Cranial Nerve Injury: Diagnosis And Treatment Essay For Aria." (70 Characters)

Cranial Nerves and Their Functions

30 yrs old Aria waas taken to the emergency department with many lacerations on the right side of her face and arm. Aria's right wrist is shattered and she has fractures in her temporal bone, according to X-ray reports. Aria's discomfort was addressed and her arm was cast. After complaining of dizziness, Aria was requested to undergo additional tests to rule out any other injuries (Howard CC, 2019). Aria's hearing was tested using a tuning fork, and it was determined that she only possessed hearing on her left side. Aria was also given a smelling test, and she was able to distinguish vanilla extract from others. The taste test revealed that on the right side of her tongue, aria had difficulty discriminating between sweet and salty tastes. A comprehensive eye exam found that aria could see a pen light with the both eyes, that her visual acuity was normal, and that her peripheral vision was alright. Aria's symmetry was also examined, and she showed weakness on the right side of her body in the eyebrow, eyes, lips, and forehead. Aria has been diagnosed with Cranial nerve injury, and a CT scan is suggested (Howard CC, 2019).

The goal of this research is to figure out which of Aria's cranial nerves are causing her problems. The nerves in the brain stem and brain that relay information are known as cranial nerves. Taste, touch, smell, sight, and hearing are all senses that the brain receives via the cranial nerve.

Based on the results of the Lab Cranial Nerve Evaluations and the information from Aria's ER assessment, I hypothesized that the Aria's, Facial, Vestibulocochlear, and Trigeminal Nerves have all been impacted.

Aria was said to have some weakening in her eyelids, brows, lips, and forehead. I know that failing this exam would indicate that the Facial Nerves have been impacted based on what I studied in lab. Aria's facial nerve appears to be impacted, based on accounts of her inability to discern sweet and salty sensations on the anterior right side of her tongue. Aria couldn't hear the tuning fork when she was locked on her left side, but she could hear it when she was on her right side. It's possible that her Vestibulocochlear nerve is impacted as well.

1. The olfactory Nerve - The olfactory nerve is examined by having the subject smell coffee, vanilla extract, and alcohol through their left and right nostrils without looking at them.

The subject will close their eyes and use their finger to plug their nostril. The chemicals would be then placed 10 cm underneath the nostril that was not occluded. The patient will next inhale regularly and alternate between both nostrils, identifying the aroma (Bluedoor, 2016).

2. The Optic Nerve –
3. The Snellen Test is a distance vision test that determines how clear your vision is at a distance. For this the person will be asked to stand around 20ft away from the eyechart and then need to read the letters from left to right in order. Their vision would be determined by the tiniest line that could be read.
4. The optic nerve was also evaluated by peripheral vision. The subject would sit in a chair, while the tester moved in an arc toward the subject's nose.
5. The Oculomotor Nerve –
6. The eye muscles stimulate the oculomotor. For this test the alphabet His tracked with just pencil when facing completely ahead and having the patient follow the movement.
7. The oculomotor nerve regulates pupil dilatation and constriction. A light can be shone into the eye to see if this is true. By doing so, you can determine whether the pupil constricts or dilates in response to light.
8. The Trochlear Nerve –
9. The oblique muscle of the eye is controlled by this motor neuron. This motor neuron nerve controls eye movement.
10. To assess the eye movement symmetry, the patient glances down at the tip of his nose.
11. The Trigeminal Nerve - Both motor and sensory govern the jaw muscle, as well as sensory input to the face (Hoehn, 2016).
12. The subject will be instructed to chew on a tongue depressor to test the motor capabilities of the trigeminal nerves (Bluedoor, 2016).
13. To evaluate the sensory functions of the trigeminal nerves, the patient will close their eyes and a Von Frey hair will then be lightly touched on the face in various spots, with the subject indicating whether or not they could feel it. A hot and cold metal probes will be used to repeat the process (Bluedoor, 2016).
14. The Abducens Nerve - It is a motor nerve that connects the brain to the body. The lateral rectus eye muscle is controlled by this nerve. Eye abduction is possible because to this eye muscle.
15. The symmetry of lateral eye movement is used to test whether the Abducens nerve is functioning properly.
16. The Facial Nerve - Taste and facial expression are controlled by the Facial Nerve, which is both motor and sensory (Hoehn, 2016).
17. To evaluate motor function, have the subject wrinkle their brows, live their brows, grin, and pucker their lips (Bluedoor, 2016).
18. Place salt and sugar water on the subject's tongue to assess the sensory function of facial nerve. Then, by asking the person if they can taste at different spots on the tongue, you can see if they can (Bluedoor, 2016).
19. The Vestibulocochlear Nerve - A pure sensory nerve that regulates balance and transmits auditory information (Marieb & Hoehn, 2018).
20. Put a tuning fork near the mastoid process behind the subject's ear.

Make a tuning fork sound and see if the person can hear the instrument (Bluedoor, 2016).

1. To check for balance, set the tuning fork on the subject's forehead, strike the instrument, and see if it can be perceived in the both ears (Bluedoor, 2016).
2. Place the subject in front of a whiteboard, facing away from it. Draw a line parallel to the board on each side of the subject's body, have them stand in place for 2 minutes with their eyes open, looking straight ahead, then repeat with their eyes closed and the person standing perpendicular to the  board. Keep an eye out for any swaying to the side (Bluedoor, 2016).

9 The Glossopharyngeal as well as the Vagus Nerves –

 The sensory and motor nerves are included. The pharynx and larynx are controlled by motor neurons, while taste buds are controlled by sensory fibres. (Marieb, Hoehn, & Hutchinson, 2013).

1. The sense of taste are assessed by performing the salt and sugar test.
2. The uvula's vibrations are assessed by having the individuals pronounce "ahh" while holding their mouth open and tongue down with a tongue depressor.
3. The Accessory nerve -The trapezius and sternocleidomastoid muscles are controlled by the Accessory Nerve, which is a motor nerve. Applying resistance to the subject's head and having them provide counter-pressure by moving their head towards you completes the task. This is done to determine the subject's muscle strength in both arms.
4. Hypoglossal Nerve - Marieb and Hoehn (2018) identified a motor neuron that controls the intrinsic tongue muscles.
5. Have the subject protrude their tongue in the middle of their mouth, and watch for any deviations to the right or left. The tongue should not stray from its natural position in the middle of the mouth (Bluedoor, 2016).

Where N is Normal

2. Optic Nerve:
3. Visual Acuity (no glasses):

Right eye -20 / 30

Left Eye 20/20 

1. Peripheral Vision

Where, N is normal

3. Oculomotor Nerve
4. Subject tracked the alphabet H properly with left and right eyes
5. Eye Lid Position: Both normal

Pupil Size and Shape: Size and shape of pupil are found to be equal in both left and right eyes

1. Eye Lid Position: Normal in both the left and right eyes
2. Pupillary Reflex: Normally present
3. Trochlear Nerve:
4. The subject was able to look at the tip of the nose with right and left eyes, normally.
5. Trigeminal Nerve:
6. Temporalis Contraction Strength: Equal in both the sides
7. Masseter Contraction Strength: Equal in both the sides 

Abducens Nerve: Left and right eyes can laterally abduct.

Facial Nerve:

Facial Expression: All within normal limits

Where Y is YES

Taste Function

Where Y is YES

Vestibulocochlear Nerve

Rhine Test

Where Y is YES

1. Weber Test: Equa hearing in both the ears
2. Romberg Test: With eyes closed, there is very little swaying on both sides, and there is no swaying when the individuals' eyes are open.
3. Vagus and Glossopharyngeal Nerve -
4. Phonation
5. Uvula and Palate rise in the midline: Yes
6. No deviation observed
7. The Speech was normal
8. The swallowing was normal
9. The Gag Reflex present on the left and right sides
10. Accessory Nerve
11. Sternocleidomastoid strength (0, very weak, to 4 very strong): 4/4 Right and Left
12. Trapezius strength (0, very weak, to 4 very strong): 4/4 Right and Left
13. 11. Hypoglossal Nerve
14. Straightening out the tongue with no deviation to the left or right is normal. 

Conclusion

After conducting a set of tests, I believe the Individual suffers from Cranial nerve injury. Aria's left side of her body appears to be the most impacted, given her head injury occurred on the right side of her head. I believe the CT scan results will reveal damage to the brain, but I do not believe the harm will be permanent. When Aria fell, her face, vestibulocholear, and trigeminal nerves were all impacted. Aria should start wearing a helmet when riding her bike from now on. A CT scan, in my opinion, would only be necessary if the symptoms persisted. 

References

Bluedoor, LLC. (2016). Human Anatomy and Physiology 1 Laboratory Manual Howard Community College (3 ed.). minneapolis, MN: bluedoor, LLC.

Hoehn, E. N. (2016). Human Anatomy & Physiology (11th ed.). San Francisco: Pearson Education.

Howard Community College. (2019). BIOL 203 Lab Report Assignment. Arias Case. Columbia, Maryland: Howard Community College.

Marieb, E. N., & Hoehn, K. N. (2018). Human Anatomy & Physiology. San Francisco, CA: Pearson Education, Incorporated.