CRANIAL NERVE

Cranial Nerve Introduction Assessment

Introduce CN What cases it is Procedure Normal Findings Abnormal Findings

normally
assessed

I Function: Dysosmia, Get non-noxious Pt will be able to Anosmia - inability

Olfactory (S) smell Anosmia, odors like mga smell and recognize to detect smell
reception and Hyposmia, coffee or tobacco odors (seen in patients
interpretation Hyperosmia, while the pt eyes with frontal lobe
Head injury, are closed lesions)
Most commonly Brain injury, putting the odors
injured CN in Stroke in one nostril
head trauma separately

II Function: Left side Snellen chart Pt will have 20/20 Blindness -

Optic (S) visual acuity hemiplegia (for visual acuity) vision Hemianopsia (½
and visual field - have the patient visual field loss)
stand 20 feet
from the eye Bilateral
chart and read hemianopsia
the smallest line (tunnel vision)
they can read
easily. Progress Quadrantanopia
down the chart (¼ visual field loss)
until they reach a
line where at
least 2 errors are
made.

Confrontation
test (for visual Unimpaired visual
field screening) - field
have the patient
cover one eye
and look directly
into your eye or
nose. Use your
hand to see
where the patient
can begin to see
in all fields

Pupillary light
response - Pt’s eye will constrict
shine a light on a
patient's eyes
(while blocking
 the other eye)
and observe for
constriction on
the same side.
(also tested on
CN III)

III, IV, VI Oculomotor: Horner’s Ask the patient to Pt will be able to Ptosis - inability to
Oculomotor (M) raise eyelids, syndrome, Bell’s watch the tip of follow H pattern open eyelids
Trochlear most extraocular palsy, MS, your finger with Mydriasis
Abducens movement Meningitis, his/her eyes only
Hypertension, while you trace
(P) pupillary Diabetes, an H-pattern in Vertical diplopia
consideration, Aneurysms, the air. when looking
change in lens Brain herniation downward;
shape For (P) on CN III Pt will have compensatory
Accommodation accommodation head tilt to
Trochlear: reflex and reflex (pupil will opposite shoulder
(M) downward, accommodation dilate when looking
inward eye convergence at a far object; pupil
movement reflex-- have the will constrict when Internal
patient look at a focuses on near strabismus,
Abducens stick then move it object) and inability to abduct
(M) lateral eye towards and accommodation the eye
movement away the face of convergence reflex
the pt (adduction of eye Accommodation
when pt looks at reflex and
close object) accommodation
convergence
reflex-

V Function: (S) Ask pt to Pt will be able to Loss of

Trigeminal (S) pain and close eyes and distinguish between proprioception of
temperature of TMJ d/o, distinguish sharp and soft touch. face, Loss of
face; sensation Trigeminal between sharp sensation of face,
for anterior neuralgia, Head and soft touch on Pt will have a Trigeminal
tongue trauma, Tumor, the maxilla and functional movement neuralgia
Cluster mandible. of jaw
(M) headache Mastication
mastication/jaw (M) Put fingers problem
reflex on bilat.
Masseters and
Largest cranial temporalis
nerve muscle and ask
to bite down.

Jaw Jerk Relfex

VII Function: (S) ask the pt to (S) pt will be able to Pt will have
Facial (S) Taste to ant Bell’s palsy, identify familiar identify the taste difficulty correctly
 ⅔ of the tongue Ramsey-hunt tastes such as identifying taste on
and pharynx syndrome, sweet, bitter, the right side of the
stroke, GBS, sour etc. tongue
(M) Facial mm Aneurysm,
expression Traumatic (M) Ask the (M) pt will be able to (M) pt will show
except jaw close injury, Tumor patient to frown, do facial expressions weakness on the
eyelids, labial smile, blow and symmetrically affected of the face
speech wrinkle brow and unable to do
facial expressions
(P) Secretion of
saliva

VIII Function: Paget’s disease (E) ask the pt to (E) pt will be able to Vertigo- the
Vestibulocochl (S) hearing and of the bone, march in place march in place c illusions of a
ear equilibrium Vertigo, with closed eyes closed eyes s falling spinning
Vestibular movement
neuritis, (H) tap a tuning (H) pt will be able to
Labyrinthitis, fork and place to hear it equally on Nystagmus- rapid
Acoustic the vertex of the both ears and uncontrolled
neuroma pt’s head then movement of the
ask the pt if eye
he/she hears it
louder then the
other ear

IX Function: GBS,
Glossopharyn (S) nasopharynx, Dysphagia, (S) pt will be (S) pt should elicit Dysphonia- having
geal gag reflex, taste Dysphonia, asked to open gag reflex an abnormal voice
on post ⅓ of Glossopharynge his/her mouth
tongue al neuralgia while PT will Dysphagia-
touch his/her difficulty in
(M) voluntary throat with a swallowing
muscle for tongue depressor
swallowing and
phonation (M) pt will be (M) pt’s uvula wont
asked to open deviate on either
(P) saliva their mouth and both side and will not
production say “AHH” and have a difficulty in
PT will observe if swallowing
the uvula is
deviating on one
side

X Function: Polio, GBS, IBS Ask the pt to Pt will have no

Vagus (S) sensation of swallow and difficulty in
pharynx speak swallowing and will
be able to speak
(M) Motor audibly
function in
pharynx and
 vocal cords

(P) secretion of
digestive system,
peristalsis,
carotid reflex,
lungs and
digestive tract

XI Function: Polio, GBS, Pt will be asked Pt should be able to Pt will elicit

Accessory (M) Innervates neuropathy to shrug his shrug shoulders and weakness and
SCM and Upper shoulder against turn head from side when they contract
trapz resistance from to side the neck muscles,
PT’s hands and the affected side
turn his head will be absent
side to side showing atrophy
against PT’s
resistance

XII Function: Polio, Ask the pt to Pt should be able to Atrophy and

Hypoglossal (M) Tongue syringomyelia , protrude tongue move its tongue Fasciculations
movements Amyotrophic at midline then without any difficulty which leads to a
lateral sclerosis, move it from side tongue deviation
Multiple to side because of
sclerosis, GBS, I want you to weakness of the
Sarcoidosis, stick your tongue intrinsic muscles
Progressive out all the way
bulbar palsy, out and move it
Aneurysm, in and out then
Kennedy’s side to side.
disease, Then can you
Aneurysm at close your mouth
brain base, and put your
Unilateral 12th tongue over to
nerve palsy, this cheek and
Motor neuron push it out hard
diseases, then now the
Progressive other side.
bulbar palsy

VIDEO SOURCE
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