猜題技巧:選擇題答案通常都是CN6,其次是CN4,再其次是CN3
CN2 Optic nerve
視為forebrain tract,不是true nerve
當optic nerve有問題而oculomotor nerve intact時,患眼有RAPD。
Optic nerve創傷的種類及原因:
traumatic optic neuropathy → blunt forehead trauma
optic nerve transection → 眼窩穿刺傷(Stabbing injury)
optic nerve avulsion → 直接壓迫globe
traumatic ant. ischemic optic neuropathy → short post. ciliary 斷掉artery
CN3 Oculomotor nerve
* CNⅢ中的pupil fiber位於內側,對壓力敏感,當temporal lobe的uncus被壓迫時,會造成pupil dilation
* 3rd palsy要考慮在ICA及 post. communicating a. 間是否有aneurysm
* CNⅢ與sympathetic fiber入眼途徑「沒有」相關。
=> 與CN5,CN6, carotid artery有關。
CN4 Trochlear nerve
* 唯一不通過muscle cone直接支配EOM
* CN Ⅳ 比其它cranial nerve更易受到trauma
* 由中腦發出的CN中,只有Trochlear nerve從doral面發出(轉軸抹個油就從背後溜走,其它3,5,6都乖乖從中腦媽媽的肚子生出來)
CN5
* Marcus Gunn Jaw winking: trigemino-oculomotor sikynesis (CN5 motor與CN3錯誤連結)
CN6
* 在cavernous內則是第六對易受傷
* Ocular neuromyotonia以CN6最常見
* CC-fistula最易壓迫CN6 (3,4,6皆有可能,但CN6最容易中獎)
* Ocular neuromyotonia最常見於CN6
CN7 Facial nerve
* Sarcoidosis最易involve的cranial nerve
* Bilateral CNⅦ palsy見於
Mobius syndrome
Sarcoidosis
Gullen-Barve syndrome
NF-2 (bilateral acoustic neuroma)
* Facial nerve五大分枝(AAO習題):
Temporal, Zygomatic, Buccal , Marginal mandbular, Cervical (AAO)
福袋大放送:
postpartaum pituitary necrosis → pituitary gland infaction → hypopituitarion且會有CNⅡⅢⅣⅤⅥ plasy(2~6全中)
Cavernous sinus lesion會影響CN 3,4,5,6(6th nerve palsy最早發生)
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