Trigeminal nerve cranial nerve

trigeminal neuralgia, cranial nerve assessment

1. Trigeminal nerve Submitted to Mr Anand L Associate professor College of nursing AIIMS Bhubaneswar Evaluator: Mr L Anand Presenter: Shruti Shirke [ Asso professor, CON AIIMS BBSR] M.Sc Neuroscience Nursing

2. Introduction Largest cranial nerve Mixed nerve Described by F allopius and again by Meckel in 1748 Name given by W inslow It is the nerve of first brachial arch

3. Branches 3 branches Ophthalmic – sensory Maxillary – sensory Mandibular - mixed

4. Origin

5. Ophthalmic nerve divisions Frontal Nasociliary Lacrimal

6. Maxillary nerve division In middle cranial fossa In pterygopalatine fossa In infraorbital canal On face

7. Mandibular nerve division Trunk Anterior division Posterior division

8. Examination

9. Sensory Ask the patient to close his eyes and say ‘yes’ each time he feels you lightly touch them using the edge of a tissue. Do this in the area of V1, V2, V3 Superficial pain – dull and sharp Temperature sensation Use an orange stick to test touch on the anterior 2/3 rd of the tongue. Ask the patient to close his eyes and indicate when they feel you touch the tongue

10. Motor Inspect for the wasting of muscles of mastication Ask the patient to clench his teeth: feel the masseter , estimating their bulk Ask the patient to open his jaw against your hand, which is providing resistance and note any deviation

11. R eflexes Corneal reflex

12. Jaw jerk

13. Lesions of 5 th cranial nerve Nuclear lesion Causes Tumor Demyelination Vascular lesion Syringomyelia (onion skin pattern)

14. Cont. Dorsal mid pontine lesion: I psilateral atrophy Weakness of muscles Ipsilateral facial sensory loss Contralateral hemiplegia and hemianaesthesia

15. Ipsilateral atrophy

16. Lesion of lower end of medulla and upper cervical cord Ipsilateral loss of pain and temperature over the face and contralateral hemianaesthesia and hemiplegia

17. Lateral medullary syndrome – occlusion of the posterior inferior cerebellar artery Ipsilateral loss of pain and temperature over the face and contralateral hemianaesthesia Ipsilateral horner’s syndrome ( occulo sympathetic palsy) Ipsilateral cerebellar signs Vertigo, nausea and vomiting

18. Horner’s syndrome Smaller pupil D rooping eye lid Little or no sweating on the affected side

19. Preganglionic trigeminal nerve lesion Causes: Tumors Meningeal irritation Usually accompanied with 7,8&9

20. Gasserian ganglion lesion Facial pain Causes: Tumor Abscess Herpes zoster – herpes zoster ophthalmicus Raeder’s paratrigeminal syndrome: lesion close to gasserian ganglion

21. Post ganglionic nerve lesion Causes: Cavernous sinus lesion (3,4,6, 5-ophthalmic and maxillary) Gradenigo’s syndrome – ipsilateral Vth, VIth nerve palsy, Retro orbital pain Superior orbital fissure syndrome(3,4,6, ophthalmic)

22. Queries ?

23. Thank you