Cranial Nervous Examination Flashcards
Cranial nerve I name and function
Olfactory nerve - smell
Cranial nerve II name and function
Optic nerve - vision
Cranial nerve III name and function
Oculomotor - eye movement
Cranial nerve IV name and function
Trochlear - eye movement
Cranial nerve V name and function
Trigeminal - facial sensation/chewing
Cranial nerve VI name and function
Abducens - eye movement
Cranial nerve VII name and function
Facial - facial expression
Cranial nerve VIII name and function
Vestibulocochlear - hearing and balance
Cranial nerve IX name and function
Glossopharyngeal - soft palette movement
Cranial nerve X name and function
Vagus - swallowing
Cranial nerve XI name and function
Accessory - shoulder elevation and head turning
Cranial nerve XII name and function
Hypoglossal - tongue movement
Which attributes of cranial nerve I do you assess
Ability to smell
How do you assess ability to smell
Ask if the patient has noticed any change in their sense of smell
Which attributes of cranial nerve II do you assess
Visual acuity
Visual fields
Pupillary reflexes
Fundus
Which attributes of cranial nerves III, IV and VI do you assess
Eye movements
Accommodation
How do you assess visual acuity
Ask the patient to read something out at a distance, covering one eye (wearing their glasses or contacts if they have them)
How do you assess visual fields
Inattention (look at my nose and point to which side i make a gesture to) Visual fields (one eye at a time, compare your own visual fields to the patients' using a pin) Blind spot (compare your own blind spot to the patients')
How do you assess pupillary reflexes
Shine a torch into patient’s eyes
Swinging torch test
How do you assess the fundus
By ophthalmoscopy
How do you assess eye movements
Note ptosis and abnormal position
Ask patient to follow finger side to side and then in an H pattern
How do you assess accommodation
Ask patient to look at finger as you move it closer towards them and observe convergence
Which attributes of cranial nerve V do you assess
Sensory
Motor
Reflexes
How do you assess facial sensation (V)
Ask patient to close eyes and inform you when they feel you touch their forehead, cheek and jaw on both sides
How do you assess facial motor function (V)
Ask patient to open jaw against resistance
Palpate jaw muscles while asking them to clench their jaw
How do you assess facial reflexes (V)
Corneal reflex - can be assessed with cotton wool on the nostril (same nerve)
Jaw jerk reflex
Which attributes of cranial nerve VII do you assess
Facial tone
Motor
Sensory
How do you assess facial tone (VII)
Look for signs:
reduced wrinkling
drooping of mouth
How do you assess facial motor function (VII)
Raise eyebrows
Screw up eyes
Puff out cheeks
How do you assess facial sensory function (VII)
Ask:
Have you noticed any changes in taste
Have you become increasingly bothered by loud noises
Which attributes of cranial nerve VIII do you assess
Hearing
How do you assess hearing in cranial nerve exam
Occlude one ear and whisper to patient asking them to repeat. Repeat on other side.
Which attributes of cranial nerve IX, X, XII do you assess
Palate function
Tongue function
How do you assess palate function
Movement of uvula (ask patient to say ahhhh)
Speech
Swallowing water
How do you assess tongue function
Appearance (wasting, fasciculating, spastic)
Movement (left to right, resistance against cheek)
Which attributes of cranial nerve XI do you assess
Motor
How do you assess motor function (XI)
Shrug shoulders
Turn head against resistance
Further investigations after cranial exam
Peripheral neural exams Formal hearing test Nerve conduction study Bloods CT/MRI head
