Cranial Verve

7/25/2019 Cranial Verve

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Review of

Clinical Neuroanatomy

& Neurologic Examination(6)

Base onM. Saiful slam! Neuroanatomi "ungsional

#eter$uss! %oical $iagnosis in Neurology

'axman! Clinical Neuroanatomy

"uller! Neurology Examination Mae Easy


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Saraf ranial

*a +, asang

- +, aa i /rainstem

0ai merua1an etun0u1 1uat aanya lesi

i /rainstem /ila itemu1an lesi saraf

1ranial


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%oografi

mesensefalo

n! -23

ons! n4 5

meula

o/longata!

n 2+,


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n 7lfactorius

Merua1an ton0olan ota1 /u1an saraf yang

se/enarnya

7lfactory at8way7lfactory nervescri/riform lateolfactory

/ul/olfactory tractanterior erforate su/stance

/erca/ang ua 1e

lateral olfactory stria ( ara8iocamal gyrus) an meial olfactory stria ( lim/ic system)


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n


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n 9 inferior view


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n 9 7ticus

:isual at8wayRetinal ganglion cells otic is1otic

nerveor/itotic canalotic c8iasmotic tractlateral geniculate /oy otic

raiationocciital lo/e an suerior

colliculi (retectal area)


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n


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n

*a , 1omonenmotori1 (ocular movement)

tia otot unya nu1leus seniri2seniri

arasimatis (miosis9 a1omoasi lensa) nucleus einger west8al

gangglion ciliaris


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n


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n 7culomotor at8way

Mi/rainintereuncular fossa /etween

suerior cere/ellar artery an osterior cere/ral

arterytentorial ege cavernous sinus meial or/ital fissure oculomotor nerve9

suerior ivision (levator ale/rae an suerior

rectus muscles) an inferior ivision (meial an

inferior rectus an inferior o/li;ue muscles) or

arasymat8etic fi/ers ciliary ganglion


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n : %roc8learis

Mi/rainorsal /rainstem /elow t8e

inferior colliculiaroun t8e cere/ral

eunclelateral wall of t8e cavernoussinusor/ital fissure suerior o/li;ue

muscle


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n : */usens

#osterior margin of ons u t8e clivus

t8roug8 t8e ura mater etrous aex

lateral to internal caroti artery in t8ecavernous sinus or/ital fissure

lateral rectus muscle


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%8e


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=a>eCenter


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Reflek Pupil

retinan.

oticus tract

c8iasma

otic tractretectal nuclei

nucl einger

west8alggl

ciliaris m.sinc8ter

uil


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?alur refle1 1onvergensi an

a1omoasi n oticusc8iasmaotic tract

geniculatum lateral raiatio otica

area +@2+52+retectal areanu1leusmotori1 n (rectus meial) A nu1leus

einger west8al rectus meial 7$S

an otot siliaris 7$S


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n :. %rigeminus

%eriri ari , 1omonensensoris (utama)

e1sterosetif! wa0a89 mu1osa 8iung roiosetif! gigi2geligi an otot2otot engunya8

motoris

otot2otot engunya8


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Sensoris #art of n :


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n : 7nion $istri/ution


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Sensoris n :

wa0a8

mu1osa mulut9 8iung9 sinus aranasal

uramater

1ornea

se/agian M*E an mem/rana timani


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Motori1

m. maseter

m. temoralis

m. terygoieus internus

m. terygoieus externus


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Refle1

Refle1 1ornea afferent n :+rimary sensory efferent n :

Refle1 /ersin afferent n :+rimary sensory efferent N :9 9

Refle1 mani/ula afferent n :-nucleus mesensefali1nucleus

motori1m. maseter


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N : ("acialis)

omonenmotori1 (BE)

otot2otot wa0a8 A staeius

sensori1 (:*) ,- anterior lia8

telinga /agian /ela1ang

otonom (arasimatis) (:E) lacrimal9 su/mani/ular9 su/lingual


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Nu1leus N :

$i ons osterolateral

Dntu1 gustatory /ersama2sama engan n

nucleus tractus olivarius n.intermeius


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#er0alanan N :

#ons (cere/elloontine angle) a/ove t8eoliveinternal acoustic meatus

etrous yrami(canal of facialnerve)geniculum of facial nervenervus intermeiusgreater etrosal nervegustatory fi/ers) meial wall of t8e

tymanic cavitystylomastoi foramenmuscles of facial exression


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er0alanan nervus :

n etrosus1e lacrimal glan

=angglion geniculatum

meatus acusticus internus

n :

ca/ang 1e otot staeius

c8ora tymani1e ,- lia8 ean

gl. su/mani/ula an lingualis

otot2otot wa0a8

n :

n. intermeius


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Nu1leus motori1 n :

*a ua suerior an inferior

suerior (inervasi ari 1orte1s /i8emisfer)otot frontalis

inferior (inervasi ari satu 8emisfer)otot2otot wa0a8 i /awa8 alis


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n : central vs erifer

Central #erifer


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f erifer9 '8ere is t8e level

Bul/areri8eral tie aresis of n : isilateral lesion

acomany wit8! aresis of 1ontralateral extremities (8emiaresis

alternans)

aresis of n suranuclear

Cere/elloontine angle /efore

geniculate gangglionaccomany wit8 n : istru/ance


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=eniculate eri8eral tie aresis of N :9 N : not affecte

*fter staeial nerve 8yeracusis

secretion of lacrimal not affecte

*fter c8ora timani ageusia

secretion of maniu/lar an su/lingual not affecte


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*fter foramen stylomastoieusaresis of facial muscle

8yoest8esia osterior art of t8e external ear lacrimal9 su/lingual9 su/mani/ular reserve

8ieracusis

ageusia of ,- ortion of tongue 2


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N : (:esti/ulococ8lear)

*a ua inti inti vesti/ularis (eseim/angan)

inti coc8learis (enengaran)omonen 1euanya aala8 SS (Secial

Sensory)


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#er0alanan N : (:esti/ular #art)

:esti/ular recetor

:esti/ular nuclei

suerior Meial lateral nferior

"locconoular

lo/e of Cere/ellum=a>e Center

:esti/ulosinal

%ract


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SueriorFateral

Meial

nferior

:esti/ular at8way


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Coc8lear at8way

$ari coc8leaggl siralis n.coc8learis

masu1 1e nu1leus orsal an ventral

nucleus orsal se/agian langsung nai1 1ecoliculus inferior melalui lemniscus

lateralis9 se/agian menyilang 1e

1ontralateral /aru nai1 1e 1oli1ulus inferiormelalui lemniscus lateral


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Coc8lear at8way

nu1leus ventral se/agian 1ecil langsung

1e atas lewat lemniscus lateral 1e

1oli1ulus inferior9 se/agian /esarmenyilang melalui trae>oi /oy

nu1leus ventral 1ontralateral /aru nai1

melalui lemniscus lateral 1e 1oli1ulusinferior


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Coc8lear at8way

$ari inti lemniscus lateral se/agian /esar

lgsung 1e 1oli1ulus inferior isilateral

se/agian 1ecil menyilang 1e 1oli1ulusinferior 1ontra lateral

$ari 1oli1ulus inferior meial geniculate

t8alamus1orte1s auitori1 area ,,Broamann


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Coliculus inferior

Meial geniculate

lemniscuslateral

$orsal nuclei

ventral

nucl%rae>oi

/oy

to

t8alamus


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Clinical Relevance of n :

Coc8lear tuli a1i/at lesi sentral 0arang satu sisi 1arena

saling silang 0alurnyaFesi sering erifer 1ena n : a1i/at Geres

>ooster oticus (Ramsay Gunt synrome) atautumor i C#* atau 1erusa1an itelinga tenga8

a1i/at trauma atau otitis meiaBisa 0uga a1i/at s1lerosis saat masu1 i

meatus acusticus internus a1i/at meningitis


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n =lossofaringeus

omonennya

motori1 (BE)

m. stylofaringeus sensori1 (S*)

+- osterior lia89 tu/a eustac8ii9 cavum timani

otonom (:E) glanula arotis


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Nu1leus n

Bersama engan nu1leus 9 cranial

nucl am/iguus

Nucl tract olivarius sensasi +-osterior lia8


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#er0alanan n

Meulla0ugular foramen /etween caroti

artery an internal 0ugular vein root of t8e

tongue9 mu1osa faring9 tonsil9 +- osterior lia8mem/eri1an ca/ang2ca/ang tymani! cavum timani an tu/a

stylofaring! otot stylofaringeus

lingual! +- osterior lia8 (taste caroti sinus!


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Clinical Relevance of N alsy

Sering 1arena trauma /asis cranii

gangguan sensoris +- osterior lia8

Refle1 munta8 menurun

isfagia

Salivasi menurun ari arotis


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n ! :agus

omonen

motori1 (BE)! alatum mole9 faring

otonom (:E)! otonomic system of t8oracic9 a/organ

Sensoris e1sterosetif (S*)! meatus acusticus ext

interosetif (:*)! sens from t8oracic9 a/ organ


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Nu1leus n. vagus

N. am/iguusmotori1

orsal nuclei of vagusotonom

inferior salivatory nucleusotonom


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=angglion ari n vagus

*a , i foramen 0ugularesuerior

S* ari vagus an glossofaringeus9 selan0utnya 1enucl tract sinalis n : t8alamus st

inferior :* vagus ari organ2organ t8ora1s an a/omen

nucl tractus solitariust8alamus st


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#er0alanan n :agus

Meula o/longata foramen 0ugulare

iantar a. carotisvena 0ugularis t8ora1s

vagus 1anan iean oesofagus vagus 1iri i /ela1angca/ang ca/ng

1e 0antung9 /ronc8ii 8iatus oesofagus

. a/omen 1e lexus celiac9 renal9gaster etc


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#er0alanan vagus

uramater u fossa osterior meatus acusticus e1sternus

faring suerior laring recurrent laringeus cariac /ranc8 /ronc8ial /ranc8 a/ominal organ /ranc8


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n. vagus


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n . *ccecorius

omonen!

Murni motori1 untu1 otot2otot le8er

sternocleiomastoieus

trae>ius


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n

*a , /agianars cranialis

nucl. am/iguus memersarafi otot intrinsi1 laring

ars sinalis verte/ra C+24

memersarafi sternocleio an trae>ius


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#er0alanan n

$ari anterior 8orn C+24 nai1 1e atas

/erga/ung engan ars cranialis9 setela8

1eluar ari foramen 0ugulare terisa8 ,ramus internus /er0alan /ersama n.vagus

an e1sternus memersarafi

sternocleiomastoieus an trae>ius

nucl am/iguus


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nucl am/iguus

foramen 0ugulare

n. vagus

n ars cranial

n ars sinaln


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Clinical Relevance

arese n sering iatrogeni19 sering 1arena/ea8 le8er

ter0ai 1elumu8an sternocleiomastoieus antrae>ius H atas 1arena H /awa8 aat inervasiari C,23

/ila 1erusa1an n setela8 sternocleio ma1a

1elumu8an e1slusif 8anya i trae>ius 1elumu8an suranu1lear 0arang 1arenamenaat inervasi /i8emisfer


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Clinical Relevance

Bila yang ter1ena n 1iri ma1a lumu8

sterno1leio 1iri9 #x menole8 1e 1anan

/ila 1ena 1euanya misal seuo/ul/arle8er tia1 /isa tega1


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n Gioglossus

Murni motori1

nervasi ari tra1tur 1orti1o/ul/ar

1ontralateral


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#er0alanan n

nucl n canalis 8ioglosus

foramen 8yoglosus otot2otot lia8


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n


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Clinical Relevance

inervasi suranu1lear tut ari 8emisfer

1ontralateral 0ai /ila aa lesi

suranu1lear ter0ai eviasi lia8 saat/ergera1

/ila lesi /ul/ar atau erifer iem9 teraat

fasi1ulasi9 atroi lia8


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N alsy

elumu8an

genioglosus

1anan9 lia8eviasi 1e 1anan


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Cranial Verve

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