Head injuries and cranial nerves Flashcards
What are good questions to ask for head injury history?
LOC
Vomiting
Amnesia
Bleeding disorder
Mechanism
Previous injury
Age 65
Drugs/alcohol
What is the olfactory cranial nerve and its number?
C1
Transmits the sense of smell
What are the optic and oculomotor cranial nerves and what are their numbers?
Optic is C2
Oculomotor is C3
Both transmit visual information to the brain
What is the Oculomotor cranial nerve and what is its number
C3
Innovates eye muscles
What is the trochlear cranial nerve and what is its number?
C4
Innervates the superior oblique muscle
(looking toward nose)
What is the trigeminal cranial nerve and what is its number?
C5
Receives sensation from the face and innovates the muscles of mastication
What is the abducens cranial nerve and what number is it?
C6
Innovates the lateral rectus
Looking outward
What is the Facial nerve and what number is it?
C7
Provides motor innervation to the muscles of facial expression
What is the vestibulocochlear cranial nerve and what is its number?
C8
Senses sound, rotation and gravity
What is the glossopharyngeal cranial nerve and what is its number?
C9
Motor: Pharyngeal musculature
Sensory: posterior part of tongue, tonsil and pharynx
What is the Vagus cranial nerve and what is its number?
C10
Motor : Heart, lungs, bronchi
What is the cranial accessory cranial nerve and what is its number?
C11
Controls sternocleidomastoid and trapezius muscles
What is the hypoglossal cranial nerve and what is its number?
C12
Provides motor innervation to the muscles of the tongue
What should you look out for in regard to the 3rd, 4th and 6th cranial nerve tests?
Ptosis (drooping of upper eyelid)
Nystagmus
Paralysis
How do you test the first cranial nerve?
Olfactory nerve
Ask the patient if they have noticed any recent changes to their sense of smell.
How do you asses the second cranial nerve?
Optic nerve
Visually assess pupils
Pen torch to look for symmetry
If one pupil is bigger than other then problem with cranial nerve
How do you asses the 3rd, 4th ad 6th cranial nerves?
OCULOMOTOR,
TROCHLEAR AND ABDUCENS
Ptosis (eyelid drooping)
Abnormal eye movements
How do you asses the 5th cranial nerves?
Trigeminal
Sensory assessment:
- Gently touch patients face on their forehead, cheek and lower jaw. Check for sensation
Motor:
- Assess for chewing muscles
-Apply pressure under jaw and ask pt to keep mouth open
-Ask pt to clench teeth and feel for muscles
How do you asses the 7th cranial nerve?
Facial
- BIG SMILE
- FROWN AND RAISE EYEBROWS
- PUFF OUT BOTH CHEEKS
- SCREW EYES TIGHTLY SHUT AND THEN RESIST EYES BEING OPENED
Can pts with bells palsy move their eyebrows?
Only the unaffected side
How do you test for the 9th and 10th cranial nerve?
GLOSSOPHARYNGEAL AND
VAGUS
Inspect pts uvula and soft pallet.
Can pt swallow
Midline uvula
How do you test for the 8th cranial nerve?
Vestibulocochlear nerve
Whisper something random and get the, to whisper it back, rinnes test or the webers test (tuning fork tests)
What is the abbreviated mental test?
A test for confusion, a score of below 8 indicates confusion.
Questions:
- HOW OLD ARE YOU?
- WHAT TIME IS IT?
- WHAT YEAR IS IT?
- WHERE ARE WE NOW?
- WHO AM I AND WHO IS THIS (OTHER PERSON)?
- WHAT IS YOUR DATE OF BIRTH?
- WHEN DID WWII START (OR OTHER APPROPRIATE EVENT)?
- WHO IS THE PRIME MINISTER?
- COUNT BACKWARDS FROM 20.
- REMEMBER AN ADDRESS.
What is the babinskis reflex?
TEST OF THE PLANTAR REFLEX. WITH A POINTED IMPLEMENT DRAW A LINE UP
THE LATERAL EDGE OF THE SOLE OF THE FOOT AND THEN ACROSS THE BALL OF
THE FOOT.
* PLANTAR FLEXION- NORMAL RESPONSE
* DORSIFLEXION- ABNORMAL RESPONSE. THIS IS A POSITIVE BABINSKI’S
REFLEX AND INDICATES A DISTURBANCE IN THE MOTOR RESPONSE OF THE
CNS, EXCEPT IN CHILDREN UNDER 2 FOR WHOM IT IS A NORMAL RESPONSE.
CAN BE PERFORMED ON THE UNCONSCIOUS PATIENT.
