walsh MS3 unit 2

olfactory function

smell

optic function

vision; afferents for pupillary and accommodation reflexes

oculomotor motor efferent function

moves eye up, down, medially; raises upper eyelid; efferent for vestibulo-ocular reflex

oculomotor parasympathetic efferent function

constricts pupil; adjusts shape of the lens of the eye; efferent for pupillary and accommodation reflexes

trochlear function

moves eye medially and down; efferent for vestibulo-ocular reflex

trigeminal sensory function

somatosensation from the face, TMJ, eyeball; afferent for corneal reflex

trigeminal motor efferent function

chewing

abducens function

abducts eye; efferent for vestibulo-ocular reflex

facial motor efferent function

facial expression; closes eye; protects hearing; efferent for corneal reflex

facial sensory function

taste

facial parasympathetic efferent function

tears; salivation

vestibulo-cochlear function

sensation of head position relative to gravity and movement afferent for vestibulo-cochlear reflex; hearing

glossopharyngeal sensory function

sensation from pharynx, posterior tongue, middle ear; afferent for gag and swallowing reflexes; taste

glossopharyngeal motor efferent function

constrict pharynx

glossopharyngeal autonomic function

blood pressure and chemistry from carotid artery

glossopharyngeal parasympathetic function

salivation

vagus sensory function

sensations from pharynx, larynx, skin in external ear canal

vagus efferent motor function

regulates swallowing and speech; efferent for gag and swallowing reflexes

vagus autonomic function

afferents from viscera

vagus parasympathetic function

regulates viscera

accessory function

elevates shoulders, turns head h

hypoglossal function

moves tongue

anosmia

loss of sense of smell

causes: common cold, trauma to cribriform plate, meningioma

monocular vision / ipsilateral blindness

complete lesion of the optic nerve

internuclear opthalmoplegia

ipsilateral inability to adduct the eye; caused by damage/demyelination of the medial longitudinal fasciculus

seen often in MS pts and can result in double vision

trochlear opthalmoplegia

eye is deviated up and ipsilaterally-superior oblique - CN IV dysfunction

ptosis

droopy eyelid - CN III dysfunction

internal/medial strabismus

cannot abduct eye - CN VI dysfunction

medial longitudinal fasciculus function

coordination of eye movement

near triad

pupillary constriction (CN III), eyes converge (CN III & medial rectus), lens becomes more convex

near triad dysfunction

diplopia or blurred vision

trigeminal neuralgia

severe, sharp, stabbing pain when eating, talking, or touching face; CN V

difference between facial nerve lesion and corticobrainstem tract lesion

facial nerve: cannot close eyes or contract muscles on ipsilateral side

corticobrainstem tract: can close both eyes and generate an emotional smile

bell’s palsy

idiopathic / from viral infection or immune disorder; swelling of the facial nerve within the temporal bone'

inability to move facial muscles

bell’s palsy symptoms

sensory: normal facial somatosensation

special senses: sometimes hearing is louder in affected ear, loss of taste from anterior 2/3rds tongue

autonomic: salivation and tear production affected in severe cases

motor: paresis/paralysis of ipsilateral face; eye must be tapes closed in severe cases

ramsay hunt syndrome

facial and vestibulocochlear nerve dysfunction; symptoms include acute facial paralysis, blisters on external ear, balance/gaze stability/vertigo/hearing issues

acoustic neuroma

tumor in internal ear canal between trigeminal, facial, and cochlear nerve that can stretch/impair all three depending on size

Vagus nerve impairment

difficulty speaking/swallowing, poor digestion, loss of gag and swallowing reflexes

uvula deviation to strong (unaffected) side

oral phase of swallowing

food in mouth lips close (7)

jaw, cheek, and tongue movements manipulate food (5,7,12)

tongue moves foot into pharynx (12)

larynx closes (10)

swallow reflex triggered (9)

pharyngeal/laryngeal phase of swallowing

food moves into pharynx (9)

soft palate rises to block food from nasal cavity (10)

epiglottis covers trachea to prevent food from entering lungs (10)

peristalsis moves food to entrance of esophagus, sphincter opens, food moves into esophagus (10)

esophageal phase of swallowing

peristalsis moves food into stomach (10)

accessory nerve (CN XI)

innervates SCM and trapezius

hypoglossal nerve (CN XII)

innervates muscles of the tongue

lesion presentation: tongue deviate to ipsilateral side

peripheral sensitization

activation of silent nociceptors + nociceptors fire more APs in response to a stimulus than under normal conditions (increased response of nocicieptor to same stimulus)

central sensitization

neurons in the central nociceptive pathways exhibit elevated responses to incoming stimuli; increased activity at synapses between nociceptive afferents and protection neurons in the dorsal horn strengthens the synapses, leading to amplification of incoming nociceptive messages (increased response of central neurons to peripheral input)

signs of central sensitization

hyperalgesia, allodynia, temporal summation, spontaneous pain, secondary hyperalgesia

hyperalgesia

increased pain in response to a noxious stimulus

allodynia

pain in response to an innoculus stimulus (ex; putting a shirt on when sunburnt)

temporal summation

increased pain response to a repeated stimulus

spontaneous pain

pain that is temporarily distinct from an external stimulus

secondary hyperalgesia

pain in regions outside of the injured area

chronic primary pain

pain occurring in the absence of clearly identifiable tissue injury. Pain is a disease arising from dysfunction of the nociceptive system

ex: migraine, chronic nonspecific LBP, fibromyalgia, complex regional pain syndrome

chronic secondary pain

pain initially arises from an underlying disease or specific injury. pain is a SYMPTOM

nociceptive ex: tendonitis, OA, cancer pain

neuropathic ex: sciatica, carpal tunnel, denervation pain, SCI, stroke, phantom limb pain

fibromyalgia symptoms

6+ different pain sites, moderate to severe sleep problems or fatigue, tenderness, dyscognition, MSK stiffness, environmental hypersensitivity

migraine symptoms

4-72 hours,

2 of: unilateral location, pulsating quality, moderate/severe pain, aggravated/caused by avoidance of routine physical activity

1 of: nausea, vomiting, photophobia, phonophobia

typical distribution: eye/skin around, temple, teeth, scalp, neck, and inside skull

episodic tension type headache symptoms

mid to moderate pain, bilateral distribution, not aggravated by physical activity, no nausea or vomiting, photophobia OR phonophobia, 30 mins - 7 days

cervicogenic headache

unilateral, cause in upper c spine, triggered by cervical ROM restriction, superior cervical ganglion and trigeminal nucleus interaction with referred pain, potential atlas role, misalignment, suboccipital muscle tightness/pain

complex regional pain syndrome diagnostic criteria

continuous pain disproportionate to the inciting event + 1 of each:

sensory: allodynia, hyperalgesia, hypoesthesia

vasomotor: temperature or skin color abnormalities

sudomotor: edema or sweating abnormalities

motor/trophic: muscle weakness, tremor, hair/nail/skin abnormalities

complex regional pain syndrome hallmark signs

regional distribution (not dermatome/peripheral nerve)

s/s worse in unilateral distal extremity

onset is hours - weeks

lack of obvious correlation of its symptoms to original injury

acute phase: redness, increased temp, edema

chronic phase: skin cold, atrophy, autonomic deficits, hypo/hyperhydrosis

ectopic foci neuropathic pain

damage to neurons allows for AP generation without peripheral stimulation

ephaptic transmission neuropathic pain

damage to myelin allows AP in one axon to initiate an AP in a nearby axon

aka cross talk

red flags for excessive pressure/hydrocephalus/tumor

HA present at waking

pain triggered by coughing, sneezing, straining

vomiting

symptoms worsen when lying down

red flags for intracranial disease/tumor/encephalitis/meningitis

progressive worsening over days-weeks

neck stiffness, vomiting

rash, fever

hx cancer, HIV infection

red flags for hemorrhage

HA after head injury

abrupt onset

HA associated with onset of paralysis or reduced level of consciousness

3 Ds of chronic pain

distress, disuse, disability