Cranial Nerves Examination

CRANIAL NERVES EXAMINATION
The patient should be fully relaxed. Cooperation. Explain the procedure to the patient. Examination ONLY if indicated. Findings should be recorded one by one. Negatives are as important as positives. Full equipments for the different tests. The Anatomy should be reviewed.
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Examine both sides (Right and Left). Remind yourself whether the nerve is:
i. ii. iii. iv. v.
Motor muscle suppliedsupplied- , sensory areas coveredcovered- , mixed, contains parasympathetic fibers 3rd, 7th, 9th, 10th , involved in reflex as afferent or afferent.
Higher cerebral functions. Meningeal irritation. Cranial nerve examination. Motor system. Autonomic system. Sensory system.
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Olfactory I
Optic II
Occulomotor III
Trochlear IV
Trigeminal V
Abduscens VI
Facial VII
Vestibulochoclear
VIII
Glossopharyngeal
IX
Vagus X
Accessory XI
Hypoglossal XII
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Ask the subject to recognize a common type of smell e.g. oil of peppermint. Loss of sense of smell is called anosmia.
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Investigate the following tests:

Acuity of vision. Color vision. Field of vision (confrontation test). Fundoscopy (examination of the optic disc by ophthalmoscope).
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The three nerves are examined together. They innervate the extrinsic muscles of the eye. The recti muscles act as elevators and depressors alone when the eye is in abduction, and the obliques act similarly when the eye is in adduction.
In (VI) nerve paralysis, there is inability to move the eye ball outwards (squint), the eye turns medially due to unopposed action of the medial rectus. Paralysis of medial rectus causes lateral deviation of the eye. In (IV) nerve paralysis there is inability to look down and outwards
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a. Sensory division: M Test for the sense of touch, pain and temperature in the face, keeping in mind the regions supplied by ophthalmic, maxillary & mandibular divisions of the nerve. N Reflex function: Test for corneal reflex (afferent fibers are through 5th nerve and efferent fibers through the 7th nerve).
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b. Motor division: - Ask the subject to clench his teeth and feel the prominence of temporal and masseter muscles. The muscles would remain soft on the paralyzed side. - To test the function of pterygoid muscles ask the subject to open the mouth, the lower jaw moves towards the paralyzed side due to unopposed action of the opposite healthy pterygoid muscle.
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A- Sensory division: Test the anterior 2/3rd of the tongue for the sense of taste using strong solutions of sugar, salt, and quinine.
b. Motor division: This is responsible for facial expression, it is tested as follows: M Ask the subject to wrinkle the forehead. Wrinkles do not appear on the paralyzed side. N Ask the subject to close his eyes forcibly and you try to open them forcibly. In case of paralysis, the eyes remain open or if can be closed, they can be opened with minimal force.
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b. Motor division: O Ask the subject to show his teeth & observe the nasolabial folds and the angles of the mouth. On the paralyzed side the nasolabial folds are flattened and the angle of the mouth seems to be drawn towards the healthy side. P Ask him to whistle. It is not possible in case of 7th nerve paralysis. Q Ask him to inflate the cheeks with air. Tap each cheek lightly with a finger. On the paralyzed side air escapes from the mouth.
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This is responsible for hearing and balance. Rinnes test: test: Set a tuning fork into vibration and hold it opposite the ear. When it can no more be heard, put its base over the mastoid process. Normally it would not be heard at this point also. In middle ear disease the vibration will be heard over the bone after it could no more be heard through the ear. In middle ear disease the bone conduction remains normal when air conduction is diminished. In nerve deafness, air conduction and bone conduction are equally diminished.
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Webers test: test: A vibrating tuning fork is set against the middle of the forehead of the subject. He would hear better on the side with middle ear deafness.
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Tickle the posterior wall of pharynx and observe the pharyngeal reflex. The afferent & efferent fibers of this reflex lay in the 9th cranial nerve. The sense of taste may also be tested over the posterior 1/3rd of the tongue.
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Ask the subject to open his mouth and say AA-H-H-H- and observe the elevation of the soft palate. On the side of lesion, the soft palate is not elevated.
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Ask the subject to rotate the chin to one side against resistance. Examine sternomastoid and trapezius muscles for bulk and power of contraction. Paralysis of stemomastoid will produce failure to rotate the chin to opposite side.
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Ask the subject to protrude his tongue out. The tongue would be pushed towards the paralyzed side.
SR
IO
SR
LR
Rt
MR
MR
Lt
LR
IR
SO
IR
Optic Nerve inflammed
Optic Nerve cut Temporal fibers Post L geniculate n. Post L. geniculate n.
Optic Chiasma
Optic Tract Post L. geniculate body Occipital Region
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2
Rt
Lt
3 4 5

Cranial Nerves Examination

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Cranial Nerves Examination

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CRANIAL NERVES EXAMINATION

Investigate the following tests:

Optic Nerve inflammed

Optic Nerve cut Temporal fibers Post L geniculate n. Post L. geniculate n.

Optic Tract Post L. geniculate body Occipital Region

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