Neuro-clinics 25

Dr Pratyush Chaudhuri

Supported by Mankind Pharmaceuticals and Nirmal clinics

Glossopharyngeal & Vagus

IX & X cranial nerve

Function of glossupharyngeal

• Stylopharyngeus muscle

• Autonomic supply to parotid gland

• Sensory supply

• Reflexes

Pharyngeal or gag reflex

Carotid sinus reflex

Vagus Nerve

• Also called pneumogastric nerve• Longest cranial nerve

• Responsible for the functioning of the swallowing muscles of the pharynx and the laryngeal muscle

• Parasympathetic function are numerous• Largest and most important parasympathetic

nerve• Essential for regulation of the heart.

• Predominantly inhibitory in nature• Vagus stimulation - bradycardia

• Vagal parasympathetic cause broncho-spasm and increased secretion.

• It is a stimulant of the GIT up to the colon

• Special somatic sensory, general somatic sensory, general visceral sensation

Clinical examination of vagus

• Motor functionExamination of the soft palateDifficulty in swallowing more for liquids

Difficulty in palatal phonation – K, q, Ch – sound similar to cleft palate

• Observe the pharyngeal muscle movement“rideau phenomenon” – curtain movement -

movement of the the pharyngeal wall to the nonparalysed side.

• Paralysis of cough • Hoarseness of voice +/- dyspnoea

Autonomic function

• Aschners ocular phenomenon or oculocardiac reflex. ( absent in vagal paralysis)

• Vomiting reflex• Swallowing reflex• Cough reflex• Sneeze (sternutatory) reflex• Sucking reflex. (normal in neonates. If occurs

in adults – known as atz or wolfing reflex)

• Singultus• Yawning reflex• Carotid sinus reflex: vagal type , cerebral type

and the depressor type.Responses may be in the form of

1. Hyperactive carotid sinus reflex2. Carotid sinus syncope.

Clinical presentation

• Glossopharyngeal neuralgia

Trigger points- tonsillar fossa and the tonsillar pillers

Pain during eating and swallowing

• Irritation of vagusBradycardia, vomiting, hypertonus of GIT(basis of projectile vomiting of raised ICT)

Explains the cushing reflex

Vagus also responsible for kussmaul breathing, cheyne stokes respiration etc

• Pharyngismus• Palatal myoclonus• Vaso-vagal syncope

Paralytic involvement of vagus• Supra-nuclear- in pseudobulbar palsyResults in spastic dysarthria or dysphagia

• Nuclear involvement- in bulbar polio, GB syndrome, other lesions affecting the brainstem

• Infra nuclear – most common is the recurrent laryngeal nerve paresis