Cranial Nerve/Neuro Routine Testing

Question 1

What is typically included in routine neuro testing?

Answer 1

• Cranial nerves II - XII (taste and smell are not routinely tested unless otherwise warranted)
• Proprioception and cerebellar function
• Sensory function
• Deep tendon reflexes

Question 2

How is Cranial Nerve II/Optic nerve tested?

Answer 2

• Near and distance vision (i.e., Snellen, 20/20, animals, etc.)

Question 3

How is Cranial Nerve III/Oculomotor nerve tested?

Answer 3

• PERRLA
• Eyelid open/close
• Cover/uncover
• All Cardinal Points except:
  - Superior oblique muscles - crossed eyes with downward gaze
  - Lateral rectus muscles - lateral abduction

Question 4

How is Cranial Nerve IV/Trochlear nerve tested?

Answer 4

• Cardinal point: Superior oblique muscles - crossed eyes with downward gaze

Question 5

How is Cranial Nerve V/Trigeminal nerve tested?

Answer 5

• Facial muscle tone for symmetry or twitching and clenched jaw
• Sensation at scalp, cheek, and chin with multiple tools (sharp, dull, and cotton)
• Corneal light reflex symmetric blink and reflection

Question 6

How is Cranial Nerve VI/Abducens nerve tested?

Answer 6

Cardinal Point: Lateral rectus muscles (lateral abduction of eyes)

Question 7

How is Cranial Nerve VII/Facial nerve tested?

Answer 7

• Symmetric facial features with:
  
  • smile
  • frown
  • puffed cheeks
  • pucker lips
  • wrinkle forehead
• Clear speech
• Only if indicated:
  
  • identification of tastes (sweet and salty)

Question 8

How is Cranial Nerve VIII/Vestibulocochlear nerve tested?

Answer 8

• Hearing with:
  
  • whisper test
  • Weber test (equal on both sides)
  • Rinne test (air > bone)
• Balance with:
  
  • Romberg test

Question 9

How is Cranial Nerve IX/Glossopharyngeal nerve tested?

Answer 9

• Gag reflex
• Only if indicated:
  • taste (bitter and sour)

Question 10

How is Cranial Nerve X/Vagus nerve tested?

Answer 10

• Motor function by saying, “Ahhh”
• Gag reflex
• Swallowing
• Speech

Question 11

How is Cranial Nerve XI/Spinal Accessory tested?

Answer 11

• Shrug shoulders
• Rotate head to sides

Question 12

How is Cranial Nerve XII/Hypoglossal nerve tested?

Answer 12

• Tongue movements

Question 13

How ar3e proprioception and cerebellar function tested?

Answer 13

• Rapid rhythmic and alternating movements
• Accuracy of movements
• Balance with Romberg test
• Gait
• Heel-toe walking

Question 14

How is sensory function tested?

Answer 14

• Superficial pain and touch are present at the distal points of each extremity
• Vibration and position senses present (test the great toe)

Question 15

How are deep tendon reflexes tested?

Answer 15

• Test all deep tendons and plantar reflex with a reflex hammer:
  
  • reactions should be present and smooth without clonus