Neurology exam signs - Cranial Nerves Flashcards
1
Q
How would you test the olfactory nerve?
A
- Test each nostril with smelling salts if available
- Ask if noticed any change in smell
2
Q
What mnemonic would you use for remembering what to examine when assessing the optic nerve?
A
- Acuity
- Fields
- Reflexes
- Optic disc
3
Q
How would you assess visual acuity?
A
- Snellen chart
- Near vision
- Volour vision
4
Q
How far away is a snellen chart read from?
A
6 metres
5
Q
How would you record acuity?
A
- If patient gets >2 wrong, use previous line as acuity
- If patient gets 2 wrong, use that line
6
Q
What would you use to assess colour vision?
A
Ishihara plates
7
Q
How would you assess visual fields?
A
- Visual inattention
- Visual fields
- Blind spots
8
Q
When assessing inattention, what does inattention on one side mean?
A
Identification of one hand when both are moving
- Means there is a contralateral parietal lesion
9
Q
Where would a lesion be if someone had bitemporal hemianopia?
A
Optic chiasm
10
Q
Where would a lesion be if someone had monocular field loss?
A
Intra-ocular pathology or ipsilateral optic nerve pathology
11
Q
Where might someone have a lesion if they had homonymous hemianopia?
A
Contralateral optic tract/radiation lesion, or occipital cortex if macular sparing is present
12
Q
How would you assess blind spots?
A
- Hold red pin between you and patient
- Check they can see in the middle
- Move horizontally, mapping blind spots
13
Q
What would a central scotoma indicate?
A
Optic nerve lesion
14
Q
What would a large blind spot indicate?
A
Papilloedema
15
Q
What reflexes would you assess when assessing the optic nerve?
A
- Accommodation
- Direct and consensual pupillary reflexes
- Swinging light test
16
Q
How would you interpret pupils that were symmetrical, but when light is shone in one eye, neither pupils constrict?
A
Afferent lesion (optic nerve) in the eye the light was shone in
17
Q
How would you interpret a persistenly dilated pupil in one eye, while the other is reactive to light?
A
Efferent lesion (occulomotor nerve) in the dilated pupil eye
18
Q
How would you interpret pupils becoming more dilated when light is shone in one eye than the other?
A
https://www.youtube.com/watch?v=HSYo7LhfV3A
That eye is relatively less sensitive to light, indicating a relative afferent pupillary defect
19
Q
How would you examine the optic disc?
A
Opthalmoscopy
20
Q
How would you examine CN III, IV, and V?
A
- Inspect
- H-test
- Saccades test
21
Q
What would horizontal nystagmus on H-testing of CN III, IV and VI indicate?
A
- Cerebellar pathology
- Vestibular pathology
22
Q
If there was complex opthalmoplegia on H-testing of CN III, IV and VI, what would you consider doing?
A
Get patient to raise eye for 20 seconds and test for fatiguability - myaesthenia gravis
23
Q
How would you remember the different muscles for each eye movement?
A
- SR, LR and IR are all on the lateral side of the eye, from top to bottom
- IO, MR and SO and on the medial side of the eye, from top to bottom
24
Q
How would you remember which nerves supply which muscles in the eye?
A
SO4LR6, and all other are 3
- Superior Oblique CN 4
- Lateral Rectus CN 6
25
How would the eye sit with a CNIII lesion?
Down and out
26
What nerve lesion would be present if the eye could not move inferiorly when facing medially?
CN 4 - Trochlear nerve supplying Superior oblique
27
What nerve lesion would be present if the eye could not move laterally?
CN 6 - Abducens nerve supplying lateral rectus
28
What would you think of as casues of complex opthalmoplegia?
* **Graves**
* **Mitochondrial disfunction**
* **Myaesthenia**
* **Brainstem lesion**
29
How would you inspect the trigeminal nerve?
* **Temporalis/masseter wasting**
* **Sensory**
* **Jaw clench and open against resistnace**
* **Corneal reflex**
* **Jaw jerk**
30
What are the components to the corneal reflex?
* **Afferent** - CN V, V1
* **Efferent** - CN VII
31
What are the components to the jaw jerk reflex?
CN V afferent and efferent
32
How would you assess facial nerve?
* **Inspect**
* **Motor**
* Raise eyebrows
* Scrunch eyes
* Bear teeth
* Puff out cheeks
33
Why is the forehead spared in a UMN lesion?
Due to bilateral UMN innervation
34
How would you assess the vestibulocochlear nerve?
* **Crude hearing test**
* **Weber's test**
* **Rinne's test**
* **Vertigo testing** - Romberg's/unterbergers
35
If, when performing Weber's test, somoene can hear louder in one side than the other, what would this mean?
The louder side has a conductive problem, or the quiter side has a sensorinerual loss
CONFIRM WITH RINNE's TEST
36
If, following weber's test showing louder hearing in the right ear, you did rinne's test and the patient found the test louder when holding the tuning fork against their mastoid, what would this indicate?
Conductive problem in that side
37
If, following weber's test showing louder hearing in the right ear, you did rinne's test and the patient found the test quiet on both air and bone conduction when holding the tuning fork to their left ear, what would this indicate?
Sensorineural loss in their left ear
38
How would you assess glossopharyngeal and vagus nerve?
* **Inspect** - open and say aahhh for palate symmetry
* **Motor** - assess speech, cough and swallow
* **Gag reflex**
39
How would you examine the accessory nerve?
* **SCM/Trapezius wasting**
* **Turn head against resistance**
* **Shrug shoulders**
40
How would you examine the hypoglossal nerve?
* **Inspect tongue** - wasting and fasciculations
* **Stick out tongue and move from side to side**
* **Days of the week backwards**
41
What is uvual deviation indicative of?
CN 10 lesion
42
What side does the uvula deviate towards in a CN 10 lesion?
Away from side of lesion
43
What side does the tongue deviate to if there is a hypoglossal nerve palsy?
Same side as the lesion
44
What would you do to complete a cranial nerve exam?
Full upper and lower limb neuro
45
What are causes of optic atrophy?
* **Post-optic neuritis/MS**
* **Arteretic ischaemia** - TA
* **Microvascular ischaemia**
* **Compression** - SOL, raised ICP
* **Glaucoma**
* **Toxins**
46
What are causes of CN III palsy?
**M**edical
* **M**icrovascular ischaemia (diabetes)
* **M**igraine
* **M**S/autoimmune
Surgical
* P**C**OM
* **C**avernous sinus lesion
* **C**ancer
47
What are causes of CN VI palsy?
* **Raised ICP**
* **Microvascular ischaemia**
* **SOL**
* **Trauma**
48
What are causes of unilateral CN VI palsy?
* **Bell's palsy**
* **Ramsay Hunt syndrome**
* **SOL** - neuroma, facial nerve tumour, meningioma
* **Lyme disease**
* **Nerve infiltration** - TB, sarcoid, lymphoma
* **Parotid tumour/surgery**
49
What are causes of bilateral facial nerve palsy?
* **Lyme disease**
* **Sarcoidosis**
* **Guillain Barre**
* **Amyloidosis**
* **Myaesthenia**
* **Muscular dystrophies**
50
What are causes of bulbar palsy?
* **MND**
* **Brainstem infarct**
* **SOL**
* **Gullain barre**
* **Polio**
* **Syringobulbia**
* **Neurosyphilis**
51
What are causes of pseudobulbar palsy?
* **MND**
* **High brainstem infarct/SOL**
* **Bilarteral internal capsule infarct**
* **Traumatic brain injury**
* **Progressive supranuclear palsy**
52
What type of motor neuron lesion is bulbar palsy?
LMN
53
What type of motor neuron lesion is pseudobulbar palsy?
UMN
54
If someone was showing signs of multiple nerve palsies involving CN III-VI, what might you suspect?
Cavernous sinus syndrome
55
What signs indicating lesions in CN V-VIII and cerebellar signs indicate of where the lesion is?
Cerebellopontine ange lesion
56
What could be causing clinical signs of CN IX-XI palsies?
9-11 = jugular foramen syndrome
57
What could be the causing signs of CN IX, X and XII palsies?
58
What might be the cause of signs CN IX + X lesions, horner's syndrome, cerebellar signs and sensory distrubance (ipsilateral face, contralateral body)?
Lateral medullary syndrome
59
What might be causes of complex opthalmoplegia?
* **Graves disease** - soft tissue
* **Muscle** - mitochondrial myopathy
* **Myaesthenia gravis**
* **Cavernous sinus syndrome**
* **Mononeuritis multiplex**
* **MS**
* **Stroke**
* **SOL**
* **Trauma**
60
What could cause a unilateral ptosis?
* **Horner's syndrome**
* **CN III palsy**
* **Idiopathic**
61
What are causes of bilateral ptosis?
* **Myaesthenia gravis**
* **Myotonic dystrophy**
* **Congenital**
* **Neurosyphilis**
62
What are 1st order (central) causes of horners syndrome?
* **MS**
* **Spondylosis**
* **SOL**
* **Syringomyelia**
* **Stroke**
* **Lateral medullary syndrome**
63
What are 2nd order (pre-ganglionic) causes of horner's syndrome?
* **Pancoast tumour**
* **Cervical rib**
* **Thyroid carcinoma/goitre**
64
What are 3rd order (post-ganglionic) casues of horner's syndrome?
* **Carotid artery dissection**
* **Radial neck dissection**
65
What are causes of monocular visual field loss?
* **Retinal** - Central retinal artery/vein occlusion, retinal detachement
* **Optic nerve** - Optic neuritis, optic atrophy, glaucoma
66
What are causes of bitemproal hemianopia?
Optic chiasm lesion
* **Craniopharyngioma**
* **Pituitary tumour**
67
What are causes of homonymous hemianopia without macular sparing?
Contralateral optic tract/whole optic radiation lesion
* **SOL**
* **MCA infarct**
68
What would cause homonymous inferior quadrantopia?
Inferior = Parietal lesion = Contralateral Superior optic radation
* **Parietal tumour**
* **MCA infarct**
69
What would cause superior homonymous quadrantopia?
Superior = Temporal = Contralateral inferior optic radiaiton
* **Temporal tumour**
* **MCA occlusion**
70
What might cause homonymous hemianopia with macular sparing?
Contralateral occipital visual cortex lesion
* **PCA infarct**
71
What are causes of chroea?
* **Huntington's chorea**
* **Stroke**
* **Syndenhams chorea**
* **Drugs** - anti-epileptics, levodopa
* **HIV**
72
What are causes of hemiballismus?
* **Subthalamic stroke**
* **SOL**
* **Traumatic brain injury**
* **HIV**
73
What are causes of athetosis?
* **Asphyxia**
* **Neonatal jaundice**
* **Thalamic stroke**
74
What are causes of dystonia?
* **Primary dystonia**
* **Brain trauma**
* **Drugs**
* **Wilson's disease**
* **PD**
* **Huntington's Disease**
* **Stroke**
* **SOL**
* **Encephalitis**
* **Asphyxia**
75
What are causes of myoclonus?
* **Epilepsy**
* **Essential myoclonus**
* **Metabolic**
* **Physiological**
* **Toxins/drugs**
* **SOL**
* **MS**
* **PD**
* **CJD**
76
What are causes of parkinsonism?
* **Parkinson's disease**
* **Vascular parkinsonism**
* **Parkinson's plus** - Multisystm atrophy, progressive supranuclear palsy, lewy body dementia, corticobulbar degeneration
* **Others** - anti-cholinergic drugs, wilson's disease, communicating hydrocephalus, supratentorial tumours
