nerve abnormalities including VII (labial dysarthria), X (palatal dysarthria), or XII(lingual dysarthria). For simplicity, one can include speech under the mental statusexamination when a specific etiology for the speech difficulty is not clear.8.
The above guidelines are for a screening mental status examination only. There are manydifferent forms of the mental status examination that can be adapted to specificcircumstances.
Cranial Nerve Examination
If in doubt about whether or not a cranial nerve finding is abnormal,
check for symmetrybetween the two sides.I
– Smell (optional) – Testing smell is not part of a routine screening examination. Coffee, floralscents, or cloves are all adequate. Avoid using noxious odors (i.e. – ammonia, alcohol). Smelltesting is particularly useful when a subjective lack of taste or smell is a primary symptom. Twomost common causes – prior head trauma and smoking.
– Vision – Screen corrected (i.e.- with glasses) visual acuity with a vision card. Allow thepatient to hold the card. Screen for major visual field deficits by having the patient cover oneeye and identify an object (often a finger) in the center of each visual quadrant of each eye.
– Pupillary examination – Normal size in moderate light for adults is 3-4 mm. Larger inchildren and smaller in the elderly (senile miosis). Acceptable asymmetry is
1 mm. Check both direct and consensual reactions. For patients with a dark pigmented iris, try using a secondflashlight held from below or above the face to illuminate the pupils without causingconstriction.
III, IV, VI
– Extraocular movements. Check horizontal, vertical, and inferonasal (down and in)eye movements. Can the patient move the eyes from side-to-side fully so as to eliminate thesclera from view? Nystagmus is a rapid, beating movement of the eyes – (usually in a horizontalplane) that is triggered by eye movement. Remember that VI controls abduction and IV controlsinferonasal movement. III controls the other eye movements. Ask the patient to follow yourfinger with his/her eyes as you elicit the eye movements.
– Corneal response, facial sensation, and pterygoid power. Use a wisp of cotton and lightlytouch the cotton to the surface of each cornea. Note if both the direct and consensual cornealresponses are present. Check pin and light touch sensation on each cheek. Check pterygoidmuscle power by having the patient keep the jaw open against resistance provided by theexaminer’s hand. If the pterygoid muscles are weak, then the jaw will deviate toward the side of the weakness.
– Facial expression – Test the muscles of facial expression by having the patient raise theeyebrows, close the eyes tightly, and smile. Note any asymmetry in the extent of facialmovement and speed of movement on the two sides of the face.
– Hearing – Rub the fingers together by each ear so that the fingers can normally be heard,but no movement of the fingers or arms seen by the patient. Vestibular function is screened