CRANIAL NERVE EXAM

Question 1

I – Olfactory Nerve

Answer 1

Have you noticed any change in your sense of smell?

Question 2

II – Optic Nerve

Answer 2

Visual Acuity
- Any changes in your vision? Consider Snellen chart

Question 3

II, III- Optic and Oculomotor Nerves

Answer 3

Assess pupils
- Shape – Abnormal shapes can be congenital or due to pathology.
- PEARL - Both pupils should constrict equally with light shined in one

Question 4

III, IV, VI – Oculomotor, Trochlear and Abducens Nerves

Answer 4

Note any Ptosis (drooping of eyelid/s)
Have you been having any double vision?
Eye Movements
- H - Test: Move finger in an ‘H’ shape and have patient follow with their eyes only to assess motor function.

Question 4

V – Trigeminal Nerve

Answer 4

Sensory:
Light touch test on three branches of nerve
- Forehead (Opthalmic Branch)
- Cheeks (Maxillary Branch)
- Jaw (Mandibular Branch)

Motor:
Clench teeth: Feel for equal bilateral muscle mass/tone
Open mouth against resistance: Feel for strength and deviation (will deviate to side of lesion)

Question 5

VII – Facial Nerve

Answer 5

Facial expressions:
- Raise eyebrows and frown
- Big Smile
- Puff out cheeks
- Can they close eyes tight and resist you trying to open them (gently).

Question 6

VII – Vestibulocochlear Nerve

Answer 6

Have you noticed any changes in your hearing?
Whisper test:
- Whisper a number or word 15cm away from ear and ask patient to repeat it. (Cover other ear)

Question 7

IX & X – Glossopharyngeal and Vagus Nerves

Answer 7

Say “Ahhh!”
- Check that uvula remains mid-line
- Check that soft palate raises equally

Question 8

XI – Accessory Nerve

Answer 8

Ask patient to shrug shoulders against resistance
Turn head left and right against resistance

Question 9

XII – Hypoglossal Nerve

Answer 9

Stick out tongue, Check for deviation (deviation always towards side of lesion)
Place finger on patient’s cheek and have them push tongue against it, assess power

Question 10

Pronator drift

Answer 10

Hold both arms out straight with palms facing upwards and eyes closed.
See if one arm changes position or drops - 30 sec

Question 11

Fine Motor Movement

Answer 11

Can pt mime piano playing?

Question 12

Finger to Nose

Answer 12

Pt to touch tip of your finger to their nose repeatedly with eyes open and closed
– vary finger positions also

Question 13

Gait Tests

Answer 13

Assess Patients Walking:

• Heel to Toe
• Walk on Toes
• Walk on Heels
• Walk Normally

Question 14

Rhomberg’s Test

Answer 14

Can patient remain standing with eyes closed?
Do they wobble?
Is there significant different between eyes open and closed?

Question 15

Co-ordination Assessment

Answer 15

alternating hand movements

Question 16

Memory Assessment

Answer 16

Confidently perform mini mental test with patient
- include recall 2 objects
- address
- memorable date