CRANIAL NERVES

• Olfactory
• Optic
• Oculomotor
• Trochlear
• Trigeminal
• Abducent
• Facial
• Vestibulocochlear
• Glossopharyngeal
• Vagus
• Accessory
• Hypoglossal
 ORGANISATION OF CRANIAL NERVES

• The cranial nerves have central motor and/or

sensory nuclei within the brain and peripheral
nerve fibers that emerge from the brain and
exit from the skull to reach their effector or
sensory organs
 MOTOR NUCLEI OF CRANIAL NERVE
• SOMATIC MOTOR AND BRANCHIOMOTOR NUCLEI
• The somatic motor and branchiomotor nerve fibers of a cranial nerve are
the axons of nerve cells situated within the brain.
• These nerve cell groups form motor nuclei and innervate striated muscle.
• Each nerve cell with its processes is referred to as a lower motor neuron.
• Such a nerve cell is, therefore, equivalent to the motor cells in the
anterior gray columns of the spinal cord.
• The motor nuclei of the cranial nerves receive impulses from the cerebral
cortex through the corticonuclear (corticobulbar) fibers. These fibers
originate from the pyramidal cells in the inferior part of the precentral
gyrus (area 4) and from the adjacent part of the postcentral gyrus. The
corticonuclear fibers descend through the corona radiata and the genu of
the internal capsule
• They pass through the midbrain just medial to the
corticospinal fibers in the basis pedunculi and end by
synapsing either directly with the lower motor neurons within
the cranial nerve nuclei or indirectly through the internuncial
neurons.
• The corticonuclear fibers thus constitute the first-order
neuron of the descending pathway, the internuncial neuron
constitutes the second-order neuron, and the lower motor
neuron constitutes the third-order neuron.
• The majority of the corticonuclear fibers to the motor cranial
nerve nuclei cross the median plane before reaching the
nuclei.
• Bilateral connections are present for all the cranial motor
nuclei except for part of the facial nucleus that supplies the
muscles of the lower part of the face and a part of the
hypoglossal nucleus that supplies the genioglossus muscle.
 General Visceral Motor Nuclei
• The general visceral motor nuclei form the cranial outflow of the
parasympathetic portion of the autonomic nervous system.
• They are the Edinger-Westphal nucleus of the oculomotor nerve

• the superior salivatory nucleus

• lacrimal nuclei of the facial nerve
• the inferior salivatory nucleus of the glossopharyngeal nerve
• the dorsal motor nucleus of the vagus.
• These nuclei receive numerous afferent fibers, including
descending pathways from the hypothalamus.
 Sensory Nuclei of the Cranial Nerves
• It includes somatic and visceral afferent nuclei.
• The sensory or afferent parts of a cranial nerve are the axons of nerve
cells outside the brain and are situated in ganglia on the nerve trunk.
• or may be situated in a sensory organ, such as the nose, eye, or ear.
• These cells and their processes form the first-order neuron.
• The central processes of these cells enter the brain and terminate by
synapsing with cells forming the sensory nuclei.
• These cells and their processes form the second-order neuron.
• Axons from these nuclear cells now cross the midline and ascend to
other sensory nuclei, such as the thalamus, where they synapse.
• The nerve cells of these nuclei form the third-order neuron, and their
axons terminate in the cerebral cortex.
• The olfactory nerve is
composed of unmyelinated
thin processes (rootlets) of
the olfactory hair cells in
the nasal mucosa.
• Fascicles of the olfactory
nerve pierce the cribriform
plate of the ethmoid bone,
enter the cranial cavity, and
terminate on neurons in
the olfactory bulb.
 Olfactory Epithelium
• The olfactory epithelium is located in the mucous
membrane lining the roof of the nasal cavity on
the inferior surface of the cribriform p late of the
ethmoid bone.
• The olfactory epithelium contains three types of
epithelial cells:
• receptor cells,
• supporting cells
• basal cells
 Receptor Cells
• Olfactory receptor cells are bipolar sensory neurons.
• Their perikarya are located in the lower part of the olfactory epithe-lium.
Each cell has a single dendrite that reaches the surface of the epithelium
and forms a knoblike expansion that extends beyond the epithelial
surface.
• From this expansion, 10 to 20 nonmotile cilia project into a layer of fluid
covering the epithelium.
• The olfactory cilia contain receptors for odorant molecules.
• From the basal part of the perikaryon, a nonmyelinated axon emerges
and joins with axons of adjacent receptor cells to form the olfactory
nerve .
• Olfactory nerve bundles penetrate the cribriform plate of the ethmoid
bone to reach the olfactory bulb-.
 Supporting (Sustentacular) Cells
• Supporting cells are columnar epithelial cells that
separate the olfactory receptor cells
• . The surface of supporting cells has microvilli that
project into the fluid layer covering the epithelium.
• supporting cells provide mechanical support to the
receptor cells.
• and con-tribute, along with Bowman's gland, to
the elaboration of the overlying mucus.
• supporting cells remain stable
 Basal Cells
• Basal cells are polygonal cells limited to the
basal part of the epithelium.
• They are the source of new epithelial cells.
• Mitotic activity persists in these cells through
maturity
 Bowman's Glands
• Bowman's glands contain serous and mucous cells and
are located beneath the epithelium
• . They send their ducts in between epithelial cells to
pour their secretion onto the surface of the
epithelium..
• bathing the cilia of receptor cells and the microvilli of
supporting cells.
• The secretion of Bowman's glands plays an important
role in dissolving odorous substances and diffusing
them to receptor cells.
 OLFACTORY BULB
• This ovoid structure possesses several types of nerve
cells, the largest of which is the mitral cell . The
incoming olfactory nerve fibers synapse with the
dendrites of the mitral cells and form rounded areas
known as synaptic glomeruli.
• Smaller nerve cells, called tufted cells and granular
cells, also synapse with the mitral cells.
• The olfactory bulb, in addition, receives axons from
the contralateral olfactory bulb through the olfactory
tract.
 Olfactory Tract
• This narrow band of white matter runs from the posterior end of the
olfactory bulb beneath the inferior surface of the frontal lobe of the
brain.
• It consists of the central axons of the mitral and tufted cells of the bulb
and some centrifugal fibers from the opposite olfactory bulb.
• As the olfactory tract reaches the anterior perforated substance, it
divides into medial and lateral olfactory striae.
• The lateral stria carries the axons to the olfactory area of the cerebral
cortex, namely, the periamygdaloid and prepiriform areas .

. The medial olfactory stria carries the fibers that cross the median plane
in the anterior commissure to pass to the olfactory bulb of the opposite
side.
• The periamygdaloid and prepiriform areas of the
cerebral cortex are often known as the primary
olfactory cortex.
• The entorhinal area (area 28) of the
parahippocampal gyrus, which receives numerous
connections from the primary olfactory cortex, is
called the secondary olfactory cortex.
• These areas of the cortex are responsible for the
appreciation of olfactory sensation.
• The primary olfactory cortex sends nerve fibers to
many other centers within the brain to establish
connections for emotional and autonomic responses
to olfactory sensations.
 Bilateral anosmia
• Caused y common cold and allergic rhinitis
• Involve olfactory mucosa.
 Unilateral anosmia
• Disease involve olfactory nerves ,olfactory
bulb and tract
• Caused by fracture of anterior cranial fossa
involve cribriform polate invvolve olfactory
nerve.
• Frontal lobe tumor of cerebral cortex involve
olfactory bulb or tract
 Optic Nerve
• ORIGIN OF THE OPTIC NERVE
• The fibers of the optic nerve are the axons of the cells in the
ganglionic layer of the retina.
• They converge on the optic disc and exit from the eye, about 3 or
4 mm to the nasal side of its center, as the optic nerve .
• The fibers of the optic nerve are myelinated, but the sheaths are
formed from oligodendrocytes rather than Schwann cells, since
the optic nerve is comparable to a tract within the central nervous
system.
• The optic nerve leaves the orbital cavity through the optic canal
and unites with the optic nerve of the opposite side to form the
optic chiasma.
 Optic Chiasma
• The optic chiasma is situated at the junction of the anterior
wall and floor of the third ventricle.
• Its anterolateral angles are continuous with the optic
nerves, and the posterolateral angles are continuous with
the optic tracts.
• In the chiasma, the fibers from the nasal (medial) half of
each retina, including the nasal half of the macula,1 cross
the midline and enter the optic tract of the opposite side,
while the fibers from the temporal (lateral) half of each
retina, including the temporal half of the macula, pass
posteriorly in the optic tract of the same side.
 Optic Tract

• The optic tract emerges from the optic chiasma and

passes posterolaterally around the cerebral
peduncle.
• Most of the fibers now terminate by synapsing with
nerve cells in the lateral geniculate body, which is a
small projection from the posterior part of the
thalamus.
• A few of the fibers pass to the pretectal nucleus and
the superior colliculus of the midbrain and are
concerned with light reflexes .
 Lateral Geniculate Body

• The lateral geniculate body is a small, oval swelling

projecting from the pulvinar of the thalamus.
• It consists of six layers of cells, on which synapse
the axons of the optic tract.
• 1,4,6 opposite side retina
• 2.3,5 same side retina
. The axons of the nerve cells within the geniculate
body leave it to form the optic radiation
 Optic Radiation
• The fibers of the optic radiation are the axons of the
nerve cells of the lateral geniculate body.
• The tract passes posteriorly through the retrolenticular
part of the internal capsule and terminates in the visual
cortex (area 17), which occupies the upper and lower
lips of the calcarine sulcus on the medial surface of the
cerebral hemisphere.
• The visual association cortex (areas 18 and 19) is
responsible for recognition of objects and perception of
color.
 Neurons of the Visual Pathway
• Four neurons conduct visual impulses to the visual
cortex:
• (1) rods and cones, which are specialized receptor
neurons in the retina.
• (2) bipolar neurons, which connect the rods and cones
to the ganglion cells.
• (3) ganglion cells, whose axons pass to the lateral
geniculate body.
• (4) neurons of the lateral geniculate body, whose
axons pass to the cerebral cortex.
 Binocular vision
• In binocular vision, the right and left fields of vision are projected on portions
of both retinae.
• The image of an object in the right field of vision is projected on the nasal
half of the right retina and the temporal half of the left retina.
• In the optic chiasma, the axons from these two retinal halves are combined
to form the left optic tract.
• The lateral geniculate body neurons now project the complete right field of
vision on the visual cortex of the left hemisphere and the left visual field on
the visual cortex of the right hemisphere.
• The lower retinal quadrants (upper field of vision) project on the lower wall
of the calcarine sulcus, while the upper retinal quadrants (lower field of
vision) project on the upper wall of the sulcus.
• the macula lutea is represented on the posterior part of area 17, and the
periphery of the retina is represented anteriorly
 Visual reflaxes
• Direct and consensual light reflexes
• Accomodation reflex
• Corneal reflaxe
• Visual body reflaxes
• Pupilary skin reflex
 Direct and Consensual Light Reflexes

• If a light is shone into one eye, the pupils of

both eyes normally constrict.
• The constriction of the pupil on which the
light is shone is called the direct light reflex.
• the constriction of the opposite pupil, even
though no light fell on that eye, is called the
consensual light reflex
• The afferent impulses travel through the optic nerve, optic chiasma,
and optic tract .
• a small number of fibers leave the optic tract and synapse on nerve
cells in the pretectal nucleus, which lies close to the superior colliculus.
• The impulses are passed by axons of the pretectal nerve cells to the
parasympathetic nuclei (Edinger-Westphal nuclei) of the third cranial
nerve on both sides.
• Here, the fibers synapse and the parasympathetic nerves travel
through the third cranial nerve to the ciliary ganglion in the orbit .
. Finally, postganglionic parasympathetic fibers pass through the short
ciliary nerves to the eyeball and the constrictor pupillae muscle of the iris.
Both pupils constrict in the consensual light reflex because the
pretectal nucleus sends fibers to the parasympathetic nuclei on both sides
of the midbrain
The fibers that cross the median plane it close to the cerebral aqueduct
in the posterior commissure.
 Accommodation reflex
• When the eyes are directed from a distant to a near object, contraction of the medial recti
brings convergence of the ocular axes; the lens thickens to increase its refractive power by
contraction of the ciliary muscle; and the pupils constrict to restrict the light waves to the
thickest central part of the lens.
• The 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.
• The visual cortex is connected to the eye field of the frontal cortex
• . From here, cortical fibers descend through the internal capsule to the oculomotor nuclei
in the midbrain
• . The oculomotor nerve travels to the medial recti muscles.
• Some of the descending cortical fibers synapse with the parasympathetic nuclei (Edinger-
Westphal nuclei) of the third cranial nerve on both sides.
• the fibers synapse, and the parasympathetic nerves travel through the third cranial nerve
to the ciliary ganglion in the orbit.
• Finally, postganglionic parasympathetic fibers pass through the short ciliary nerves to the
ciliary muscle and the constrictor pupillae muscle of the iris
 Corneal Reflex
• Light touching of the cornea or conjunctiva results in
blinking of the eyelids
• . Afferent impulses from the cornea or conjunctiva
travel through the ophthalmic division of the trigeminal
nerve to the sensory nucleus of the trigeminal nerve .
• Internuncial neurons connect with the motor nucleus
of the facial nerve on both sides through the medial
longitudinal fasciculus.
• The facial nerve and its branches supply the orbicularis
oculi muscle, which causes closure of the eyelids.
 Visual body reflex
• The automatic scanning movements of the eyes and head
that are made when reading,
• the automatic movement of the eyes, head, and neck
toward the source of the visual stimulus, and the protective
closing of the eyes and even the raising of the arm for
protection are reflex actions of body.
• The visual impulses follow the optic nerves, optic chiasma,
and optic tracts to the superior colliculi.
• The impulses are relayed to the tectospinal and tectobulbar
(tectonuclear) tracts and to the neurons of the anterior gray
columns of the spinal cord and cranial motor nuclei.
 Pupillary Skin Reflex
• The pupil will dilate if the skin is painfully stimulated by
pinching.
• The afferent sensory fibers have connections with the
efferent preganglionic sympathetic neurons in the lateral
gray columns of the T1 AND T2 segments of the spinal cord
• . The white rami communicantes of these segments pass to
the sympathetic trunk, and the preganglionic fibers ascend
to the superior cervical sympathetic ganglion.
• The postganglionic fibers pass through the internal carotid
plexus and the long ciliary nerves to the dilator pupillae
muscle of the iris.
 Lesion of visual pathway
• Caused by
• Expending tumour of brain
• Involve pituitary and meninges.
• Cerebrovascular accedient
• Mostly involve optic nerve and optic tract
 Circumferential blindness
• Caused by optic neuritis
• . Optic neuritis occur following spread of
infection from the sphenoid and ethmoid
sinuses; the nerve is infected as it passes
through the optic canal to enter the orbital
cavity.
BITEMPORAL HEMIANOPIA
a sagittal section of the optic chiasma . This condition
is most commonly produced by a tumor of the
pituitary gland exerting pressure on the optic chiasma.
CONTRALATERAL HOMONYMOUS HEMIANOPIA
division of the optic tract or optic radiation or
destruction of the visual cortex on one side; the lesion
would produce the same hemianopia for both eyes—
that is, homonymous hemianopia .
If the right optic tract is divided, for example, a left
temporal hemianopia and a right nasal hemianopia
will occur
• NASAL HEMIANOPIA
• Nasal hemianopia caused by a partial lesion of
the optic chiasma on its lateral side
• BITEMPORAL HEMIANOPIA
• Bitemporal hemianopia would follow a sagittal
section of the optic chiasma . This condition is most
commonly produced by a tumor of the pituitary
gland exerting pressure on the optic chiasma.
• TOTAL BLINDNESS OF ONE EYE
• Total blindness of one eye would follow complete
section of one optic nerve
 Oculomotor Nerve (Cranial Nerve III)
• OCULOMOTOR NERVE NUCLEI
(1) the main motor nucleus and
(2) the accessory parasympathetic nucleus.
• The main oculomotor nucleus is situated in the anterior part of the
gray matter that surrounds the cerebral aqueduct of the midbrain.
• It lies at the level of the superior colliculus.
• The nucleus consists of groups of nerve cells that supply all the
extrinsic muscles of the eye except the superior oblique and the
lateral rectus.
• The outgoing nerve fibers pass anteriorly through the red nucleus
and emerge on the anterior surface of the midbrain in the
interpeduncular fossa.
• The main oculomotor nucleus receives corticonuclear fibers from
both cerebral hemispheres
• . It receives tectobulbar fibers from the superior colliculus and,
receives information from the visual cortex.
• It also receives fibers from the medial longitudinal fasciculus, by
which it is connected to the nuclei of the fourth, sixth, and eighth
cranial nerves.
• The accessory parasympathetic nucleus (Edinger-Westphal nucleus) is
situated posterior to the main oculomotor nucleus
• The axons of the nerve cells, which are preganglionic, accompany the
other oculomotor fibers to the orbit.
• Here, they synapse in the ciliary ganglion, and postganglionic fibers
pass through the short ciliary nerves to the constrictor pupillae of the
iris and the ciliary muscles.
• The accessory parasympathetic nucleus receives corticonuclear fibers
for the accommodation reflex and fibers from the pretectal nucleus
for the direct and consensual light reflexes.
 Course of the Oculomotor Nerve
• The oculomotor nerve emerges on the anterior surface of the midbrain .
• It passes forward between the posterior cerebral and the superior cerebellar
arteries.
• It then continues into the middle cranial fossa in the lateral wall of the
cavernous sinus. Here, it divides into a superior and an inferior ramus, which
enter the orbital cavity through the superior orbital fissure.
• The oculomotor nerve supplie extrinsic muscles of the eye: the levator palpebrae
superioris, superior rectus, medial rectus, inferior rectus, and inferior oblique.
• It also supplies, through its branch to the ciliary ganglion and the short ciliary
nerves, parasympathetic nerve fibers to the following intrinsic muscles: the
constrictor pupillae of the iris and ciliary muscles.
• Therefore, the oculomotor nerve is entirely motor and is responsible for lifting
the upper eyelid; turning the eye upward, downward, and medially; constricting
the pupil; and accommodating the eye.
 complete lesion of the oculomotor nerve
• the eye cannot be moved upward, downward, or inward.
• At rest, the eye looks laterally (external strabismus), owing to
the activity of the lateral rectus, and downward, owing to the
activity of the superior oblique.
• The patient sees double (diplopia).
• There is drooping of the upper eyelid (ptosis) due to paralysis
of the levator palpebrae superioris.
• The pupil is widely dilated and nonreactive to light, owing to
paralysis of the sphincter pupillae and unopposed action of
the dilator (supplied by the sympathetic). Accommodation of
the eye is paralyzed.
Incomplete lesions of the oculomotor nerve

• The condition in which the innervation of the

extraocular muscles is spared with selective loss of the
autonomic innervation of the sphincter pupillae and
ciliary muscle is called internal ophthalmoplegia.
• The condition in which the sphincter pupillae and the
ciliary muscle are spared with paralysis of the
extraocular muscles is called external ophthalmoplegia.
• The conditions most commonly affecting the
oculomotor nerve are diabetes, aneurysm, tumor,
trauma, inflammation, and vascular disease
 Trochlear Nerve (Cranial Nerve IV)
• TROCHLEAR NERVE NUCLEUS
• The trochlear nucleus is situated in the anterior part of the gray matter that
surrounds the cerebral aqueduct of the midbrain
• It lies inferior to the oculomotor nucleus at the level of the inferior
colliculus.
• The nerve fibers, after leaving the nucleus, pass posteriorly around the
central gray matter to reach the posterior surface of the midbrain.
• The trochlear nucleus receives corticonuclear fibers from both cerebral
hemispheres
• . It receives the tectobulbar fibers, which connect it to the visual cortex
through the superior colliculus .
• It also receives fibers from the medial longitudinal fasciculus, by which it is
connected to the nuclei of the third, sixth, and eighth cranial nerves.
 Course of the Trochlear Nerve
• The trochlear nerve, the most slender of the cranial nerves
and the only one to leave the posterior surface of the
brainstem, emerges from the midbrain and immediately
decussates with the nerve of the opposite side
• . The trochlear nerve passes forward through the middle
cranial fossa in the lateral wall of the cavernous sinus and
enters the orbit through the superior orbital fissure
• .The nerve supplies the superior oblique muscle of the
eyeball.
• The trochlear nerve is entirely motor and assists in turning
the eye downward and laterally.
 lesions of the trochlear nerve
• patient complains of double vision on looking
straight downward
• because the superior oblique is paralyzed, and
the eye turns medially as well as downward
• patient has great difficulty in turning the eye
downward and laterally