CN IX, X, XI, XII and palsies

Usually clinically assessed together
IX - Glossopharyngeal nerve
1. Anatomy
  1. It divides into two ganglia
    1. Superior glossopharyngeal ganglion
    2. Petrous or inferior glossopharyngeal ganglion
  2. Mixed nerve
    1. Parasympathetic fibers
    2. Motor fibers
      1. from nucleus ambiguous in reticular formation to stylopharyngeus
    3. Sensory fibers
      1. from posterior 1/3 of tongue to nucleus solitarius
      2. from upper pharynx to caudal spinal trigeminal nucleus
      3. from carotid body baroreceptors and carotid sinus chemoreceptors to nucleus solitarius
  3. Fibers go between internal jugular vein and carotid
    1. Vascular pathologies may impact
2. Signs and symptoms
  1. Pharyngeal reflex
3. Diseases
  1. Peripheral neuritis
  2. Tumors of posterior fossa
  3. Jugular vein thrombosis
  4. Basilar skull fractures
  5. Meningitis
  6. Internal carotid artery dissection
  7. Glossopharyngeal neuralgia
  8. Progressive bulbar paralysis
  9. Syringobulbia
X - Vagus nerve
1. Anatomy
  1. Parasympathetic supply to several viscera
  2. Branches
    1. Auricular branch
    2. Meningeal branch
    3. Pharyngeal branch
    4. Laryngeal branch
2. Signs and symptoms
  1. Changes in vocalization, swallowing and palatal movements
    1. Patients cough in a weak way
  2. Autonomic dysfunctions
3. Diseases
  1. 3 major syndromes
    1. Vagus nerve irritation
    2. Vasovagal attack
    3. Superior laryngeal nerve neuralgia
  2. Bilateral palsy is incompatible with life
XI - Accessory nerve
1. Anatomy
  1. Pure motor nerve
  2. 2 origins
    1. Nucleus ambiguus
    2. Accessory nucleus
2. Signs and symptoms
  1. Drooping shoulder
  2. Winged scapula
  3. Weakness of forward elevation of the scapula
3. Diseases
  1. Syringobulbia
  2. Syringomyelia
  3. Herpes Zoster infections
  4. Tumors
  5. Usually lesions are unilateral
XII - Hypoglossal nerve
1. Anatomy
  1. Innervation to
    1. Styloglossus
    2. Hypoglossus
    3. Genioglossus
  2. Nucleus is beneath the floor of the IV ventricle
  3. Proximity to both internal carotid artery and jugular vein
2. Signs and symptoms
  1. Dysphagia
  2. Unilateral atrophy of the tongue
3. Diseases
  1. Lesions in medulla
  2. Amyotrophic lateral sclerosis
  3. Compressive/expanding lesions
    1. Tumors
    2. Aneurysms
    3. Jugular vein occlusion
    4. Supranuclear lesions
Palsies and other syndromes
1. Bulbar palsy
  1. Causes
    1. Lesions of medullary cranial nerve nuclei
    2. Lesions of cranial nerves themselves
    3. Neuromuscular junction lesions
    4. Muscles diseases
2. Pseudobulbar palsy
  1. There may be complete anarthria
  2. Usually bilateral involvement of descending corticobulbar and/or corticopontine pathways
3. Brainstem syndromes
  1. Pontine syndromes
    1. Foville syndrome
  2. Medullary syndromes
    1. Wallemberg syndrome (lateral medullary syndrome)
      1. Alternating syndrome
        Ipsilateral to lesion
        Contralateral to lesion
    2. Dejerine syndrome (medial medullary syndrome)
      1. Alternating syndrome
        Ipsilateral to lesion
        Contralateral to lesion
  3. Midbrain syndromes
    1. Weber syndrome
    2. Benedikt (paramedian midbrain syndrome)
    3. Parinaud (dorsal midbrain syndrome)

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CN IX, X, XI, XII and palsies

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