Primarily meant for 3rdyr students of Physiotherapy.

1. CRANIAL NERVE
EXAMINATION
SUVARNA GANVIR
PROFESSOR,
DVVPF’S COLLEGE OF PHYSIOTHERAPY ,
AHMEDNAGAR
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2. OBJECTIVES
At the end of the lecture the learner should be able to
 Enumerate Cranial Nerves
 Describe Function of each cranial Nerve
 Describe assessment of each Cranial Nerve along
with abnormal findings and possible cause of lesion.
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3. CRANIAL NERVES
I Olfactory Nerve- Sensory
II Optic Nerve- Sensory
III Occulomotor Nerve- Motor
IV Trochlear Nerve- Motor
V Trigeminal Nerve- Sensory
and Motor
VI Abducent Nerve- Motor
VII Facial Nerve- Sensory and Motor
VIII Vestibulocochlear Nerve- Sensory
IX Glossopharyngeal Nerve- Sensory
and Motor
X Vagus Nerve- Sensory and Motor
XI Spinal accessory Nerve- Motor
XII Hypoglossal Nerve- Motor
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4. I OLFACTORY NERVE
FUNCTION- Smell
Test sense of smell on each side (close off
other nostrils) with the help of odour of
common items such coffee, soap, cloves
etc.
Abnormal findings- anosmia (inability to
detect smells), seen with frontal lobe lesion.
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5. II OPTIC NERVE
FUNCTION- Vision
Test visual acuity.
 Central: Snellen eye chart; test each eye separately, test at
distance of 20 ft. note the number of line which patient can
clearly see.
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6. Test peripheral vision by confrontation method .
Each quadrant is checked by asking the patient to
fix his gaze straight forward and therapist
showing different numbers with fingers in each
quadrant which patient has to identify.
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7. field defect homonymous hemianopia.
Abnormal findings- blindness,
myopia (impaired far vision),
Presbyopia (impaired near vision)
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8. III OCCULOMOTOR
FUNCTION- Pupillary reflex
 Pupillary reactions is tested by having
the patient stare into the distance as
the examiner shines penlight obliquely
into each pupil.
 Abnormal findings- absence of pupillary
constriction.
 Examine pupillary size/shape- Anisocoria
(unequal pupils)
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9. III, IV & VI
OCCULOMOTOR, TROCHCLEAR, ABDUCENT
NERVE
FUNCTION- Extraocular Movements
 Patient is asked to look in each direction
and follows moving finger in the figure
of H without moving the head .
 Abnormal findings- Strabismus, double
vision, impaired eye movements
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10. 10

11. V - TRIGEMINAL NERVE
FUNCTION- Sensory- Face
 Test pain, light touch sensations-forehead,
cheeks ,jaw simultaneously on both sides.
 Test corneal reflex-touch lightly with wisp of
cotton in the outer corner and blinking
occurs.
 Abnormal findings-loss of facial sensation,
Trigeminal neuralgia
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12. V- TRIGEMINAL NERVE
FUNCTION- Motor- Muscles of mastication
 Palpate temporal and masseter muscles.
 Have patient clench teeth, or hold jaw
against resistance.
 Abnormal- Weakness, wasting of muscles
when opened, deviation of jaw to ipsilateral
side.
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13. VII- FACIAL NERVE -
MOTOR
FUNCTION- Facial Expression
 Test motor function facial muscle. Raise
eyebrows, frown, show teeth, smile, close
eyes tightly, puff out both cheeks.
 Abnormal findings- paralysis- inability to
close eye, drooping corner of mouth,
difficulty with speech articulation.
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14. VII- FACIAL NERVE- SENSORY
FUNCTION- Taste to anterior two thirds of
tongue.
 Apply saline solution and sugar solution using a
cotton swab.
 Abnormal findings- incorrectly identifies
solution.
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15. VIII -VESTIBULOCOCHLEAR
NERVE
vestibular functions
 Test eye-head coordination: vestibular ocular
reflex (VOR)
 With patient’s eyes fixed rotate head by 20 deg
and take back to midline rapidly. Look for the
movement of eyes
 Abnormal findings- vertigo, disequilibrium.
Gaze instability with head rotation, nystagmus
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16. VIII - VESTIBULOCOCHLEAR
NERVE
Cochlear function
 Weber Test
 Rinne Test
 Abnormal findings- Unilateral or
bilateral conductive loss.
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17. IX & X - GLOSSOPHARYNGEAL AND
VAGUS NERVE
 Function- Phonation and Swallowing
 Listen to voice quality.
 Abnormal Findings- Dysphonia: hoarseness denotes
vocal cord weakness.
 Examine Swallowing function .
 Abnormal findings- Dysphagia.
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18. IX & X - GLOSSOPHARYNGEAL
AND VAGUS NERVE
 Function- Palatal, Pharyngeal control
 Have patients say 'ah' observe motion of soft
palate and position of uvula.
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19. Abnormal findings- Palate fails to
elevate-Lesion of CN 10;
Asymmetrical elevation with
unilateral paralysis.
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20. Gag reflex-
Stimulate back of the throat lightly
on each side- reflex contraction of
back and throat to remove the stimulus out.
Abnormal findings- absent reflex.
Lesion of CN 9 and possibly 10.
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21. XI -SPINALACCESSORY
NERVE
 Examine bulk of Trapeziums muscle
Abnormal finding- LMN: atrophy,
fasciculation, ipsilateral weakness
 Examine Strength of Trapeziums muscle-
shrug both the shoulder against resistance
Abnormal findings- inability to shrug
ipsilateral shoulder, shoulder droop.
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22. 22
Sternoceidomastoid muscle- Check for Bulk and
Strength
Strength - turn head each side against resistance for
checking strength of muscle on opposite side.
Abnormal findings- inability to turn the head opposite
side, weakness of ipsilateral sternocleidomastoid and
contralateral trapezius.

23. XII - HYPOGLOSSAL NERVE
Tongue movement
Listen to patient's articulation.
Abnormal findings- dysarthria.
Ask the patient to protrude tongue, move side to side .
Abnormal Findings - Impaired movements, deviation to
weak side.
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25. SUMMARY
 12 Cranial Nerves
Sensory or motor or sensory motor
Stimulus is followed by a response
Note abnormal findings
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26. Commonly asked questions
 Enumerate all cranial nerves- 3M
 Weber and Rinne test – 3M
 Gag Reflex – 3M
 Vestibulo Occular Reflex – 3M
 Test for Peripheral Vision – 3M
 Describe assessment of any one cranial
nerve 7M
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27. REFERENCE
Physical rehabilitation by Susan B O’Sullivan – 5th Edition
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