CRANIAL NERVE EXAM

Cranial Nerve I (Olfactory nerve)

-Responsible for the sense of smell

-Type: Sensory

To test the adequacy of function of the olfactory nerve:

 The client is asked to close his eyes and occlude.

 The examiner places aromatic and easily distinguish nose. (E.g. alcohol,
vinegar, coffee).

 Ask the client to identify the odor.

 Each side is tested separately, ideally with two different substances.
CRANIAL NERVE II (OPTIC NERVE)

-responsible for the sense of vision

-is assessed by testing for visual acuity and peripheral vision

-Type: Sensory Nerve

Visual acuity
- is tested using a snellen chart and E chart.
E chart- is used for those who are illiterate and unfamiliar with the
western alphabet, the illiterate E chart, in which the letter E faces in
different directions, maybe used.
SNELLEN CHART

 The chart has a standardized number at the end of each

line of letters; these numbers indicates the degree of visual
acuity when measured at a distance of 20 feet.

 The numerator 20 is the distance in feet between the chart

and the client, or the standard testing distance. The
denominator 20 is the distance from which the normal eye
can read the lettering, which correspond to the number at
the end of each letter line; therefore the larger the
denominator the poorer the version.
In testing for visual acuity you may refer to the
following:

 The room used for this test should be well lighted.

 A person who wears corrective lenses should be tested with and without them to check
for the adequacy of correction.

 Only one eye should be tested at a time; the other eye should be covered by an opaque
card or eye cover, not with client’s finger.

 Make the client read the chart by pointing at a letter randomly at each line; maybe
started from largest to smallest or vice versa.

 A person who can read the largest letter on the chart (20/200) should be checked if
they can perceive hand movement about 12 inches from their eyes, or if they can
perceive the light of the penlight directed to their yes.
Peripheral vision or visual fields

Visual field confrontation test

 provide a gross measurement of
peripheral vision.
Follow the steps on conducting the
test:
 The examiner and the client sit or stand opposite each other, with the eyes at the same,
horizontal level with the distance of 1.5 – 2 feet apart.
 The client covers the eye with opaque card, and the examiner covers the eye that is opposite to
the client covered eye.
 Instruct
the client to stare directly at the examiner’s eye, while the examiner stares at the client’s
open eye. Neither looks out at the object approaching from the periphery.
 Theexaminer hold an object such as pencil or penlight, in his hand and gradually moves it in
from the periphery of both directions horizontally and from above and below.
 Normally the client should see the same time the examiners sees it.

180 degrees- normal visual field.

Cranial Nerve III, IV & VI (Oculomotor,
Trochlear, Abducens)

All the 3 Cranial nerves are tested

at the same time by assessing the
Extra Ocular Movement (EOM) or
the six cardinal position of gaze.
Type: MOTOR
Procedure:
 Stand directly in front of the client and hold a finger or a penlight about 1 ft from the
client’s eyes.

 Instruct the client to follow the direction the object hold by the examiner by eye
movements only; that is without moving the neck.

 The nurse moves the object in a clockwise direction hexagonally.

 Instruct the client to fix his gaze momentarily on the extreme position in each of the six
cardinal gazes.

 The examiner should watch for any nystagmus.

NYSTAGMUS- jerky movements of the eye

-Normally the client can hold the position and there should be no nystagmus.
 CRANIAL NERVE V(Trigeminal Nerve)

Sensory function: Ipsilateral face general sensations(touch, pressure,

temperature, pain, vibration)
-responsible for the general sensation of Anterior 2/3 of the tongue

Motor function: supplies muscles of mastication.

 – Note any Wasting of muscles of mastication.

 – Ask the patient to clench his teeth, then feel the masseters & estimate their
bulk.
 – Ask the patient to open his jaw against the resistance of your hand, and
note any deviation.
2 REFLEXES

1. Corneal Reflex

-using a damp cotton wool; lightly touching the lateral

edge of the cornea while the patient looks upwards
2. Jaw Jerk or Reflex
-ask the patient to let his mouth hanging loosely open,
place your forefinger in the midline between lower lip and
chin then percuss finger with a hammer and note any reflex
(shutting of the jaw), normally it is absent.
CRANIAL NERVE VII (FACIAL NERVE)

Sensory Function:
-responsible for the Taste sensation of Anterior 2/3 of the
tongue
-by applying cotton buds on the patient’s tongue dipped in
Sugar, Salt, Vinegar, Quinine solutions, with rinsing his mouth
out between each test.
MOTOR FUNCTION: Facial Expressions

– Note any asymmetry (whole face, blinking, eye closure) or

flattening of the nasolabial folds.
– Ask the pt. to wrinkle the forehead or look up.
– Ask the pt. to bare his teeth.
– Ask the pt. to screw his eyes to keep them closed while you
are trying to open them.
– Ask the pt. to blow out his cheeks.
Reflexes:

– Corneal Reflex
– Glabellar tap produce blinking in response to the first
several taps.
CRANIAL NERVE VIII (AUDITORY OR
VESTIBULOCOCHLEAR NERVE)
2 BRANCHES:
a. Vestibular Branch- sensory nerve
-responsible for the EQUILIBRIUM
-assessment of same with cerebellar functions
b. Cochlear Branch-sensory nerve
-responsible for HEARING
-Assess clients ability to hear spoken word and
vibrations of tuning fork
CRANIAL NERVE
IX( GLOSSOPHARANGEAL NERVE)
TYPE:Motor and Sensory Nerve

-responsible for swallowing ability and gag reflex

- Responsible for tongue movement and taste (posterior
tongue)
CRANIAL NERVE X(VAGUS NERVE)

TYPE: Motor and sensory nerve

-responsible for the Sensation of pharynx and larynx

-responsible for swallowing
-responsible for vocal cord movement
GAG REFLEX
-Both Glossopharyngeal Nerve and Vagus Nerve are being
assessed.
-Unpleasant test
-use the more reliable Water Swallow test instead (in fully
conscious patients) and observe for absent swallow, cough or
delayed cough, or change in voice quality.
 – Say “Ah”, and look at the movements of the palate &
uvula.
 – Ask the patient to puff out his cheeks with the lips tightly
closed and feel for air escaping from their nose.
CRANIAL NERVE XI(ACCESSORY NERVE)

TYPE: Motor nerve

-responsible for head movement

-responsible for shrugging of shoulders
-Ask client to shrug shoulders against resistance from your hands and turn
head to side against resistance from your hand (repeat on the other side)
-Observe for any shoulder or neck muscle wasting or hypertrophy.
-Shrug Shoulders against resistance.
-Turn Head against Resistance.
CRANIAL NERVE XII( HYPOGLOSSAL
NERVE)
TYPE: Motor nerve

-responsible for protrusion of the tongue

-Ask client to protrude tongue at midline, then move it side to
side.
-Observe for Wasting, fasciculation or involuntary movement.
– Test power, by asking the patient to press his tongue against his
cheek while you apply pressure from the outside
– Assess speech & Swallowing