Cranial Nerve Exams Flashcards
orofacial pain frequently involves which disorders?
neuropathic pain disorders
what is the cranial nerve exam for the olfactory nerve ?
- check nasal passages
- use none irritating familiar stimulus like coffee, chocolate etc
what is a common reason someone may have temporary loss of their sense of smell? permanent loss?
- swelling and congestion of nasal cavity due to common cold or allergies
- unilateral or bilateral anosmia from cribriform plate, olfactory groove meningiomas or tumors of the frontal lobe
what is the cranial nerve exam for the optic nerve ?
- measure of visual acuity
- testing of visual fields
- testing of the pupillary light reflex
- visualization of the fundus (not dentists)
what are the cranial nerve exams for Oculomotor, Trochlear and Abducens nerves ?
- determining if the patient has ptosis
- pupillary response to light
- accommodation: allows eyes to focus on near objects and convergence and pupillary constriction of both eyes
- extraocular eye movements
what is the cranial nerve exam for the trigeminal nerve ?
- touch skin with sharp end of a pointed object
- hold warm or cold object against the skin
- lightly touch skin with a cotton swab
determine if both sides feel the same amount of sensations as well as each branch of the nerve - corneal reflex: see if patient blinks after light touch of cotton to cornea
what is the cranial nerve exam for the facial nerve ?
- raise eyebrows
- frown
- close eyes tightly
- smile
- show teeth
- puff out cheeks
what is the cranial nerve exam for the vestibularcochlear nerve ?
- walking heel to toe in a straight line
- patient covers one ear and examiner whispers in the other (conductive hearing loss or sensorineural)
what is the cranial nerve exam for the glossopharyngeal and vagus nerve ?
- listen for voice hoarseness
- have the patient say “AH”, the soft palate should move up symmetrically with uvula at midline
- check the gag reflex on both sides
what is the cranial nerve exam for the spinal acccessory nerve ?
- inspect the trapezius for any atrophy, symmetry, fasciculation
- test trap for strength by having patient raise shoulders against resistance
- test sternocleidomastoid by having the patient turn head and push against hand
what is the cranial nerve exam for the hypoglossal nerve ?
- have patient stick tongue straight out and move side to side
what is quantitative sensory testing (QST)?
offers insight on potential mechanism contributing to an individuals experience of pain by assessing their perceived response to standardized delivery of stimuli
what is classic ramsay hunt syndrome?
- a complication of varicella zoster virus infection / reactivation in the geniculate ganglion
Symptoms - paroxysmal pain in deep ear
- rash of ear or mouth
- LMN facial palsy
- (vertigo and ipsilateral hearing loss from CN VIII)
what is trigeminal neuralgia?
- demyelinating compression, compression of nerve root close to its entry into the pons or spontaneous nerve firing and cross talk among adjacent fibers causing sever electrical shock like pain
- can be caused by a tumor, multiple sclerosis, vascular anomalies
what is Horner’s Syndrome?
- interruption of the sympathetic nerve supply to the eye
- miosis, partial ptosis and loss of hemifacial sweating
