Cranial Nerve Assessment

Question 1

Cranial Nerve 1

Answer 1

Olfactory

Test for smell after a direct blow to the forehead above the nasal bridge, which might involve a fracture of cribriform plate, otherwise, not done routinely

Question 2

Cranial Nerve 2 (5)

Answer 2

Optic Nerve

1. Vision test - visual acuity
2. Shape and size of pupils
3. Penny test; have patient follow penny with eyes
4. Examine optic fundi
5. Pupillary reaction to light, accommodation, constriction

Question 3

Cranial Nerve 3 (3)

Answer 3

Oculomotor

1. Inspect eyelids for drooping
2. Inspect pupil size and reactivity and accommodation
3. Six cardinal fields of gaze eye movement test

Question 4

Cranial Nerve 4 (3)

Answer 4

Trochlear

1. Inspect eyelids for drooping
2. Inspect pupil size and reactivity and accommodation
3. Six cardinal fields of gaze eye movement test

Question 5

Cranial Nerve 5 (4)

Answer 5

Trigeminal

1. Inspect FACE for muscle atrophy and tremors
2. Palpate jaw muscles as child makes “monster face” clenching their jaws
3. Test for touch and temperature sensation on eitehr side of face
4. Corneal reflex is deferred

Question 6

Cranial Nerve 6 (5)

Answer 6

Abducens

1. Inspect eyelids for drooping
2. Inspect pupil size and reactivity and accommodation
3. Six cardinal fields of gaze eye movement test
4. Dysfunction can result from lesions anywhere along the six nerve nucleus in dorsal pons and lateral rectus muscle within orbit
   * Has longest course of all CNs
5. ICP can cause stretching of CN 6 (will have inability to abduct the eye to look laterally)

Question 7

Cranial Nerve 7 (4)

Answer 7

Facial

1. Check facial symmetry
2. Smile and frown test
3. Shut eyes tight
4. Puff out cheeks

*Lyme disease presents with peripheral palsy of CN 7 (eyebrows and forehead paralyzed)

Question 8

Cranial Nerve 8 (2)

Answer 8

Acoustic

1. Screen for hearing loss / hearing (tuning fork)
   * Test for hearing loss from 500-6,000 or 8,000 decibles (higher frequency hearing loss that is found w/ mild sensorineural damage)
2. Test for equilibrium using audioscope or audiometer

Question 9

Cranial Nerve 9 (3)

Answer 9

Glossopharyngeal

1. Test ability to swallow and gag reflex
2. Test for sweet/sour taste
3. Look at uvular deviation

Question 10

Cranial Nerve 10 (3)

Answer 10

Vagus

1. Listen to vocal quality
2. Inspect rise of soft palate when child says “ah ah” or “ha ha” (uvular deviation)
3. Check for swallowing difficulties (do this w/o giving fluid if there is a suspected head injury)

Question 11

Cranial Nerve 11 (2)

Answer 11

Spinal Accessory

1. Test sternocleidomastoid muscle - head rotation against resistance
2. Test trapezius muscle - upwards shoulder movements stronger than the examiner’s downward pressure

Question 12

Cranial Nerve 12 (4)

Answer 12

Hypoglossal

1. Inspect tongue - symmetry, tremors, atrophy
2. Pressure on tongue against cheek and check for strength
3. Quality of lingual sounds like l,t,d, and n
4. Unilateral lesions: protruded tongue deviates toward the affected weaker side and at rest it goes towards opposite side (of patient!)