Cranial Nerve I – Olfactory Nerve

Olfactory Nerve (CN I) – entirely sensory nerve; contains axons that conduct nerve impulses for olfaction
—sense of smell
• Located on inferior surface of cribriform plate & superior nasal conchae
• Odor-sensitive olfactory receptors
Sensory Pathway of Olfactory Nerve
1) When we breathe in, we breathe in particles in the air, “odorants” that get caught in
mucous membrane—olfactory epithelium
2) Bundles of axons of olfactory receptors that come down through cribriform plate
receive odorants
3) Send messages up via olfactory nerves to the olfactory bulb (on other side of cribriform plate)
4) Olfactory bulbs continues on as olfactory tract—bundle of myelinated axons in the CNS—into
the brain itself
5) From olfactory tract  primary olfactory area of brain in temporal lobe
**Sense of smell does NOT travel through thalamus—major relay station for everything else**
Clinical Connection: Anosmia
Anosmia – loss of sense of smell
• May be caused by infections of nasal mucosa, head injuries in which cribriform plate of ethmoid
bone is fractured, lesions along olfactory pathway or in brain, meningitis, smoking, or cocaine
use
• Test: blinded odor test
• Loss of sense of smell also early indicator of Alzheimer’s disease

Cranial Nerve II – Optic Nerve

Optic Nerve (CN II) – entirely sensory nerve; contains axons that conduct nerve impulses for vision—
sense of sight
• Technically a tract of brain & not a nerve
Sensory Pathway of Optic Nerve
1) Light enters pupil & hits rods & cones (in retina)  initiate visual signals
2) Information is relayed to bipolar cells
3) Which transmit signals to ganglion cells
4) Axons of all ganglion cells in retina of each eye join to form optic nerve (exits back of eye via
optic foramen)
5) 2 Optic nerves (from both eyes) crisscross & merge to form optic chiasm

- Within chiasm, axons from medial half of eye cross to opposite side
6) Regrouped axons (some from each eye) form optic tracts
7) Sensory information relays through thalamus
8) Primary visual area in occipital lobe
Clinical Connection: Anopia
Anopia – blindness due to defect in or loss of one or both eyes
• May be caused by fractures in orbit (bone), brain lesions, damage along visual pathway,
diseases of nervous system (e.g. MS), pituitary gland tumors, cerebral aneurysms
• May result in defects in visual field & loss of visual acuity
• Test: Snellen eye chart, Confrontation test (looks at whole visual field)
Diplopia – double vision

Cranial Nerve III – Oculomotor (III) Nerve

**Oculomotor, trochlear & abducens nerves are motor cranial nerves that control muscles that move
eyeballs**
Oculomotor Nerve (CN III) – entirely motor nerve; contains motor axons responsible for movement of
eyeball, adjust lens & constriction of pupil (extrinsic & intrinsic eye muscles)
• Oculomotor (III) nerve has widest distribution among extrinsic eye muscles
• Because it’s a motor pathway (not sensory), pathway is flip & thus originating in brain
o Motor nucleus located in anterior part of brain
• Branches into superior & inferior branches
o Superior branch  superior rectus (sits atop eye to lift it up) & levator palpebrae (elevates
eye lid) muscles
 o Inferior branch  medial rectus, inferior rectus, inferior oblique & intrinsic eye muscles
Clinical Connection: Dysfunction of Oculomotor Nerve
• Strabismus – both eyes do not fix on same eye lid  one or both eyes may turn inward/outward
• Ptosis – drooping of upper eyelid (b/c levator palpebrae muscle doesn’t work
• Also includes dilation of pupil (normal reaction is a constricted pupil in reaction to light),
movement of eyeball downward & outward on damaged side, loss of accommodation for
near vision
• Diplopia – double vision
• Caused by trauma to skull/brain, compression d/t aneurysm, lesions of superior orbital fissure
• Test: pupil reflex, H pattern, accommodation

Cranial Nerve IV – Trochlear Nerve

Trochlear Nerve (CN IV) - entirely motor nerve; contains motor axons responsible for movement of eye
• Smallest of the 12 cranial nerves
• Only cranial nerve that arises from posterior aspect of brainstem
• Motor nucleus located in midbrain
• Contributes to movement of eye  innervates superior oblique muscle (extrinsic eye muscle)
• Damage to trochlear nerve can also result in strabismus & diplopia

Cranial Nerve V – Trigeminal Nerve

Trigeminal (CN V) – mixed (both sensory & motor) cranial nerve; largest of cranial nerves
• Responsible for sensations from scalp, face & oral cavity; chewing (muscles of
mastication); controls inner ear muscle
• Emerges from 2 roots on anterolateral pons
• Has 3 branches: (1) ophthalmic, (2) maxillary, (3) mandibular
(1) Ophthalmic nerve – smallest branch (sensory)
(2) Maxillary nerve – intermediate sized branch (sensory)
(3) Mandibular nerve – largest branch (sensory & motor)
Clinical Connection: Dysfunction of Cranial Nerve V
Trigeminal neuralgia – neuralgia (pain) relayed via one of more branches of trigeminal (V) nerve
• Caused by inflammation or lesions
• Shar cutting or tearing pain that lasts few second to minute caused by anything pressing
on trigeminal nerve or its branches
• Occurs almost exclusively in those over 60 years of age
• Can be first sign of disease (e.g. MS, diabetes) or lack of vitamin B12 (causes nerve damage)
Paralysis of muscle of mastication – Injury to mandibular nerve may cause chewing muscle
paralysis & loss of sensations (touch, temperature, proprioception) in lower part of face
• Sensory test – test for sensation on forehead, cheek, jaw (like dermatomes)
• Motor test – test whether or not they can clench teeth

Cranial Nerve VI – Abducens Nerve

Abducens Nerve (CN VI) – entirely motor nerve; contains motor axons responsible for eye movement
• Somatic motor axons extend from nucleus  innervates lateral rectus muscle (extrinsic eye
muscle)
o Causes abduction (lateral rotation) of eyeball
• Motor nucleus located in pons
• Damage to abducens (VI) nerve  affected eyeball cannot move laterally beyond midpoint &
eyeball usually directed medially  strabismus or diplopia

Cranial Nerve VII – Facial Nerve

Facial Nerve (CN VII) – mixed (sensory & motor) nerve
• Sensory axons pass to geniculate ganglion—cluster of cell bodies of sensory neurons of
facial nerve within temporal bone & end in pons
• Sensory axons responsible for taste from anterior 2/3 of tongue, sensations from skin in
external ear canal, scalp & face
• Branchial motor neurons: control of muscles of facial expression & middle ear, scalp,
neck muscles
• Autonomic motor neurons: secretion of tears & saliva
 Clinical Connection: Bell’s Palsy
Bell’s palsy – paralysis of the facial muscles
• Causes loss of taste, decreased salivation, loss of ability to close eyes (even during sleep)
• Caused by damage to facial (VII) nerve d/t conditions such as viral infection (e.g. shingles)
or bacterial infections (e.g. Lyme disease)
o Nerve can be damaged by trauma to skull or brain, tumors, stroke
• Test: smile, close eyes, taste

Cranial Nerve VIII – Vestibulocochlear Nerve

Vestibulocochlear Nerve (CN VIII) – sensory cranial nerve; formerly known as acoustic or auditory nerve
• Has 2 branches: (1) vestibular branch & (2) cochlear branch
(1) Vestibular branch – carries impulses for equilibrium

(2) Cochlear branch – carries impulses for hearing

Clinical Connection: Dysfunction of Cranial Nerve VIII

Vestibulocochlear nerve may be injured as result of trauma, lesions or middle ear infections
• Vertigo – subjective feeling that one’s own body or environment is rotating
• Ataxia – muscular incoordination
• Nystagmus – involuntary rapid movement of eyeball
o Vertigo, Ataxia & Nystagmus—caused by injury to vestibular branch of
vestibulocochlear nerve (CN VIII)
• Tinnitus – ringing in ears
o Caused by injury to cochlear branch
o Or deafness
• Test: hearing test or balance test

Cranial Nerve IX – Glossopharyngeal Nerve

Glossopharyngeal Nerve (CN IX) – mixed (sensory & motor) nerve; responsible for taste, assists in
swallowing, secretion of saliva, sensation from skin of external ear/upper pharynx, monitors BP, O2 & CO2
levels in blood
• Sensory axons of glossopharyngeal nerve arises from:
(1) Taste buds on posterior 1/3 of tongue
(2) Proprioceptors from swallowing muscles
(3) Baroreceptors (pressure-monitoring receptors) in carotid sinus  monitor blood pressure
(4) Chemoreceptors (receptors that monitor blood levels of oxygen & carbon dioxide)
in carotid bodies
(5) External ears
• Motor axons arise from medulla, includes:
o Stylopharyngeus (swallowing) muscle
o Parotid gland  release of saliva
Clinical Connection: Dysfunction of Cranial Nerve IX
Glossopharyngeal nerve may be injured as result of trauma or lesions
• Dysphagia – difficulty swallowing
• Aptyalia – reduced secretion of saliva; loss of sensation in throat
• Ageusia – loss of taste sensation
• Test: taste sensation (in posterior 1/3 of tongue), gag reflex
o Pharyngeal (gag) reflex – rapid & intense contraction of pharyngeal muscles
o Except for normal swallowing, pharyngeal reflex designed to prevent choking by
not allowing objects to enter throat
o
Cranial Nerve X – Vagus Nerve
Vagus Nerve (CN X) – mixed (sensory & motor) nerve; responsible for swallowing, vocalization &
coughing; motility & secretion of GI organs; constriction of respiratory passageways; decreases HR
• Widely distributed in head, neck, thorax & abdomen
• Sensory neurons deal with variety of sensations (e.g. proprioception, stretching)
 • Parasympathetic axons  gland of GI tract & smooth muscle of respiratory passageways &
digestive organs
• Motor neurons arise from medulla  muscle of pharynx, larynx & soft palate involved in
swallowing & vocalization
Clinical Connection: Dysfunction of Cranial Nerve X
Injury to vagus nerve d/t trauma or lesions, can cause:
• Vagal neuropathy/paralysis – interruptions of sensations from many organs in thoracic
& abdominal cavities
• Dysphagia – difficulty in swallowing
• Tachycardia – increased heart rate
• Tests: say “ahhh” or cannot pronounce words “egg” or “rub”
Cranial Nerve XI – Accessory Nerve
Accessory Nerve (CN XI) – branchial motor cranial nerve; responsible for movement of head & pectoral
girdle
• Motor neurons innervates sternocleidomastoid muscle & trapezius muscles to coordinate
head movements
• Motor axons in anterior gray horn in spinal cord
• Divided into (1) cranial accessory nerve & (2) spinal accessory nerve  exit spinal cord & join
together into 1 nerve
Clinical Connection: Dysfunction of Cranial Nerve XI
If accessory (XI) nerve is damaged d/t trauma, lesions or stroke
• Paralysis of sternocleidomastoid & trapezius muscles – person unable to raise shoulders &
has difficult in turning head
• Test: ask to shrug shoulders or ask to turn head
Cranial Nerve XII – Hypoglossal Nerve
Hypoglossal Nerve – motor cranial nerve; important for speech, manipulation of food & swallowing
• Motor axon nucleus in medulla oblongata
• Innervates muscles of tongue  speech & swallowing
Clinical Connection: Dysfunction of Cranial Nerve XII
Injury to hypoglossal (XII) nerve can be d/t trauma, lesions, stroke, ALS (Lou Gehrig’s), infections in
brainstem
• Difficulty in chewing
• Dysarthria – difficulty in speaking
• Dysphagia – difficulty in swallowing
• When protruded, tongue curls toward affected side  affected side atrophies
• Test: ask to protrude tongue & move it around