Cranial Nerve Testing Flashcards
CN I: Olfactory
- Check to make sure Pt can inhale/exhale through both nostrils
- Keep one nostril closed while smelling with other
- Present test tube with common odor
Normal: Identify scent
Abnormal: Unable to smell/identify scent
CN II: Optic
- Snellen wall chart at 20 ft OR hand held card at 14 inches
- Assess each eye separately.
- 20/20 = able to read at 20 ft with same accuracy as person with normal vision.
ALSO
- Have Pt cover one eye and say “now” when they can see your finger wiggle.
- Position finger equidistant between your eye and Pt eye, just outside your own
peripheral field. - Test each quadrant (laterally, medially, superiorly, inferiorly)
CN III: Oculomotor
- Check for asymmetry in eye lids
- Ask Pt to gaze upwards without moving head
Normal: Bilateral eye lids raise during upward gaze
Abnormal: An eyelid is drooping at rest and does not raise during upward gaze
CN II and CN III Pupillary Response
- Pt looks straight ahead
- Hold light laterally from eye. Move inward.
- Observe response
- Now shine light in same eye but observe the opposite pupil
- Test each eye separately.
Normal: Pupillary constriction in both eyes
Abnormal: Pupillary consriction not elicited in the illuminated eye and/or the non-illuminated eye.
CN III, IV, and VI Extraocular eye movement
- Hold Pt head stationary with tip of finger about 18 inches in front of face.
- As them to fixate on finger
- Move finger in an H pattern to test horizontal and vertical gaze
Normal: Tracks finger smoothly
Abnormal: Can’t
CN III, IV, and VI Convergence Testing
- Hold Pt head stationary.
- Ask Pt to focus both eyes on finger (2 ft away)
- Instruct Pt to tell you when finger becomes blurry
- Slowly move finger towards Pt nose.
Normal: Both eyes adduct with bilateral pupillary constriction. Blurriness 4-6 inches from face
Abnormal: One or both eyes do not converge and/or pupils do not constrict.
CN V: Trigeminal Sensation
- Ask patient to say “touch”
- Perform trial in intact area
- Eyes closed
- Test 3 sensory divisions of CN V (forehead - opthalmic, cheek - maxillary, jaw - mandibular)
CN V: Trigeminal Motor
- Palpate R and L temporalis muscles (lat. aspects of forehead)
- Ask Pt to tightly close jaw
- Palpate masseter muscles (where lower jaw connects to skull)
- Ask Pt to tightly close jaw
- Ask Pt to move jaw side to side. Observe for deviation.
Normal: Pt will demonstrate normal strength and deviation
Abnormal: Weakness during jaw closure or lat. displacement
CN VII: Facial
- Observe face for asymmetry
- Pt performs following movements:
- wrinkle forehead
- tightly close eyes and don’t let me open them
- smile
- puff your cheeks
- purse your lips
- frown
CN VIII: Vestibulocochlear (Cochlear)
- Pt cloeses their eyes and points to ear where they hear the sound.
- Rub fingers together 5 cm away from R or L ear
- Test both ears
CNIII: Vestibulocochlear (VOR Cancellation Testing)
- Pt focuses on your nose
- Rotate Pt head 30 degrees laterally to R and L as you move with them
- Observe if Pt must make saccadic eye movements to keep up
CN IX Glossopharyngeal and CN X Vagus
- Ask Pt to open mouth and say “aaah”
- Examine the uvula
Normal: Uvula should rise straight up and in midline
Abnormal: Uvula does not rise midline
CN XI: Accessory
- Ask Pt to turn their head to either R or L and examine SCM
- Place hand on cheek facing away from you and ask Pt to hold as you turn head to you
- Test both R and L sides
CN XII: Hypoglossal
- Inspect tongue for atrophy or fasciculations with tongue resting.
- Pt protrudes tongue. Observe for deviations from midline
- If there is any suggestion of deviation to one side, direct Pt to push the tip of tongue into either cheek while you provide counter pressure from outside.
Normal: No atrophy or fasciculations observed. Tongue protrudes without deviation.
