6. OLFACTORY NERVE
• Conveys the special
sensory information
related to smell.
• Shortest of the cranial
nerves
• It enters the skull
through the cribriform
plate of the ethmoid
bone
12. • Carefully look at head
position
• Position of eyelids
• Proptosis (forward
bulging of the eye)
• Lid lag- occurs in thyroid
eye disease, sclera can
be seen above the eyes.
Ask the
patient
whether they
have any
difficulty with
their vision
20. ABNORMAL FINDINGS
• The first plate is a test plate, if
the patient cannot see the
number – they have poor
visual acquity or functional
visual loss
• Congenital red green
blindness-x linked recessive
condition – affects-7% male
population,
• Optic nerve damage anywhere
from the photo receptors to
the lateral geniculate nucleus
of the thalamus impairs red
green colour vision before the
loss of visual acquity.
23. 3,4,6 CRANIAL NERVES
• Motor activity affecting the direction of gaze, the
position of the eyelids, and the size of the pupils are
served by the cranial nerves 3,4 and 6.
• These 3 are examined together
• Inspect the patients eye for ptosis, proctosis, squint,
shape size and symmetry of pupil.
• Examine Extra occular movements of the eyeball.
28. TRIGEMINAL NERVE
• Provides sensation to
the face , mouth, and
part of the dura and
motor supply to the
muscles of jaw.
• Largest cranial nerve
EXAMINATION
• Sensory
• motor
• Corneal reflex
• jaw jerk
30. MOTOR EXAMINATION
• Inspect for wasting of
muscles-temporalis
• Clench jaw- feel for
massetor- estimate bulk
• Open jaw against
resistance
• Jaw- deviates to one
side- pterygoid muscle
weakness
33. ABNORMAL FINDINGS
• Unilateral loss of sensation
in one or more branches of
5th nerve – result from
direct injury - facial
fractures or local invasion
by cancer
• Lesions within the
cavernous sinus- eg- cancer-
often result in loss of
corneal reflex
• Herpes zoster- reactivation
of latent herpes varicella
zoster- can affect any dorsal
root ganglion of sensory
nerves, the opthalmic
division of trigeminal nerve
is most commonly affected
Abrisk jaw jerk- psuedo bulbar
palsies, (upper motor
neurone lesions)
Trigeminal neuralgia
Chronic pain disorder that
affects the trigeminal nerve.
Symptoms:
typical:- episodes of severe,
sudden shock like pain in
the side of the face.
Atypical:-constant burning
pain
34. FACIAL NERVE
• It sends motor fibres to
the muscles of facial
expression, para
sympthathetic
secretomotor fibres to
the lacrimal, sub
mandibular,
sublingual,salivary glands.
• It receives taste sensation
from the anterior 2/3rd of
the tongue.
• Obseve the patient for
any facial assymmetry
• Impaired blinking
• Symmetry of naso labial
folds
• General symmetry of face
36. ABNORMAL FINDINGS
• In unilateral lower motor 7th nerve lesion- weakness of
both upper and lower facial muscles
• Bells palsy- acute motor neurone 7th nerve paralysis
• Bells phenomenon- patient is unable to close the eyes.
• In unilateral 7th nerve upper motor neurone lesion,
weakness( facial paresis) is marked in the lower facial
muscles, naso labial folds will be flattened, corner of the
mouth will be drooping, eye closure will be preserved.
• Facial palsy
• In parkinsons disease- result in a loss of spontaneous facial
movements
• Ramsay hunt syndrome- occurs in herpes zoster infection-
produces severe lower motor neuron facial palsy,ipsilateral
loss of taste, buccal ulceration.
39. RINNES TEST
• Normal-Air conduction
should be greater than
bone conduction ,so the
patient should able to hear
the tuning fork next to the
outer ear after- no longer
heard at mastoid.
• Abnormal- Not hearing
the tuning fork after its
moved from the
mastoid to pinna.
Bc>AC.
40. ABNORMAL FINDINGS
WEBERS TEST
In symmetrical hearing loss-
the sound heard in the
middle.
• Heard loudest in the ear
with conductive deafness
• In unilateral sensori neural
deafness the sound is
loudest in the un affected
ear.
RINNES TEST
• If the sound is louder at the
ear canal , the test is
positive,AC>BC- Normal.
• Sound is louder on the
mastoid process, the test is
negative, BC>AC.
• RINNES TEST is negative in
conductive deafness
• A positive rinnes with a
webber reffered to the
deafer ear indicates
relatively mild conductive
deafness.
41.
42. GLOSSOPHARYNGEAL AND VAGUS
• Both contain sensory , motor and autonomic
components,
• GP N- Mainly carries sensation from the pharynx ,
tonsils and taste sensation from the posterior 2/3rd
of the tongue.
• VN- Innervates upper pharyngeal ,laryngeal muscles
44. ABNORMAL FINDINGS
• Isolateted unilateral 9th nerve lesions are rare.
• Damage of vagus- deviation of the uvula when the soft palate is
elevated.
• Reccurent damage of laryngeal branch of 10th nerve- due to
• Lung cancer
• Thyroid surgery
• Mediastenal tumors
• Aortic arch aneurysm
• B/L 10th nerve lesions cause-
• Bulbar palsy
• pseudo bulbar palsy
• Unilateral lesions of 9th and 1oth nerve
• Skull base tumors
• Skull base fracture
• lateral medullary syndrome
45. ACCESSORY NERVE
• 2 Components-
• Cranial part closely related to the vagus
• A spinal part which provides fibres to the
upper trapezius and the sterno cleido mastoid.
47. ABNORMAL FINDINGS
• Isolated 11th nerve lesions are rare but the
nerve may be damaged during surgery in the
post triangle of neck, penetrating injuries,
local invasion by tumour
• Wasting of trapezius
• Wasting and weakness of sterno cleido
mastoid- mainly seen in dystrophia myotonica,
motor neuron disease.
