Cranial nerve examination

A. Preparing the patient

(CN I) Olfactory nerve

B. procedure 1. Before starting, check that there is free flow of air by occluding each nostril in turn and asking the patient to sniff in. 2. ask the patient to close his/her eyes 3. Test one nostril separately at a time, by using a nonirritating smell such as tobacco, orange, vanilla, coffee, etc. 4. Ask the patient to identify each in turn. 5. If you do not have such tools available, ask the patient to close his/her eyes and then hold a bar of soap under the patient's nose for them to smell. 6. assess the response, loss of smell sensation is known as anosmia

(CN III, IV, VI) Oculomotor, trochlear and abducent nerves

These 3 nerves are examined together as they control the external ocular muscles. 1. Inspect the eyes. Look for ptosis and nystagmus. 2. Look at pupils: shape, relative size, they are equal in both sides I. External ocular muscles movements a- Test for ocular movements 3. Hold the patient's head still with the left hand 4. Hold out the extended right index finger about 40 cm in front of the patient. 5. Ask the patient to follow your finger with their eyes through the six principle positions of gaze. 6. There should be a full range of movements of both eyes 7. Examine each eye with the other covered. The patient should follow an object through the six principle positions of gaze so each extraocular muscle's function is tested. b- Test for conjugate eye movements 8. Ask the patient to look to the right, to the left, up and down 9. Observe the eye movements N.B. The movement of the two eyes should be symmetrical II. Pupillary Light Reflex The afferent or sensory limb of the pupillary light reflex is CN2 while the efferent or motor limb is the parasympathetics of CN3. 8. Shine a flashlight into each eye while the other eye is shielded 9. Note the direct as well as the consensual constriction of the pupils. III. Accommodation reflex 10. Ask the patient to look at far object and then at a near object 11. Observe the response: constriction of the pupils, convergence and increase diopteric power of the lens.