Cranial Nerves & Functions

 

No.	Cranial Nerves	Functions
I	Olfactory Nerve	Smell
II	Optic Nerve	Vision
III	Oculomotor Nerve	Eye movement, pupil constriction
IV	Trochlear Nerve	Eye movement
V	Trigeminal Nerve	Somatosensory information (touch, pain) from the face and head, muscles for chewing.
VI	Abducens Nerve	Eye movement
VII	Facial Nerve	Taste (anterior 2/3 of tongue), somatosensory information from ear, controls muscles used in facial expression.
VIII	Vestibulocochlear Nerve	Hearing, balance
IX	Glossopharyngeal Nerve	Taste (posterior 1/3 of tongue), Somatosensory information from tongue, tonsil, pharynx, controls some muscles used in swallowing.
X	Vagus Nerve	Sensory, motor and autonomic functions of viscera (glands, digestion, heart rate)
XI	Spinal Accessory Nerve	Controls muscles used in head movement.
XII	Hypoglossal Nerve	Controls muscles of tongue

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Stoneman Syndrome

 

Stoneman syndrome or fibrodysplastic ossificans progressiva (FOP) or Munchmeyer's disease is a rare genetic disease of ectopic soft tissue calcification with hand and foot deformities leading to severe restriction of joint movements. It was first described in 1692 in a young patient who turned into wood. It may be sporadic or autosomal dominant. The disease is caused by mutation in the bone morphogenic protein (BMP) type I (Activin A receptor, type I [ACVR1]) leading to dysregulated bone formation.The incidence, as reported from Europe and United States, is around 1 in two million individuals. 

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Diffuse astrocytoma (WHO Grade II)

Patient referred due investigation for multiple sclerosis.

Age: 30 year-old

Gender: Male

Biopsy was performed: After 2 Years

MICROSCOPIC DESCRIPTION: 1-3. The sections show features of a moderately cellular astrocytic tumour. The tumour cells have mildly enlarged round and hyperchromatic nuclei with short cytoplasmic processes in a fibrillary and focally microcystic background (most likely protoplasmic astrocytes). Occasional tumour cells extend into the cerebral cortex. Mitoses are inconspicuous. No endothelial cell hyperplasia or necrosis is present. There is no oligodendroglial component. The features are those of diffuse astrocytoma. The tumour cells are IDH-1, p53 and p16 positive. The topoisomerase index is 1-2%. MGMT immunostain is negative.

DIAGNOSIS: 1-3. Brain tissue: Diffuse astrocytoma (WHO Grade II).

Left frontal low grade glioma

Discussion:

This case demonstrated the indolent progression of a left lobe low-grade tumour that was histologically proven to be a diffuse astrocytoma (WHO grade II). It is important to emphasise that no enhancement is often the rule for these tumours, but small ill-defined areas of enhancement are not rare; however, when enhancement is seen it should be considered as a warning sign for progression to a higher grade. 

This tumour expressed: IDH1 positive = mutation present = better prognosis

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Haglund syndrome

 

Haglund syndrome: insertional achilles tendinopathy and retrocalcaneal bursitis

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AORTIC RUPTURE

 

AORTIC RUPTURE

Characteristics

● Eighty to ninety per cent of patients die before reaching hospital.

● Associated with deceleration injuries, such as a fall from a height or in road traffic accidents over 40 mph.

● The aorta usually ruptures at the aortic isthmus (in 88–95%), just distal to the origin of the left subclavian artery.

Clinical features

● An aortic rupture should be suspected from the mechanism of injury.

● Chest or inter-scapular pain will be present.

● Differential brachial blood pressures or different brachial and femoral pulse volumes are suggestive.

Radiological features

Chest radiograph

● Widened mediastinum (8 cm on a supine AP Chest radiograph (CXR)).

● Blurred aortic outline with loss of aortic knuckle.

● Left apical pleural cap.

● Left sided haemothorax.

● Depressed left/raised right main stem bronchus.

● Tracheal displacement to the right.

● Oesophageal NG tube displacement to the right.

CT Thorax

● Vessel wall disruption or extra-luminal blood seen in contiguity with the aorta is indicative of rupture.

Management

● Judicious fluid replacement.

● Adequate analgesia.

● Avoid hypertension (excess fluid replacement/pain, etc.).

● Urgent surgical involvement with a view to thoracotomy and repair. 

M.Vinothraj

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