CRANIAL NERVES

HEMACHANDRAN G
BOT 2 ND YEAR
RA1821002010077
CRANIAL NERVES
1.Olfactory nerve
2.Optic nerve
3.Occulomotor nerve
4.Trochlear nerve
5.Trigeminal nerve
6.Abducent nerve
7.Facial nerve
8.Vestibulocochlear nerve
9.Glossopharanygeal nerve
10.
Vagus nerve
11.
Spinal nerve
12.
Hypoglossal nerve
 CRANIAL NERVE MAJOR FUNCTION
CRANIAL NERVE MAJOR FUNCTION
Facial nerve Controls most facial
Olfactory nerve Smell expressions, secretion of
tears and saliva, taste
Optic nerve Vision
Vestibulocholear nerve Hearing, equilibrium
Oculomotor nerve Eyelid eyeball sensation
movement Glossopharyngeal nerve Taste, senses cortid blood
pressure
Trochlear nerve Innervates superior Vagus nerve Senses aortic blood pressure,
oblique, turns eye slows heart rate, stimulus
downwards and digestive organs, taste
laterally
Spinal accessory nerve 1. Controls trapezius and
sternocleidmastoid
2. Control swallowing
Trigeminal nerve Chewing, face and
movements
mouth touch and pain
Hypoglossol nerve Controls tongue movements
Abducent nerve Turns eye laterally
CRANIAL NERVE-1. OLFACTORY
NERVE
◦ To check
◦ Hyperosmia is increased olfactory acuity/ hyperoosmia is diminished olfactory acuity.
◦ Anomisa, the inability to recognize odors, may be unilateral or bilateral.
◦ Dysosmia is an abnormal sense of smell.
Procedure:-
◦ Simulants: coffee powder, lemon, vanilla.
◦ Simulants in cotton procedure.
◦ Patient places an index finger over one nostril to block it. (E.g., right over one finger over right nostril).
◦ Closes eyes.
◦ Examiner with 30 cm from nostril take over STIMULANT, Minimal of 7 cm.
◦ Patient recognize smell and identify stimulant.
◦ NOTE: No cues, prompts.
CRANIAL NERVE-2. OPTIC
NERVE
◦ Visual Acuity(VA).
◦ Visual fields.

VISUAL ACUITY(VA):-
◦ Assess VA with a snellen chart. Keep glasses on to correct for any refractory errors.
◦ Stands the patient 6 cm away from the chart covering each eye separately with their hand in turn.
◦ Find the line of print which the patient can comfortably read at VA is expressed next to the smallest
line that was read.
◦ E.g., 6/24 is an individual standing 6m away from the chart and can only read letters that a normal
individual can read from 24m.
VISUAL FIELD:-
◦ Ask the patient to cover their left eye with their ledt hand and then cover your right eye with your
right hand. The patient must continue to look straight ahead.
◦ Move your hand to the patient‘s upper temporal visual field quadrant
◦ Gradually move your finger to the centre of their vision from the periphery and ask the patient to
inform you as seen as they see your finger moving.
◦ Repeat for the lower temporal, upper nasal and lower nasal fields, then repeat on other eye.
◦ Any abnormality: detected can be further assesed by perimetry Or Central fields assessment.
CRANIAL NERVE-3,4 & 6. OCCULOMOTOR,
TROCHLEAR & ABDUCENTS

◦ To check
1. Pupil
2. Ptosis
3. Occular movement
4. Diploplia-Double vision
5. Conjugate movement
6. Nystagmus
◦ Three lesion- Impairment of eye movement and disturbance in pupil response.
◦ PUPIL SIZE, SHAPE, TO TORCH
◦ TORCH NORMAL EYE: only pupil on that side constricts.
◦ TORCH AFFECTED SIZE: contralateral constricts-3 Nerve intact, absent in illuminated eye, affected.
◦ PTOSIS
1. Eyelid drops over pupil when eyes fully open.
2. 3rd nerve palsy/ sympathetic lesion.
OCCULAR MOVEMENT:-
◦ Steady patient head and ask to follow object of arms length.
◦ OBSERVE ROM, EYE MOVEMENTS.
◦ SIX DIFFERENT DIRECTIONS.
DIPLOPIA:-
◦ If present, note direction of maximum displacement of images, with coloured lens
source of outer image.
◦ EYE DEVIATE TO RIGHT & DOWNWARDS
CONJUGATE MOVEMENTS:-
◦Moving eyes together horizontally, vertically in fix.
NYSTAGMUS:-
◦Loss of normal balance of eye control slow drift in one direction
CRANIAL NERVE- 5,TRIGEMINAL NERVE:-
1.Opthalmic (V1, sensory).
2.Maxillary (V2,sensory).
3.Mandibular (V3, motor and sensory).
TEST:-
4.PAIN
5.TEMPERATURE
6.Light touch
7.Coroneal reflex
8.Motor examination
9.Jaw jerk
◦PAIN:- pin prick sensation over whole face.
◦TEMPERATURE:- cold objects or hot/cold tubes over whole face.
◦LIGHT TOUCH:- compare regions and side.
◦CORNEAL REFLEX:-
1.Touch with wrisp of wet Cotton wool BLINK RESPONSE BILATERALLY
2.PLACEMENT: afferent route-opthalmic division.
3.EFFERENT ROUTE: facial nerve.
◦MOTOR:-
◦Wasting of temporalis.
1.ASK TO CLAMP JAWS TOGETHER
2.ATTEMPT TO OPEN JAW BY PRESSURE ON THIN. Ask to open mouth, JAW DEVIATION TO
WEAK SIDE OF PTERYOID MUSCLE.
◦JAW JERK:-
1.Open mouth and relax jaw. Place E finger on chin and tap with hammer.
2.SLIGHT JERK NORMAL.
3.INCREASED JERK, CLOSURE-Bilateral Upper Motor Neuron Lesion(UMNL).
CRANIAL NERVE-7. FACIAL
NERVE
◦ OBSERVES TALK AND SMILES
1. Eye closure
2. Asymmetrical elevation of one corner of mouth.
3. Flattening nasolabial fold.
◦ INSTRUCTIONS:-
1. Wrinkle forehead(FRONTALS, by looking upwards)
2. Close eyes when examiner attempts to open them(ORBICULARIS OCULI)
3. Pursue lips while examiner presses cheeks(Biccinator).
4. Show teeth(ORBICULARIS ORIS)
5. TASTE:- using sugar, sodium chloride, small quantity over anteriorly on protruded tongue.
CRANIAL NERVE-8. AUDITORY
NERVE
◦ Test by whispering numbers into 1 ear occluding other. If found impaired, if exclude wax/infection
on examining external meatus and tympanic membrane.
◦ DIFFERENTIATE:- middle ear Deafness from nerve Deafness
1. WEBER‘S TEST
2. RINNE‘S TEST
WEBER‘S TEST:-
◦ Base of tuning fork(512Hz) against vertex.
◦ Ask if sound heard more in one ear.
1. NORMAL HEARING:- equally heard.
2. CONDUCTIVE DEAFNESS:- louder in affected ear.
3. NERVE DEAFNESS:- louder in normal ear.
RINNE’S TEST:-
◦ Base of vibrating tuning fork against MASTOID BONE.
◦ Ask patient when note heard. When note disappear hold tuning fork near EXTERNAL MEATUS
patient should hear since air conduction via ossicles better than bone conduction.
1. CONDUCTIVE DEAFNESS:- bone better than air.
2. NERVE DEAFNESS:- air better than bone.
3. AUDIOMETRY:- use of pretaped with masking noise in one side of head phone.
VESTIBULAR FUNCTION:-
◦ Head thrust test.
◦ Rotate head: normal responses in both eyes (gaze maintained)
◦ Rotate head: rotation of head to affected side- eyes drift to the affected followed by catch up
saccade.
CRANIAL NERVE-9,10.
GLOSSOPHARYNGEAL,VAGUS NERVE
◦ Mostly together.
◦ VOCAL CORD PARESIS- high pitched on noting patient‘s voice.
◦ Any SWALLOWING DIFFICULTY, nasal reguritation of fluids.
◦ “Ah” By patients to open mouth-ASSYMETRY PALATAL MOVEMENTS, WEAKNESS Noted.
GAG REFLEX:-
◦ Depress patient tongue and touch palate, pharynx or tonsil on one side until GAGS, compare
sensitivity and symmetry of contraction of palate.
◦ ABSENT GAG REFLEX= Loss of sensation/ loss of motor power.
CRANIAL NERVE-11. ACCESSORY
NERVE
◦ Sternomastoid
◦ Trapezius

1. STERNOMASTOID:- Ask patient to rotate against resistance, compare bulk and power on each
side with pulling against resistance.
2. TRAPEZIUS:- Shrug shoulders and hold them against resistance compare power on each side.
Should manage no to be depress.
CRANIAL NERVE-12.
HYPOGLOSSAL NERVE
◦ Open mouth
◦ Inspect tongue
◦ LOOK- atrophy (increase folds, wasting); fibrillation (small wriggling movements).
◦ Ask to protrudge tongue. Note any difficulty or deviation. Deviation to weak side. Non-protuded
tongue cannot move to opposite side.
◦ Dysarthria, dysphagia minimal.

◦ HYPOGLOSSAL NERVE INJURY:-

1. TEST:- Ask patient to stick out tongue.
2. SYMPTOMS OF NERVE INJURY:- when paralyzed, the tongue will point to the damaged
side.
THANK YOU