Cranial nerves Flashcards
Which tra
2 3 4 6
9 and 10
How do you assess smell?
Ask patient whether they’ve noticed any changes to sense of smell
Ask them to
Causes of anosmia?
Head trauma Tumour Viral URTI COVID-19 Meningitis Parkinson's disease Blocked nostril (mucous/nasal polyp) Genetic (Kallman syndrome)
How do you inspect
Size
Shape
Symmetry
Asymmetry in pupil size is caused by
Anisocoria
Horner’s
Physiological
Third nerve palsy
Holmes-Adle syndrome
Describe how you’d assess which eye is abnormal
More pronounced in bright light, larger pupil is abnormal
In dull light????
Eye chart is called
Snellen chart
How far should the patient stand?
stand 6m away
pt should wear glasses
How do you record the results of the snellen test?
Like a fraction
Top number - distance teh chart should be read from
the bottom number is which line they can get to on the chart
If unable to read top line
Move patient closer (3m/1m)
Count fingers
Hand movements
Light perception
What is visual inattention or neglect?
Deficit in awareness of one side of visual field
Describe findings with pin hole
If improvement with pin hole, refractory problem - can be corrected with glasses/
Optic nerve pathology if no correction with pinhole
Describe a finding of visual inattention or neglect
Pt can see both of your hands individually, but when you move both at the same time, the pt can only see one hand
What do you call the visual field red pin thing?
Hap pin
What do you call the visual field red pin thing?
Hat pin
Pupillary light reflex (optic nerve 2)
Direct
Consensual
Swinging
Describe the direct and consensual light reflex test
Shine light in eye and observe pupil constriction in THAT eye
Then shine the light in the same eye but observe the consensual light reflex in the opposite side
Describe the direct and consensual light reflex test
Shine light in eye and observe pupil constriction in THAT eye
Then shine the light in the same eye but observe the consensual light reflex in the opposite side
Swinging light reflex
Relative afferent pupillary defect - optic neuritis caused by MS
See slide about causes of RAPD
Retinal damage
Optic neruoapthy
Accommodation reflex
Hold finger out and ask pt to look at your finger
Eyes should converge and constrict
Lens is pulled thin and pupil is large when you look at somethign close by
????
Describe how you’d test oculomotor nerve
Inspect ptosis
Causes of a ptosis
Oculomotor nerve palsy
Neuromascular pathology - myasthenia gravis (bilateral ptosis)
Congenital
Horner’s
Describe how you’d test for CN 3, 4 and 6
Inspect eyes - neutral position
Deviation
Nystagmus
Describe how you’d assess eye movements
Ask pt to follow your finger with their eyes (H)
Ask them to tell you if they get double vision or pain
Restriction of eye movement
Describe oculomotor nerve palsy
Inferiolaterally (down and out)
Ptosis (drooping of eye lid in that eye)
Pupil dilatation
Causes of nystagmus
Congenital
Central e.g. mid brain or cerebellar lesion
Peripheral e.g. vestibular system
Physiological (normal)
Rinner’s test
Sensorineural deafness - air is louder than bone conduction, but weber’s test - sound louder in normal ear
Conductive
Bone louder than air
Weber’s test - louder in affected air
Normally air should be louder than the bone
Weber’s test
non vibrating end of tuning fork held to forehead
Pt should hear the sound both side
CN 9 and 10
gag reflex
Inspect soft palate and uvula
Look for uvula deviation (away from affected side)
Soft palate - reduced elevation on affected side
Ask: have you experienced any swallowing difficulties or changes to your voice or cough? - ask patient to cough
Swallow
sip water
gag reflex ?
CN 11
Inspect SCM and trapezius
Muscle wasting and fasciulations
Test power - ask patient to shrug against resistance
scm - ask pt to turn their head (opposite scm causes the head turn)
CN 12
stick tongue out
wasting fasciculations
deviation (towards)
Power - ask pt to press their tongue against the cheek, whilst you feel and compare sides
Further examinations
full neuro examination
mini mental exam
asssessmetn of gait and balance
Facial nerve 7 palsy is called
Bell’s palsy
Distinguish between a
Stroke - forehead sparing (can wrinkle both sides)
Facial nerve palsy, forehead is affected
