Kai1111
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Cranial Nerve Review
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05.01.08 (4 months ago)
#1
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Would appreciate a review and any extras or clarifications:
Cranial Nerves
I Olfactory Nerve
Not usually tested, but you can ask the patient if they can smell and taste the food they eat…..and other questions….if pos, then you can formally test.
II Optic Nerve
Visual acuity w Snellen chart and/or Rosenbaum…should check ea eye separately (i.e. cover one eye and pinhole test); have them read the smallest print possible; they should wear corrective lens….does site improve w pinhole? If so, they need glasses.
Visual Fields – check w and without other eye covered
Fundoscopy
Pupillary reflexes(afferent CNII, efferent CNIII)
• direct, consensual, ‘swinging light test’
• ‘near reflex triad’
o Accomodation
o Convergence
o Pupillary constriction
III, IV,VI Occulomoter, Abducens/Trochlear, Lat Rectus
EOM. r/o ptosis, pupillary abnormalities
Check that light source falls on pupils in same place
Ptosis, r/o
EOM intact
- damage to cerebral cortex, causes paralysis on contralat side….eyes
‘look at the lesion.’ The R lat rect and L med rectus have their
motor areas in the L cerebral hemisphere.
Check ‘ductions’ - EOM adduction movement w other eye covered.
Bilat adduction defect c/w internuclear opthalmoplegia seen in MS….but the eyes can converge because the
pathway for convergence is diff then that for lat conjugate
gaze.
V - Trigeminal Nerve
Inspect face for atrophy/tremors
Palp jaw mm
Test superficial pain and touch in ea branch
If there are unexpected findings, test temperature
Test corneal reflex (afferent V, efferent VII)
VII - Facial Nerve
Inspect facial symmetry
Wrinkle forehead,, show teeth, whistle, close eyes tight, puff out
Cheeks
Taste ant 2/3 of tongue; test on each side (sweet and salty)
Sometimes w dysfnctn there is hyperacusis (dampens stapedius)
VIII Acoustic Nerve
Whisper; talk w back turned away
Weber and Rinne
Check for nystagmus – if horizontal, could be peripheral…other
Types are in the BS(if assoc w taste changes,
Swallowing probs, or speech, more likely BS)
IX, X Glossopharyngeal & Vagus Nerves
Listen for hoarseness
Say ‘ah’ and look for uvula deviation(to good side)
Gag reflex
Observe for swallowing difficulty
XI Spinal Accessory Nerve
Check SCM by having pt turn head to R and L against resistance
Check trapezius by shoulder shrug against resistance
XII Hypoglossal Nerve
Stick tongue out and move side to side
Test tongue strength
Assess lingual sounds: ‘l, t, d, n’
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