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# I II III Innervation Skull entrance/exit Origin Neuropathy Olfactory Nerve S - Smell Cribiform Plate Temporal lobe ↓smell, ↓taste (2°) Oculomotor Optic S - Sight Optic Canal w/ ophthalmic a. Only CN from CNS (MS affected) Pituitary tumor visual dysfxn Superior Orbital Fissure w/ ophthalmic v. (common tendinous ring CTR Superior Orbital Fissure Midbrain (interpeduncular fossa) Trochlear M – Eye (x Sup Oblique, Lateral Rectus), Levator Palpebrae Superioris PNS – Ciliary Body & Constrictor Pupillae M – Superior Oblique [dessicates] “down-&-out” syndrome Mydriasis, Ptosis, diplopia, lost accommodation/light reflexes Vertical diplopia-head tilt away IV V Trigeminal B– Ophthalmic S – forehead/nose, eye,↑eyelid, frontal sinus Superior Orbital Fissure (CTR) Pons ↓corneal reflex Herpes zoste (V1>V2>V3) Most affected by herpes zoster S – cheek, ↑teeth, ↓eyelid, maxillary sinus Foramen Rotundum Pons Tic douloureux S – Lower face, ↓teeth, anterior 2/3 tongue [lingual], temple, TMJ, lingual gingiva M – Mastication, Tensor Tympani, Tensor Veli Palatini, Mylohyoid, Anterior Digastric Belly M – Lateral Rectus Foramen Ovale (w/ accessory meningeal a. & lesser petrosal n.) Pons Tic douloureux Abnormal chewing, Superior Orbital Fissure (CTR) Internal Acoustic Meatus Stylomastoid Foramen Ventral Brainstem (b/t Pons & Medulla) thru cavernous sinus Ventral Brainstem (b/t Pons & Medulla) [Lateral to VI] Cavernous sinus syndrome medial eye deviation, diplopia Unilateral facial paralysis Lower motor nerve palsy Cold (idiopathic) Bell’s Palsy Petrous Ridge of Temporal Bone Ventral Brainstem (b/t Pons & Medulla) Lateral Medulla (Inferior to VIII) Sup/Inf brainstem ganglia Hearing/balance loss Vertigo V1 V2 V3 Mandibular (B) VI Abducens VII Facial (B) Maxillary S – Taste anterior 2/3 tongue [Chorda Tympani], soft palate M – Facial expression mm, Platysma, Posterior Digastric Belly, Stapedius, Stylohyoid PNS - submandibular/sublingual/lacrimal glands Intermediate nerve (VII br) VIII Vestibulocochlear IX Glossopharyngeal (B) X Vagus (B) XI Accessory XII Hypoglossal S – soft palate S – Balance (vestibular) S – Sound (cochlear) Dorsal Brainstem (ONLY CN) Supero-Lateral Pons (anatomical note: runs thru parotid gland) Internal Acoustic Meatus S – Taste/sense posterior 1/3 tongue, tonsil, pharynx, middle ear & carotid sinus M – stylopharyngeus PNS - parotid gland M - soft palate (x tensor veli palatini) larynx/pharynx (x stylopharyngeus), palatoglossal PNS – abd/thor viscera up to 2/3 Tverse colon M – Trapezius & SCM (Cranial) M – Laryngeal & Pharyngeal mm. (Spinal) Jugular Foramen Jugular Foramen Lateral Medulla (Inferior to IX) ↓taste, ↓salivation, syncope Carotid body (massage) T&A damage Dysphagia, hoarseness, stridor Foramen Magnum & Jugular Foramen (exits) Spinal rootlets enter via magnum, joining medullary roots to form IX Medulla (b/t pyramids & olive) Paralysis of SCM & Trapezius (drop shoulder, torticollis/”wryneck”) Tongue deviates towards lesion M – Tongue mm. (intrinsic & extrinsic) (x palatoglossal) Hypoglossal Canal Foramen Spinosum – middle meningeal artery/vein & nervus spinosus Foramen lacerum – membrane covers Int. carotid a.