14135832 all-cranial-nerves-examination

 The patient should be fully relaxed.
 Cooperation.
 Explain the procedure to the patient.
 Examination ONLY if indicated.
 Findings should be recorded one by one.
 Negatives are as important as positives.
 Full equipments for the different tests.
 The Anatomy should be reviewed.
drsherwanshal@gmail.com

 Examine both sides (Right and Left).
 Remind yourself whether the nerve is:
i. Motor – muscle supplied- ,
ii. sensory – areas covered- ,
iii. mixed,
iv. contains parasympathetic fibers – 3rd, 7th, 9th, 10th ,
v. involved in reflex as afferent or afferent.

 Higher cerebral functions.
 Meningeal irritation.
 Cranial nerve examination.
 Motor system.
 Autonomic system.
 Sensory system.
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Olfactory
I
Trigeminal
V
Glossopharyngeal
IX
Occulomotor
III
Facial
VII
Accessory
XI
Optic
II
Abduscens
VI
Vagus
X
Trochlear
IV
Vestibulochoclear
VIII
Hypoglossal
XII

 Ask the subject to recognize a
common type of smell e.g. oil of
peppermint.
 Loss of sense of smell is called
anosmia.
1/1

Investigate the following tests:
 Acuity of vision.
 Color vision.
 Field of vision (confrontation test).
 Fundoscopy (examination of the optic disc
by ophthalmoscope).
1/1

 The three nerves are examined together.
 They innervate the extrinsic muscles of
the eye.
 The recti muscles act as elevators and
depressors alone when the eye is in
abduction, and the obliques act
similarly when the eye is in adduction.
1/4

 In (VI) nerve paralysis, there is inability to
move the eye ball outwards (squint), the
eye turns medially due to unopposed
action of the medial rectus.
 Paralysis of medial rectus causes lateral
deviation of the eye.
 In (IV) nerve paralysis there is inability to
look down and outwards
2/4

a. Sensory division:
 Test for the sense of touch, pain and
temperature in the face, keeping in mind the
regions supplied by ophthalmic, maxillary &
mandibular divisions of the nerve.
 Reflex function: Test for corneal reflex
(afferent fibers are through 5th nerve and
efferent fibers through the 7th nerve).
1/2

b. Motor division:
- Ask the subject to clench his teeth and feel the
prominence of temporal and masseter muscles.
The muscles would remain soft on the paralyzed side.
- To test the function of pterygoid muscles ask the
subject to open the mouth, the lower
jaw moves towards the paralyzed side due to
unopposed action of the opposite
healthy pterygoid muscle.
2/2

A- Sensory division:
Test the anterior 2/3rd of the tongue for
the sense of taste using
strong solutions of sugar, salt, and
quinine.
1/3

b. Motor division: This is responsible for facial
expression, it is tested as follows:
 Ask the subject to wrinkle the forehead.
Wrinkles do not appear on the paralyzed side.
 Ask the subject to close his eyes forcibly and
you try to open them forcibly. In case
of paralysis, the eyes remain open or if
can be closed, they can be opened with
minimal force.
2/3

b. Motor division:
 Ask the subject to show his teeth & observe the nasolabial
folds and the angles of the
mouth. On the paralyzed side the nasolabial folds are
flattened and the angle of the
mouth seems to be drawn towards the healthy side.
 Ask him to whistle. It is not possible in case of 7th nerve
paralysis.
 Ask him to inflate the cheeks with air. Tap each cheek
lightly with a finger. On the
paralyzed side air escapes from the mouth.
3/3

 This is responsible for hearing and balance.
 Rinne’s test: Set a tuning fork into vibration and hold it
opposite the ear. When it can no more be heard, put its
base over the mastoid process. Normally it would not be
heard at this point also. In middle ear disease the
vibration will be heard over the bone after it could no
more be heard through the ear.
 In middle ear disease the bone conduction remains normal
when air conduction is diminished. In nerve deafness, air
conduction and bone conduction are equally diminished.
1/2

Weber’s test: A vibrating tuning fork is set
against the middle of the forehead of
the subject. He would hear better on
the side with middle ear deafness.
2/2

 Tickle the posterior wall of pharynx
and observe the pharyngeal reflex. The
afferent & efferent fibers of this reflex
lay in the 9th cranial nerve. The sense of
taste may also be tested over the
posterior 1/3rd of the tongue.
1/1

 Ask the subject to open his mouth and
say A-H-H-H- and observe the elevation
of the soft palate. On the side of lesion,
the soft palate is not elevated.
1/1

 Ask the subject to rotate the chin to
one side against resistance.
 Examine sternomastoid and trapezius
muscles for bulk and power of
contraction. Paralysis of stemomastoid
will produce failure to rotate the chin to
opposite side.
1/1

 Ask the subject to protrude his tongue
out.
 The tongue would be pushed towards
the paralyzed side.
1/1

Rt LtMR MR LRLR
SRSR
IRIR SO
IO

Optic Nerve
inflammed
Optic
Chiasma
Optic Tract
Post L.
geniculate
body
Occipital
Region
Optic Nerve
cut
Temporal
fibers
Post L
geniculate n.
Post L.
geniculate n.

1
Rt Lt
2
3
4
1
2
3
4
5
67 drsherwanshal@gmail.com

14135832 all-cranial-nerves-examination

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