In the Name of ALLAH, Ever

Beneficent, Infinitely Merciful

Cranial Nerves
Dr. Saifullah Shaikh
MBBS, MSC, M.Phil., D.Diab
Associate Professor
Learning Objectives
Enlist the names of cranial nerves & classify
on the basis of functions

Discuss the cranial nerves with respect to:

Pathways
Clinical tests & interpretation with
Lesions
Cranial Nerves

There are 12 pairs of cranial nerves

Arise from all 3 parts of the brain

Classified on the basis of functions

Contain fibers in different functional categories

 Number Name
I Olfactory

e s
II Optic
r v III Oculomotor
N e
i al IV Trochlear

r an V Trigeminal

f C VI Abducent
t o
i s VII Facial
L VIII Vestibulocochlear
IX Glossopharyngeal
X Vagus
XI Accessory
XII Hypoglossal
 Cranial Nerves & their Arrangements
Number Name
First Olfactory From
Forebrain
Second Optic
Third Oculomotor From
Midbrain
Fourth Trochlear
Fifth Trigeminal
Sixth Abducent
From Pons
Seventh Facial
Eight Vestibulocochlear
Ninth Glossopharyngeal
Tenth Vagus
From Medulla
Eleventh Accessory Oblongata
Twelfth Hypoglossal
Functional Classification
Sensory (Special)
I, II & VIII

Motor (Somatic)
III, IV, VI & XII

Mixed (Sensory & Motor)

V,VII,IX,X &XI
Cranial nerves & their
Functions

Sense of
Olfactory
Smell
Cranial nerves & their
Functions

Optic Vision
Cranial nerves & their
Functions

Extra &
Oculomotor Intra ocular
muscles
Cranial nerves & their
Functions

Movement
Trochlear of eye
Cranial nerves & their
Functions

Muscles of
Trigeminal mastication
and face
Cranial nerves & their
Functions

Nerve to the
Abducent eyeball
Cranial nerves & their
Functions

Nerve of
facial
Facial
expression
Cranial nerves & their
Functions

Vestibulo Nerve of
Balance &
cochlear Hearing
Cranial nerves & their
Functions

Glosso Nerve of
pharyngeal Tongue &
Pharynx
Cranial nerves & their
Functions

Muscles of Soft
palate, pharynx,
Vagus larynx, thorax &
abdomen
Cranial nerves & their
Functions

Accessory Neck
muscles
Cranial nerves & their
Functions

Hypoglossal Muscles of
Tongue
The Olfactory Nerve
Pathway
It is the first cranial nerve
Carries the sense of smell
Receptors of smell are present in the upper posterior
part of the nasal mucosa

Fibers pass through the cribriform plate to the

olfactory bulb

Fibers from here pass through the olfactory tract to

the temporal lobe
 Testing Smell
 Exclude local nasal pathology

 Test each nostril separately

 Donot use irritating smells like ammonia
 Ask the patient whether he can appreciate
common smells
 Ask the patient to close the eyes and one nostril
 Present common smells like
Peppermint,cloveoil, kerosene oil, soap, fruit
 Ask him to snuff and identify them
 ANOSMIA

HALLUCINATIONS
PARASOMIA OF
SMELL

Interpretation of Olfactory
nerve
 • Head injury
• TB Meningitis
Anosmia • Tumor

• Perversion of smell
Parosmia & Psychogenic

• Sometimes
Hallucinations • Temporal lobe
epilepsy
The Optic Nerve
Anatomy

• It is the second cranial nerve

• It is a special sensory nerve

• Mediates the sense of vision

• Follows the visual pathway

Visual Pathway
• Fibers from retina converge at the optic disc

• Fibers from nasal half of each retina decussate at the optic

chiasma while

• Fibers from temporal half remain on the same side

• Thus, Optic tract formed

• The fibers of optic tract go to the lateral Geniculate body &

then pass through as Optic radiations
Visual Pathway
• One group of optic radiations passes through the temporal

lobe and other group through the parietal lobe

• Finally, they are projected to the calcarine sulcus (visual

area of the occipital lobe)

 Visual Acuity Color vision Field of
vision

Fundoscopy

EXAMINATION OF OPTIC NERVE

Visual acuity
• Test each eye separately , both for
near and far vision
• Near vision is tested by asking the
patient to read standard charts
• Ask the patient to read a book or
news paper keeping it at a distance of
10 inches from the eyes
• Far vision is tested by Snellens chart
which consists of letters & lines
• Normal vision is 6/6
Color Vision

• Ishihara chart are used for this

purpose

• Ask the patient to recognize various

colors
Field of Vision

• Proper method of testing the visual

field is by Perimetry
• Rough assessment can be made by
confrontation method in which
examiner compares his own visual
field with that of the patient
Fundoscopy

• Retina can be seen with the help of

an ophthalmoscope
• The part of retina through which
fibers of second nerve pass is called
as optic disc. It is paler than the rest
of retina
• Seen in diabetic patients
 ANOPIA
COMPLETE BLINDNESS

HEMIANOPIA OPTIC ATROPHY &

BITEMPORAL & NASAL PAPILLITIS

Interpretation of Visual field

defects
 DIPLOPIA

MYOPIA HYPEROPIA
NEAR SIGHTED FARSIGHTED

Interpretation of Optic nerve

defects
DIPLOPIA, MYOPIA & HYPEROPIA
Visual Reflexes associated with Visual
Pathway
Light Reflex

Consensual Pupillary light Reflex

Accommodation Reflex

Corneal Reflex
The Oculomotor, Trochlear &
Abducent Nerves
Functional Anatomy

• Oculomotor, Trochlear & Abducent are the 3rd, 4th &

6th cranial nerves
• 3rd cranial nerve is the largest of the motor cranial
nerve
• Divides in to intra cranial & intra orbital part
• Supply Ocular muscles of eye
 EXTRA OCULAR MUSCLES OF
EYE
LATERAL RECTUS

MEDIAL RECTUS

SUPERIOR RECTUS

INFERIOR RECTUS

SUPERIOR OBLIQUE

INFERIOR OBLIQUE
LEVATOR PALPEBRAE
SUPERIORIS
 INTRA OCULAR MUSCLES OF
EYE
CILIARY MUSCLES

SPHINCTER
PUPILLAE

DILATOR PUPILLAE
Nerve Supply of Ocular muscles

• All the extra ocular muscles are supplied by the 3rd

nerve except SO4 & LR6 (i.e. superior oblique by the
4th cranial nerve and lateral rectus by the 6th cranial
nerve)
Location of Nucleus

Oculomotor Nerve
(Lies in the midbrain)

Trochlear Nerve
(Lies in the midbrain)

Abducent Nerve
(Lies in the Pons)
EXAMINATION
The Oculomotor Nerve
• Stabilize the patient’s head with one hand
• Ask him to look straight at your finger held at a
distance of 2 feet and follow it
• Move your finger medially ( to test medial rectus)
• & then upwards (to test inferior obligue)
• Move the finger laterally & then upwards ( to test
superior rectus) &
• Then downwards (to test inferior rectus)
• Note any abnormality of eye movements
• Look for the size of the pupil
The Trochlear Nerve

• Ask the patient to follow your finger medially

& then upwards (to test superior obligue)
The Abducent Nerve

• Ask the patient to follow your finger laterally (to

test the lateral rectus muscle)
INTERPRETATION
 PTOSIS
(Drooping or falling of
Upper eye lid)

PUPIL SIZE NYSTAGMUS

DILATED & FIXED (Eyes move rapidly and
Uncontrollably)

Interpretation of 3rd, 4th & 6th

Cranial nerves
The Trigeminal Nerve
Functional Anatomy

• It is the 5th cranial nerve

• It is a mixed nerve

• It is the largest of the cranial nerves

• Give rise to 3 large branches, hence the name

trigeminal nerve
Ophthalmic
Maxillary
Mandibular
EXAMINATION
The Trigeminal Nerve (Test #1)
• Place your hands on the sides of the patients cheek,
fingers being on the temple
• Ask him to clench the teeth
• Your hand will feel contracting masseter and
temporalis muscles
In unilateral paralysis, muscles of the affected sides
will not contract
In bilateral paralysis jaw hangs loosely
The Trigeminal Nerve (Test #2)

• Ask the patient to open the jaw against

resistance to test the pterygoids of both sides
• Jaw will deviate towards weak side
The Trigeminal Nerve (Test #3)

• Ask the patient to open the mouth and hang the

jaw loosely
• Place your thumb or index finger over chin
and strike it with hammer
• There is a closure of jaw, if reflex is present
The Trigeminal Nerve (Test#4)

• Corneal & Conjunctival reflex

• Ask the patient to look medially

• Touch the cornea for corneal reflex &

• Conjunctive for Conjunctival reflex with a

• Wisp of cotton from the lateral side

• Normally there is blinking or closure of eyes

INTERPRETATION
 TRIGEMINAL
NEURALGIA

CEREBELLAR PONTINE BULBAR PALSY

TUMORS (LMN Palsy)

Interpretation of 5th Cranial

nerve
Thanks