Source:Tracey A. Milligan, MD; Tamara B. Kaplan, MD; Neurology, Brigham and Women's/Massachusetts General Hospital, Boston, Massachusetts, USA
The cranial nerve examination follows the mental status evaluation in a neurological exam. However, the examination begins with observations made upon greeting the patient. For example, weakness of the facial muscles (which are innervated by cranial nerve VII) can be readily apparent during the first encounter with the patient. Cranial nerve VII (the facial nerve) also has sensory branches, which innervate the taste buds on the anterior two-thirds of the tongue and the medial aspect of the external auditory canal. Therefore, finding ipsilateral taste dysfunction in a patient with facial weakness confirms the involvement of cranial nerve VII. In addition, knowledge of the neuroanatomy helps the clinician to localize the level of the lesion: unilateral weakness of the lower facial muscles suggests a supranuclear lesion on the opposite side, while lesions involving the nuclear or infranuclear portion of the facial nerve manifest with an ipsilateral paralysis of all the facial muscles on the involved side. Cranial nerve VIII (the acoustic nerve) has two divisions: the hearing (cochlear) division and the vestibular division, which innervates the semi…
Physical Examinations III
Source: Laboratories of Jonas T. Kaplan and Sarah I. Gimbel—University of Southern California
The autonomic nervous system (ANS) controls the activity of the body's internal organs and regulates changes in their activity depending on the current environment. The vagus nerve, which innervates many of the internal organs, is an important part of the system. When our brain senses danger, vagal tone is inhibited, leading to a set of changes in the body designed to make us more prepared to fight or flee; for example, our heart rate increases, our pupils dilate, and we breath more quickly. Conversely, when the vagal system is activated, these physiological responses are inhibited, leading to a calmer state. The vagus nerve, then, acts as a kind of "brake" on our arousal. One interesting consequence of this calmer state is that it tends to promote social interaction-when we are not tensed and afraid of our immediate environment we are instead receptive to interacting with others. Poor functioning of this regulatory mechanism, therefore, may be associated with difficulties in social behavior.
One index of autonomic regulation is heart rate variability (HRV). HRV is a measure of how much the gap between one beat and the next varies over time. High HRV means there are continual fluctuations in the …
1Department of Biology, University of Iowa, 2Molecular Targeting Technologies, Inc.
1Institute for Molecular Cardiovascular Research, RWTH Aachen University, 2Human Genetic Laboratory, University of Medicine and Pharmacy
1UPRES EA3830, Institute for Research and Innovation in Biomedicine, University of Rouen, 2Neuroscience, Karolinska Institutet, 3Otorhinolaryngology, Head and Neck Surgery Department, Rouen University Hospital, 4Otorhinolaryngology, Head and Neck Surgery Department, Amiens University Hospital