Case

A 20-year-old patient is admitted to the hospital after thrown from their horse during a gallop along a pathway. The patient struck their head and did not lose consciousness. The patient exhibits difficulty with control of their tongue, but exhibits normal sensation and expressions from the face and scalp, a normal gag reflexes, and is able to swallow. They are are also able to hear instructions and turn their head left and right. You suspect a base of skull fracture and cranial nerve damage.

Question 1/4 - What nerve to you think has been injured?

Click on your selected option(s) below  (correct = 1, over-thinking = 2+)

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Incorrect. The facial nerve controls the muscles of facial expression, since the patient has normal expressions this nerve must be intact.

Incorrect. The trigeminal nerve is involved in sensation to the face, while this patient exhibits normal facial sensation.

Incorrect. The glossopharyngeal nerve is the primary sensory nerve to the pharynx responsible for the sensory side of the gag reflex, which is normal in this patient (note, gag reflexes are not routinely tested as part of a neurological assessment unless there is a high degree of suspician, as they are uncomfortable for the patient).

The motor side is primarily muscles controlled by the vagus, with a small contribution from a muscle controlled by the glossopharyngeal nerve.

Incorrect. The vagus nerve regulates organ autonomic functions and larynx/pharynx. Dysfunction of the vagus would impact the ability to swallow and speak.

Incorrect. The accessory nerve controls the sternocleidomastoid and trapezius muscles. As the patient can turn their head, this indicates the accessory nerve is intact.

Correct! The hypoglossal nerve is involved in control of tongue, consistent with the patient symptoms.