nervios craneales parte ii (pares vii-xii)
TRANSCRIPT
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NERVIOS CRANEALES PARTE II (Pares VII-XII)
Humberto Cabañas Vela R4PED
Neurología Pediátrica
8-Junio-2012
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VII. FacialM = Expresión facialS = 2/3 ant. LenguaA = secretomotor gls. Submandibulares, sublingulales y lacrimales
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Snell, 2001
(hipotálamo) + vía sens V1 p/lagrimal y tracto
solitario lingual p/gusto
VPM
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Motoneurona superior
Motoneuronainferior
Snell, 2001
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Snell, 2001
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Snell, 2001
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Snell, 2001
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LESIONES VII VI (paresia RE) + VII = Puente
VIII + VII = CAI
Sonofobia = N. para músculo del estribo
Pérdida gusto 2/3 ant = Proximal a origen de cuerda del tímpano
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LESIONES VII Masa parotídea + VII = PB CA de parótida
Laceraciones profundas del rostro = Ramas
Parálisis orbicular exclusiva = Motoneurona superior
Hemiplejia facial = Motoneurona inferior (ptosis palpebral y comisural bucal, epífora y sialorrea ipsilateral). Conserva expresión facial mimética (emocional). Parálisis de Bell (del conducto facial).
Hemiplejia mimética = lesión de tracto reticular del facial
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VIII. VestibulococlearS1 (utrículo,, sáculo)= Equilibrio estáticoS2 (canales semicirculares) = Equilibrio dinámicoS3 (cóclea) = Sonido
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POSICIÓN MOVIMIENTO
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Snell, 2001
VP
Cápsu
la
inte
rna
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Cross-section of the human ear (reprinted from Brodel, 1946) Møller, 2006
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Møller, 2006
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Møller, 2006
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Møller, 2006
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Møller, 2006
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Snell, 2001
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Møller, 2006
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Snell, 2001
Formación reticular
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Vía ascendente: organización tonotópica en Corti Núcleos cocleares V
y D Lemnisco Colículo Áreas 41 y 42
Vía descendente• Retroalimentación• Inhibición• Discriminación
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4142: Reconoc.
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LESIONES VIII Vestibular Nistagmo = lesión de vía VIII III, IV, VI (semicircular)
osilación rítmica incontrolable (↔)
Componente rápido se aleja de la lesión.
Pruebas calóricas = integridad vestibular
Elevación y descenso de T°C en CAE corrientes de conveción endolinfática (*CSL)
Estimula VII vestibular nistagmo
Vértigo = Lesión laberíntica (Menière), lesión VIII, lesiones de núcleos vestibulares, lesión cerebelosa. Esclerosis mútliples, tumores e infarto/isquemia del tallo (bulbopontino).
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LESIONES VIII Coclear Acúfenos:
OI = Menière, laberintitis aguda, trauma
Nervio coclear = neurinoma del acústico, trauma
SNC = tumor, esclerosis mútliple
Sordera = Temporal bilateral
Hipoacusia
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Smith RJH, 2012
1. Voz susurrada2. Diapasones:
256 Hz (HA 10-15 dB)
512 Hz (HA 20-30 dB)
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Mixed
Giford AAP, 2009 / Snell, 2001
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IX. GlosofaríngeoM = M. estilofaríngeoS = Sensibilidad general y gusto 1/3 post. lenguaA = secretomotor a Gl. parótida
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Snell, 2001Ambiguo (FR)
Olfato
Gusto
Tacto
Seno carotídeo
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Snell, 2001
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LESIONES IX Lesiones aisladas raras
Comúnmente IX + X
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X. Vago (neumogástrico)M = M. Constrictor de la faringe, Mm. Intrínsecos de la laringeS = IXA = Af. Del seno carotídeo, motor a M. liso bronquial, cardíaco, esofágico, gástrico, intestinal y cólico hasta tercio distal de colon transverso
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Snell, 2001
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Snell, 2001
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EXPLORACIÓN REFLEJO FARÍNGEO (NAUSEOSO) IX IX, X
Simetría uvular
Arcadas (presencia y simetría)
PALADAR BLANDO (“Ah”)
Elevación
Retracción uvular simétrica
LARINGE
Afonía, disfonía = parálisis
Laringoscopia (movimientos de las cuerdas)
LESIONES SUELEN SER DE FOSA POSTERIOR (IX + X + XI + XII)
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XI. Accesorio (espinal)M1 = Raíz craneal + X: M. paladar blando, faringe y laringeM2 = Raíz espinal: Mm. ECM y trapecio
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Snell, 2001
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Snell, 2001
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ACI
ACC
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LLESIONES XI Atrofia de ECM + debilidad para rotación cefálica
contralateral
Atrofia de trapecio + ptosis del hombro ipsilateral + dificultad para levantar el brazo por arriba del plano horizontal.
TUMORES, HERIDAS EN CUELLO (cortantes o arma de fuego)
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XII. HipoglosoM = Mm. Intrínsecos de lengua, estilogloso, hiogloso, geniogloso
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Snell, 2001
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Snell, 2001
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LESIONES XII Lengua desviada a parálisis (atrofia +
fasciculaciones) = motoneurona inferior
Lengua desviada al lado opuesto a parálisis = motoneurona superior (M. geniogloso)
TUMOR, ENFERMEDAD DESMIELINIZANTES, SIRINGOMIELIA, EVC, HERIDA EN CUELLO
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BIBLIOGRAFÍA Núcleos de los nervios craneanos y sus conexiones
centrales y distribución. En: Snell RS. Neuroanatomía clínica. 5 ed. Buenos Aires: Editorial médica Panamericana; 2001. p. 329-68.
Netter FH, Dalley AF. Atlas de anatomía humana. 2 ed. Nueva Jersey: Masson; 2000.
Netter FH, Craig JA, Perkins J, Hansen JT, Koeppen Bruce M. Atlas of Neuroanatomy and neurophysiology selections from the netter collection of medical illustrations. Nueva Jersey: Icon Custom Communications; 2002.
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BIBLIOGRAFÍA Fenichel GM. Clinical pediatric neurology. 5 ed.
Filadelfia: Saunders; 2005.
Gifford KA, Holmes MG, Bernstein HH. Hearing loss in children. Pediatr Rev Junio 2009;30(6):207-16.
Smith RJH, Gooi A. Evaluation of hearing impairment in children. Uptodate ©. Topic 6297. V. 7.0. Consultado abril 2012. Última actualización 14-Mar-2012.
Møller AR. Hearing : anatomy, physiology, and disorders of the auditory system. 2 ed. San Diego: Academic Press; 2006.