CN V

• Conditions affect CN V will cause

  Weakness of jaw movements, facial pain, facial sensory loss
• Conditions affecting CNV

  • Trigeminal sensory Neuropathy
  • Trigeminal Neuralgia
  • Herpes Zoster Opthalmicus
  • Multiple Sclerosis
• Motor Symptoms

  • Quite Rare
  • Facial muscles are so strong, it makes it hand to determine weakness
  • LMNL -lateral pterygoid muscle will be impaired + jaw will not open symmetrically + jaw will deviate to weak side
• One Division suggests

  Peripheral Nerve Lesion
• More than one division suggests

  Root or Brainstem lesion
• Dissociated Sensory loss, Lost in particular modalities, eg pain and temp, but preservation of touch suggests

  Brainstem lesion
• With CN palsy favours -

  an intrinsic BS lesion
• Without CN palsy favours -

  a supratentorial lesion or upper cervical cord lesion
• Brainstem lesion affects

  Trunk, limbs and opposite side of the face
• Lesion in medulla affects

  Nociception but preserves touch sensation
• Conditions affecting CNV - at pans


  • Vascular ischemia from arterial occlusion = sudden onset
  • Neoplastic - benign or malignant = progressive onset
  • Demyelination-multiple sclerosis = recurrent
  • Syringobulbia = chronic progressive or acute traumatic
• Conditions affecting CN V. at cembellopontine Angle

  • Acoustic Neuroma = most common and is a slow growing tumour
  • Trigeminal Neuroma
  • Meningitis
• Conditions affecting CN V - at ridge/apex of petrous temporal bone

  • Petrositosis - osteitis or menginitis associated with otitis media
  • Usually has CN VI as a component
• Conditions affecting CN V - at orbital pssure skull base

  • Nasopharyngeal Cancer or metastasis
  • Trauma
• Conditions affecting CN V - at cavernous sinus

  • Look for involvement of IV, VI together with 1st division of V
  • Tumour (pituitary, meningioma, mers)
  • Intracavernous aneurysm
  • Cavernous sinus thrombosis
  • Tolosa Hunt Syndrame
• Trigeminal neuralgia


  • Usually triggered by cold air, opening jaws, hot or cold drinks
  • Can affect area from top lip up the side of the nose + around eye
  • Can also affect area from temples down the jaw + around corners of their lips
• Treatment for trigeminal neuralgia

  Often involves surgery, where they insert a protective pad inbetween trigeminal nerve and blood vessel loop
• Onion skin suggests

  Brainstem lesion