of Neurology Head of Neurology Department Nasser Hospital

2. 1.Classification of the Peripheral Nervous System. 2.Structures of the Peripheral Nerve and nerve fibers. 3.Classification of the Cranial Nerve. 4.Course, Function and Lesion of the Olfactory Nerve. 5.Course, Function and Lesion of the Optic Nerve. 6.Course, Branches, Function, and Lesion of the Oculomotor Nerve. 7.The actions of the ocular muscles. 8.Course, Function, and Lesion of the Trochlear Nerve. 9.Course, Function, and Lesion of the Abducent Nerve. LECTURE OBJECTIVES:

3. The peripheral nervous system (PNS) formed of the: 1. Somatic (voluntary or craniospinal) NS: which controls the skeletal muscles: a. Cranial nerves (12 pairs). b. Spinal nerves (31 pairs). 2. Autonomic NS: which controls the smooth muscles, cardiac muscles and glands activity: a. Sympathetic nervous system. b. Parasympathetic nervous system. Classification of the Peripheral Nervous System

4.  The peripheral nervous system consists of the cranial and spinal nerves and their associated ganglia.  There are 12 pairs of cranial nerves, which leave the brain and pass through foramina in the skull.  There are 31 pairs of spinal nerves, which leave the spinal cord and pass through intervertebral foramina in the vertebral column. The Peripheral Nervous System

5. Definition: it is an axon or a dendrite of a nerve cell. Structures of the Nerve Fiber: 1. Schwann cell. 2. Node of Ranvier. 3. Myelin sheath. 4. Mesaxon. The Nerve Fibers

7. Definition: The cranial nerves are consist of 12 pairs of nerves that arise from the brain. They exit/enter the cranium through openings in the skull. The Cranial Nerves

8.  The olfactory, optic and vestibulocochlear nerves are purely sensory nerves (128).  The oculomotor, trochlear, abducent, accessory and hypoglossal nerves are purely motor nerves.  The trigeminal, facial, glossopharyngeal and vagus nerves are mixed nerves (10975).  There are three cranial motor nerves (III, IV, & VI nerves), which supply the muscles of the eye.  There are three cranial mixed nerves (VII, IX, & X nerves), which have the same plan: each contains three types of fibers: ( motor, sensory and parasympathetic).

9. Classification of the Cranial Nerves Opening in the skullSite of nucleusFunctionName № Cribriform plate Temporal LobeSmellOlfactory1 Optic canal Occipital lobeVisionOptic2 Superior orbital fissureMidbrainMotorOculomotor3 Superior orbital fissureMidbrain MotorTrochlear4 Superior orbital fissure Foramen rotundum Foramen ovale Pons Midbrain Medulla oblongata Upper C. spinal cord Mixed Trigeminal: Ophthalmic Maxillary Mandibular 5 Superior orbital fissurePonsMotorAbducent6 Internal acoustic meatus, Facial canal, Stylomastoid foramen PonsMixedFacial7 Internal acoustic meatus Pons Hearing and balanceVestibulo-cochlear8 Jugular foramenMedulla oblongataMixedGlossopharyngeal9 Jugular foramenMedulla oblongataMixedVagus10 Jugular foramen Medulla oblongata & C1-C4 AHC of spinal cord Motor Spinal Accessory11 Hypoglossal canalMedulla oblongataMotor Hypoglossal12

12. Olfactory Nerve: (Latin for "to smell"). Function: Special sensory nerve (smell). Olfactory nerve located in the anterior cranial fossa and attached to the inferior surface of the frontal lobe. The Olfactory Nerve (I)

13. Pathway of the Smell From receptors in olfactory mucous membranes of the nasal cavity → Fibers of olfactory nerve (consist of about 20 small filaments on each side → The cribriform plate of the ethmoid bone → Olfactory groove → olfactory bulb → Olfactory tract → direct and indirect (around corpus callosum) to terminate in olfactory sensory area ( in the uncus of temporal lobe). Note: Smell as well bilateral represented.

17. 1.Unilateral anosmia. 2.Bilateral anosmia. 3.Parosmia (Smell hallucination) 4.Cacosmia (bad smell in chronic sinusitis). 5.Olfactory agnosia (higher-order loss of olfactory discrimination). Lesion of the Olfactory Nerve

18. Optic Nerve: (Latin for "to see"). Function: Special sensory nerve (Sense of vision). The Optic Nerve (II)

19. Receptors of light are rods and cones of retina → Optic nerve → Optic canal of the sphenoid bone → Optic chiasma (the nasal or medial fibers decussate to the opposite optic tract, while the temporal or lateral fibers continue in the same optic tract → Optic tract → Relay in the lateral geniculate body → Posterior limb of internal capsule → Optic radiation → End in areas 17, 18, 19 of occipital lobes. Pathway of the Vision

24. 1.Lesion in the optic nerve or retina: ipsilateral loss or decrease of vision (blindness). 2.Lesion in the optic chiasma: bitemporal hemianopsia. 3.Lesion in the optic tract: contralateral homonymous hemianopsia with loss direct and indirect light reflexes. 4.Lesion in the lateral geniculate body, internal capsule and optic radiation: contralateral homonymous hemianopsia with preserved direct and indirect light reflexes. 5.Lesion in the occipital lobe: a. Irritative: Visual hallucination. b. Destructive: contralateral homonymous hemianopsia with macular sparing and visual agnosia (the patient can see but does not recognize objects). Lesion in the Vision Pathway

28. Oculomotor nerve: (Latin for "eye" and "moving"). Function: 1. Motor function: movement of the eye ball. 2. Autonomic (parasympathetic): pupillary reaction. Site of nucleus: it lies in the tegmentum of midbrain. The oculomotor Nerve (III)

29.  The Oculomotor nerve is purely a motor nerve.  The oculomotor nerve emerges from the anterior surface of the midbrain.  The oculomotor nerve travels in the lateral wall of the cavernous sinus and then enters the orbit via the superior orbital fissure of the sphenoid bone. The Oculomotor Nerve

32. The nucleus of oculomotor nerve formed of 3 main parts: 1. The Edinger-Westphal nucleus: parasympathetic function which supplies two intraocular muscles: a. Constrictor pupillae muscle → Miosis. b. Ciliary muscle → Responsible for light and accommodation reflexes. 2. The lateral cell mass (motor function): which is divided into five parts which supplies five extra ocular muscles which are from above downwards: a. Levator palpebrea superior muscle. b. Superior rectus muscle. c. Medial rectus muscle. d. Inferior oblique muscle. e. Inferior rectus muscle. 3. The central nucleus of Perlia: motor function which supplies the medial recti muscles of the two eyes allowing to contract together when both eyes converge to look to a near object. Structure of oculomotor Nuclei

34. The oculomotor nerve supplies all the intra- and extraocular muscles except: 1.Superior oblique muscle → from the trochlear nerve – IV. 2.Lateral rectus muscle → from the abducent nerve –VI. 3.Dilator pupillae muscle → from the sympathetic fibers.

37. 1.The Lateral Rectus Muscle: abducts (laterally) the eye ball. 2.The Medial Rectus Muscle: adducts (medially) the eye ball. 3.The Superior Rectus Muscle: elevates, adducts and rotates medially. 4.The Inferior Rectus Muscle: depresses, adducts and rotates medially. 5.The Superior Oblique Muscle: depresses, abducts and rotates laterally. 6.The Inferior Oblique Muscle: elevates, abducts and rotates laterally. The Actions of the Ocular Muscles

44. 1. Superior division: which supplies the: a. Levator palpebrea superior muscle. b. Superior rectus muscle. 2. Inferior division: which supplies the: a. Medial rectus muscle. b. Inferior rectus muscle. c. Inferior oblique muscle. d. Sphincter pupillae muscle. e. Ciliary muscle. Branches of the Oculomotor Nerve

47. 1.Ptosis: paresis of the levator palpebrea superior muscle. 2.Diplopia: occurs only on elevation of eye lid. 3.Squint: divergent paralytic. 4.Mydriasis: dilated fixed pupil. 5.Loss of light and accommodation reflexes. Lesion of the Oculomotor Nerve:

52. The trochlear nerve is motor nerve. Function: motor nerve → supplies the superior oblique muscles → depresses, abducts and rotates laterally the eye ball. Site of the nucleus: it lies in the tegmentum of the midbrain. The Trochlear Nerve (IV)

54.  It is the smallest cranial nerve.  The trochlear nerve is purely a motor nerve.  The trochlear nerve emerges from the posterior surface of the midbrain.  The nerve travels in the lateral wall of the cavernous sinus and then enters the orbit via the superior orbital fissure of the sphenoid bone where it supplies the superior oblique muscle of the eye that controls downward and lateral movement of the eyeball. The Trochlear Nerve

62. Lesion of the Trochlear Nerve 1.Diplopia on looking down and out. 2.Limitation of movement during examination for eye movement down and out.

63. Abducent nerve: (Latin for "abduction"). The abducent nerve is so called because lateral rectus muscle (which it supplies) abducts the eyeball. Function: motor nerve → abducts (laterally) the eye ball → supplies the lateral rectus muscle (abduction). Site of the nucleus: it lies in the lower part of the ventral surface of pons. The Abducent Nerve (VI)

65.  The abducent nerve is purely a motor nerve.  The abducent nerve emerges from the lower border of the pons (between the pons and medulla oblongata).  The abducent nerve travels the medial wall of the cavernous sinus and then enters the orbit via the superior orbital fissure of the sphenoid bone where it supplies the lateral rectus muscle of the eye that controls abduction of the eye. The Abducent Nerve

72. 1.Diplopia on looking out wards. 2.Limitation during examination of eye movement in the outward direction. 3.Convergent paralytic squint. Lesion of the Abducent Nerve