Introduction to the cranial nerves

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Introduction to the cranial nerves

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Anatomy of the cranial base
Anatomy of the cerebral cortex
Anatomy of the cerebellum
Anatomy of the cranial meninges and dural venous sinuses
Anatomy of the brainstem
Anatomy of the basal ganglia
Anatomy of the white matter tracts
Anatomy of the limbic system
Anatomy of the blood supply to the brain
Anatomy of the diencephalon
Anatomy of the ventricular system
Anatomy of the vertebral canal
Anatomy of the descending spinal cord pathways
Anatomy of the ascending spinal cord pathways
Introduction to the cranial nerves
Cranial nerve pathways
Anatomy of the olfactory (CN I) and optic (CN II) nerves
Anatomy of the oculomotor (CN III), trochlear (CN IV) and abducens (CN VI) nerves
Anatomy of the trigeminal nerve (CN V)
Anatomy of the facial nerve (CN VII)
Anatomy of the glossopharyngeal nerve (CN IX)
Anatomy of the spinal accessory (CN XI) and hypoglossal (CN XII) nerves
Anatomy of the vagus nerve (CN X)
Anatomy of the brachial plexus
Anatomy of the muscles and nerves of the posterior abdominal wall
Vessels and nerves of the gluteal region and posterior thigh
Anatomy clinical correlates: Median, ulnar and radial nerves
Development of the nervous system
Central nervous system histology
Peripheral nervous system histology
Nervous system anatomy and physiology
Neuron action potential
Cerebral circulation
Blood brain barrier
Cerebrospinal fluid
Cranial nerves
Ascending and descending spinal tracts
Motor cortex
Pyramidal and extrapyramidal tracts
Muscle spindles and golgi tendon organs
Spinal cord reflexes
Sensory receptor function
Somatosensory receptors
Somatosensory pathways
Sympathetic nervous system
Adrenergic receptors
Parasympathetic nervous system
Cholinergic receptors
Enteric nervous system
Body temperature regulation (thermoregulation)
Hunger and satiety
Cerebellum
Basal ganglia: Direct and indirect pathway of movement
Memory
Sleep
Consciousness
Learning
Stress
Language
Emotion
Attention
Spina bifida
Chiari malformation
Dandy-Walker malformation
Syringomyelia
Tethered spinal cord syndrome
Aqueductal stenosis
Septo-optic dysplasia
Cerebral palsy
Spinocerebellar ataxia (NORD)
Transient ischemic attack
Ischemic stroke
Intracerebral hemorrhage
Epidural hematoma
Subdural hematoma
Subarachnoid hemorrhage
Saccular aneurysm
Arteriovenous malformation
Broca aphasia
Wernicke aphasia
Wernicke-Korsakoff syndrome
Kluver-Bucy syndrome
Concussion and traumatic brain injury
Shaken baby syndrome
Seizures and epilepsy
Febrile seizure
Early infantile epileptic encephalopathy (NORD)
Tension headache
Cluster headache
Migraine
Idiopathic intracranial hypertension
Trigeminal neuralgia
Cavernous sinus thrombosis
Alzheimer disease
Vascular dementia
Frontotemporal dementia
Dementia with Lewy bodies
Creutzfeldt-Jakob disease
Normal pressure hydrocephalus
Torticollis
Essential tremor
Restless legs syndrome
Parkinson disease
Huntington disease
Opsoclonus myoclonus syndrome (NORD)
Multiple sclerosis
Central pontine myelinolysis
Acute disseminated encephalomyelitis
Transverse myelitis
JC virus (Progressive multifocal leukoencephalopathy)
Adult brain tumors
Acoustic neuroma (schwannoma)
Pituitary adenoma
Pediatric brain tumors
Brain herniation
Brown-Sequard Syndrome
Cauda equina syndrome
Treponema pallidum (Syphilis)
Vitamin B12 deficiency
Friedreich ataxia
Neurogenic bladder
Meningitis
Neonatal meningitis
Encephalitis
Brain abscess
Epidural abscess
Sturge-Weber syndrome
Tuberous sclerosis
Neurofibromatosis
von Hippel-Lindau disease
Amyotrophic lateral sclerosis
Spinal muscular atrophy
Poliovirus
Guillain-Barre syndrome
Charcot-Marie-Tooth disease
Bell palsy
Winged scapula
Thoracic outlet syndrome
Carpal tunnel syndrome
Ulnar claw
Erb-Duchenne palsy
Klumpke paralysis
Sciatica
Myasthenia gravis
Lambert-Eaton myasthenic syndrome
Orthostatic hypotension
Horner syndrome
Congenital neurological disorders: Pathology review
Headaches: Pathology review
Seizures: Pathology review
Cerebral vascular disease: Pathology review
Traumatic brain injury: Pathology review
Spinal cord disorders: Pathology review
Dementia: Pathology review
Central nervous system infections: Pathology review
Movement disorders: Pathology review
Neuromuscular junction disorders: Pathology review
Demyelinating disorders: Pathology review
Adult brain tumors: Pathology review
Pediatric brain tumors: Pathology review
Neurocutaneous disorders: Pathology review
Anatomy clinical correlates: Olfactory (CN I) and optic (CN II) nerves
Anatomy clinical correlates: Oculomotor (CN III), trochlear (CN IV) and abducens (CN VI) nerves
Anatomy clinical correlates: Trigeminal nerve (CN V)
Anatomy clinical correlates: Facial (CN VII) and vestibulocochlear (CN VIII) nerves
Anatomy clinical correlates: Glossopharyngeal (CN IX), vagus (X), spinal accessory (CN XI) and hypoglossal (CN XII) nerves
Anatomy clinical correlates: Spinal cord pathways
Anatomy clinical correlates: Anterior blood supply to the brain
Anatomy clinical correlates: Posterior blood supply to the brain

Notes

Introduction to the Cranial Nerves

Figure 1. Ventral surface of the brain showing the origins of the cranial nerves.
Figure 2. Lateral view of fifth week embryo, showing innervation of the pharyngeal arches.  




Cranial NerveSensory or motor? Components
Main Function / Distribution
Olfactory nerve (CN I)
Sensory
Special Sensory
Smell
Optic nerve (CN II)
Sensory
Special Sensory
Vision
Oculomotor nerve (CN III)
Motor
Somatic Motor
Extraocular muscles (except superior oblique & lateral rectus)

Visceral Motor (Parasympathetic)


Ciliary muscle & sphincter pupillae muscle

Trochlear nerve (CN IV)
Motor
Somatic Motor
Superior oblique
Trigeminal nerve (CN V)
Both
Somatic (Branchial) Motor
Muscles of mastication
Somatic Sensory
Sensory innervation of face, scalp and mouth
Abducens nerve (CN VI)
Motor
Somatic Motor
Lateral rectus
Facial nerve (CN VII)
Both
Somatic (Branchial) Motor
Muscles of facial expression

Visceral Motor (Parasympathetic)

Submandibular, sublingual, lacrimal, and nasal glands

Somatic Sensory

Small area of skin on external ear
Special SensoryTaste from anterior 2/3 of tongue
Vestibulocochlear nerve (CN VIII)
Sensory
Special Sensory

Position and movements of head and hearing

Glossopharyngeal nerve (CN IX)
Both
Somatic (Branchial) Motor
Stylopharyngeus muscle

Visceral Motor (Parasympathetic)

Parotid gland

Visceral Sensory

Oropharynx and carotid sinus and body

Taste from posterior 1/3 of tongue
Special Sensory
Vagus nerve (CN X)
Both
Somatic (Branchial) Motor
Muscles of larynx and pharynx

Visceral Motor (Parasympathetic)

Heart, lungs, and muscle and glands of the GI tract and abdominal viscera


Visceral Sensory

Larynx, pharynx, heart, lungs, and abdominal viscera

Taste from epiglottis and laryngopharynx
Special Sensory
Accessory nerve (CN XI)
Motor
Somatic Motor
Sternocleidomastoid and Trapezius
Hypoglossal nerve (CN XII)
Motor
Somatic Motor
Muscles of the tongue
UNLABELED DIAGRAMS

Transcript

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The cranial nerves are 12 paired nerves that arise from the brain and travel through foramina and fissures in the cranium to innervate various structures, primarily in the head and neck.

Just like spinal nerves, which originate from the spinal cord, cranial nerves originate from the brain, but unlike spinal nerves which are pretty similar to each other - with all of them being mixed nerves - the cranial nerves are a mix and match of motor, sensory and autonomic functions.

Simply put, some cranial nerves are motor nerves, some are sensory nerves, some are mixed and some carry parasympathetic fibers as well.

Funnily enough, some of them aren’t even nerves at all.

The first and second cranial nerves, which are the olfactory and optic nerves, are actually brain projections that belong to the olfactory and optic tracts, but everyone likes to call them cranial nerves so we will too!

Let’s start by naming the 12 pairs of cranial nerves in order from rostral, or front of the brain, to the caudal, or back of the brain, on an image of the ventral surface of the brain: 1st Olfactory, 2nd Optic, 3rd Oculomotor, 4th Trochlear, 5th Trigeminal, 6th Abducens, 7th Facial, 8th Vestibulocochlear, 9th Glossopharyngeal, 10th Vagus, 11th Accessory, and 12th Hypoglossal.

There are many mnemonics out there to help you remember these so choose one that best fits you, but here at Osmosis we like to remember these nerves by saying:

Oh Oh Oh To Touch And Feel Very Green Vegetables A H!

Now, these nerves don’t all originate from the same place and they enter or exit at different parts of the brain.

Cranial nerves one and two enter the cerebrum, but most of the cranial nerves enter or exit at various levels of the brainstem.

Cranial nerves three and four emerge from the midbrain, and it’s worth mentioning that cranial nerve four is the only nerve to arise from the dorsal aspect of the brainstem.

Cranial nerve five, or the trigeminal nerve, arises from the pons, while cranial nerves six, seven and eight, enter or exit, at the pontomedullary junction.

Lastly, cranial nerves nine, ten and twelve, all enter or exit from the medulla.

Finally, cranial nerve eleven arises mostly from the spinal cord.

Ok, now let’s talk about the embryological development of the cranial nerves.

See, way back when we all looked a bit like intrauterine shrimp, there were six sets of tissue bands called pharyngeal arches.

Originally there were six of them, numbered logically from 1 to 6.

However the 5th doesn’t develop, so we are left with 5 pharyngeal arches numbered 1, 2, 3, 4, and 6.

During development, each pharyngeal arch develops along with a cranial nerve or one of its branches, so whatever structure develops from a particular arch is innervated by the associated nerve.

So, the first arch is associated with the trigeminal nerve, or cranial nerve five.

This arch gives rise to the mylohyoid, tensor tympani, tensor veli palatini, the anterior belly of digastric and the muscles of mastication.

The second arch is associated with and innervated by the facial nerve, or cranial nerve seven, and gives rise to the stapedius, stylohyoid, posterior belly of digastric and the muscles of facial expression.

The third arch is associated with the glossopharyngeal nerve, or cranial nerve nine , and gives rise to the stylopharyngeus muscle.

The fourth arch is associated with the superior laryngeal nerve, which is a branch of the vagus nerve, or cranial nerve ten .

This arch gives rise to the cricothyroid muscle, cricopharyngeus, muscles of the pharynx except for the stylopharyngeus,and the muscles of the soft palate except for the tensor veli palatini.

Finally, the sixth arch is associated with the recurrent laryngeal nerve - another branch of the vagus nerve - and gives rise to intrinsic muscles of the larynx, except for cricothyroid muscle, and to the upper muscles of the esophagus.

Now to better understand the anatomy and function of the cranial nerves, let’s think of the cranial nerves like tiny highways.

Just like cars traveling along highways, information travels through the cranial nerves.

This information can travel in one direction, or both.

The two lanes that make up our cranial nerve highway are motor and sensory pathways.

Motor fibers originate in the brain and carry motor signals from the brain to the structure they innervate, so they are referred to as efferent fibers, and to remember this the E in efferent stands for Exit.

Sensory fibers carry signals in the opposite direction, from their receptors in the periphery to the brain, which is why they can be referred to as afferent fibers, with the A standing from Arriving.

Now, there are three types of motor fibers: somatic motor which innervate striated muscles under voluntary control; somatic branchial motor that can only be found in cranial nerves and innervate voluntary muscles that develop embryologically from the pharyngeal - or branchial - arches; and visceral motor, specifically parasympathetic fibers, which constitute the cranial outflow of the parasympathetic division of the autonomic nervous system, and innervate smooth muscle, glands, and the heart.

As for the sensory fibers, there are also three types: somatic sensory, which carry sensory information such as pain, temperature, touch and proprioception from the skin, mucous membranes and muscles; visceral sensory, which carry information from the carotid body and sinus, pharynx, larynx, as well as, thoracic and abdominal viscera; and, lastly, special sensory, which is associated with smell, sight, taste, hearing and balance.

Now let’s see what type of information each cranial nerve carries.

Generally, cranial nerves will carry either motor information, sensory information, or both making it a mixed nerve.

Key Takeaways

The cranial nerves are a set of 12 nerves that originate in the brainstem and exit the skull through openings in the base of the skull. They control several important functions such as vision, smell, hearing, and facial movement.

The 12 cranial nerves are olfactory (I), optic (II), oculomotor (III), trochlear (IV), trigeminal (V), abducens (VI), facial (VII), vestibulocochlear (VIII), glossopharyngeal (IX), vagus nerve(X) , accessory nerve(XI) , and hypoglossal nerve(XII).

Sources

  1. "Human Anatomy & Physiology, 11th edition" Pearson (2018)
  2. "Costanzo Physiology, 7th edition" Elsevier (2021)
  3. "Moore’s Clinically Oriented Anatomy, 9th edition" Wolters Kluwer (2023)
  4. "Cranial Nerve Imaging and Pathology" Neurol Clin (2020)
  5. "Cranial Nerve Anatomy" Neuroimaging Clin N Am (2022)