SlideShare a Scribd company logo
neurology
cranial nerves examination
Dr mohamed rizk khodair
lecturer of neurology
October 6 university
Mohamedrizk.med@edu.edu.eg
‫والجراحة‬ ‫الطب‬ ‫كلية‬
Cranial nerves
Pathway of smell
From the receptors in the olfactory mucosa , the fibers of olfactory nerve pierce the cribriform plate of the
ethmoid bona and run in the olfactory groove to relay in the olfactory bulb , a new set of fibers travels in
olfactory tract to terminate in the olfactory sensory area in the uncus of the temporal lobe of both sides
1- Olfactory nerve examination
Familiar substance (mint - coffee ) .
Non irritant .
Each nostril alone .
Close the eye
Lesion in olfactory :
Anosmia: unilateral traumatic , inflammatory , neoplastic : foster Kennedy syndrome ( ipsilateral optic
atrophy due to direct pressure on optic nerve, contralateral papilledema due to increase ICT,
ipsilateral anosmia may occur due to pressure on the olfactory.
NB : Unilateral lesion of uncus doesn’t cause anosmia as the sense of smell is bilaterally represented .
Bilateral : ENT , hysterical , hereditary
Parosmia :( perverted sense of smell ) ‫متغيرة‬ ‫الراويح‬ ‫يشم‬ common in hepatitis and pregnancy
Olfactory hallucination : perception of smell usually unpleasant in absence of stimulus , due to
central olfactory affections ( temporal lobe epilepsy)
2-optic nerve
How to examine
• Visual acuity
• Color vision
• Visual field
• Fundus examination
Visual acuity
• Snellen chart .
• Counting finger 6 m to 30 cm
• Hand movement
• Perception of light
Color vision (ishihara color plates)
Field of vision
Confrontation test
Cranial Nerves: Optic
Pupil, acuity, Field, Fundi
By Confrontation test
→ Uniocular vision
→ Binocular vision
Ocular motility
Cranial Nerves: Conjugate Eye Movements
Oculomotor nerve palsy
Trochlear nerve palsy
Abducent nerve palsy
Partial or complete
ptosis
Pupil :
Size , shape , symmetry
Response to direct or indirect light reflex (ll,lll)
Accommodation reaction (ll,lll)
Ciliospinal reflex
Normal comment : Round regular reactive .
Causes of miosis : Horner syndrome (congenital or acquired ), pontine lesion, opiate toxicity
Causes of mydriasis : diminution of vision , drug , compression of 3rd CN
Each eye separate
Both eyes together
Spontaneous or with fixation
Horizontal or vertical or rotatory
Unilateral or bilateral
If it has rapid and slow phase ( direction of nystagmus is that of rapid phase)
Nystagmus
Trigeminal nerve
sensory
Pain , touch ,
Both side of the face
Ophthalmic , maxillary , mandibular
branches
The inner & outer part of the face
Motor examination of 5th Nerve :
Inspection : temporalis and masseter
palpation : temporalis , masseter
pterygoid : with and without resistance
unilateral : jaw is deviated to diseased side
bilateral : inability to open mouth
Reflexes :
Superficial reflexes : corneal & conjunctival reflexes (5&7)
Pathological reflexes : Jaw reflexes (5th&5th) normally : absent or minimally
exaggerated : bilateral UMNL above
pons
Cranial Nerves: Trigeminal: reflexes
Facial nerve :
How to examine
Muscle power
Frontalis , orbicularis oculi
Orbicularis oris , buccinators , retractor anguli
Reflexes :
Corneal reflex (5th& 7th)
Glabellar reflex (7th&7th)
Taste sensation
Facial nerve :
Upper half of face
Inspection : 1) lack of forehead corrugations
2) dribbling of tears
Palpitation :
Inability of elevate eyebrows properly
Eye can be easily opened by examiner
Glabber reflex
Normally : blinking bilateral (bilateral
contraction of orbicularis oculi ) blinking stops
after 2-3 contraction ( due to habituation )
Abnormally : lost in LMNL , exaggerated in
UMNL , persistent in parkinsonism
Lower half of face
Inspection : obliterated nasolabial fold
Deviation of the mouth to the healthy side
Dribbling of saliva , dropping of angle of mouth
Palpitation : inability to blow the check , inability to
whistle , inability to show teeth properly
Vestibulocochlear CN :
Cochlear : test for acuity of hearing
Rinne’s test : using vibrating tunining fork on mastoid process
Weber test : place tuning fork in the middle of head .
9th , 10th , 11th (cranial accessory)
CNS :
• Inspection : base of uvula , soft palate
• Palpation : use torch and tongue depressor and say ah and see the uvula
• Reflexes :
• palatal reflex (5th& 10th ) : normally stimulation of soft palate leads to its elevation .
• pharyngeal ( gag ) reflex(9th& 10th): normally stimulation of posterior pharyngeal wall lead to local
contraction and gag reflex
Exaggerated : in pseudobulbar palsy
Lost : in true bulbar palsy
Spinal accessory :
Inspection : shoulder , head
Palpation :
trapezius : ask patient to turn head rt and left , tested by asked patient to turn his chin against
resistant
Unilateral lesion : head is tilted to disease side
Sternomastoid : inspect shoulder depression , tested by elevation of shoulder against resistance
Inspection : tongue fasciculation ,tongue corrugation , wasting , abnormal movement
Palpitation : without resistant & with resistant
Hypoglossal Nerve
cranial nerve examination

More Related Content

What's hot

demyelinated disorder: multiple sclerosis.pptx
demyelinated disorder: multiple sclerosis.pptxdemyelinated disorder: multiple sclerosis.pptx
demyelinated disorder: multiple sclerosis.pptx
Mohamed Rizk Khodair
 
spinal cord disorders and paraplegia .
spinal cord disorders  and  paraplegia .spinal cord disorders  and  paraplegia .
spinal cord disorders and paraplegia .
Mohamed Rizk Khodair
 
Cranial nerve examination
Cranial nerve examinationCranial nerve examination
Cranial nerve examination
Aamir Hela
 
Physiology (sensory examination tests)
Physiology (sensory examination tests)Physiology (sensory examination tests)
Physiology (sensory examination tests)
Osama Al-Zahrani
 
Forgotten reflex testing
Forgotten reflex testingForgotten reflex testing
Forgotten reflex testing
Randy Rosenberg MD FAAN FACP
 
Clinical examination of cranial nerves
Clinical examination of cranial nervesClinical examination of cranial nerves
Clinical examination of cranial nerves
Oriba Dan Langoya
 
Cranial nerve examination
Cranial nerve examinationCranial nerve examination
Cranial nerve examination
Irfan Ziad
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .
Mohamed Rizk Khodair
 
Cranial nerve-examination.ppt
Cranial nerve-examination.pptCranial nerve-examination.ppt
Cranial nerve-examination.ppt
ShiwaniRedij1
 
Cranial nerve examination
Cranial nerve examinationCranial nerve examination
Cranial nerve examination
Johny Wilbert
 
Superfacial reflex
Superfacial reflex Superfacial reflex
Superfacial reflex
Ashaq Al-Qahtani
 
Oculomotor nerve
Oculomotor nerveOculomotor nerve
Oculomotor nerve
Amr Hassan
 
Pons anatomy and syndromes
Pons anatomy and syndromesPons anatomy and syndromes
Pons anatomy and syndromes
Amruta Rajamanya
 
Sensory disturbances
Sensory disturbancesSensory disturbances
Sensory disturbances
Helao Silas
 
Cranial nerves examination....
Cranial nerves examination....Cranial nerves examination....
Cranial nerves examination....
abeerabdulkareem
 
Brainstem syndrome vinod (1)
Brainstem syndrome vinod (1)Brainstem syndrome vinod (1)
Brainstem syndrome vinod (1)
NeurologyKota
 
peripheral neuropathy (introduction and Gillian barre syndrome .pptx
peripheral neuropathy (introduction and Gillian barre syndrome .pptxperipheral neuropathy (introduction and Gillian barre syndrome .pptx
peripheral neuropathy (introduction and Gillian barre syndrome .pptx
Mohamed Rizk Khodair
 
Repetitive nerve stimulation test
Repetitive nerve stimulation test Repetitive nerve stimulation test
Repetitive nerve stimulation test
NeurologyKota
 
Examination of cranial nerve
Examination of cranial nerveExamination of cranial nerve
Examination of cranial nerve
Iram Anwar
 
Cranial nerve examination
Cranial nerve examinationCranial nerve examination
Cranial nerve examination
Bharath omfs
 

What's hot (20)

demyelinated disorder: multiple sclerosis.pptx
demyelinated disorder: multiple sclerosis.pptxdemyelinated disorder: multiple sclerosis.pptx
demyelinated disorder: multiple sclerosis.pptx
 
spinal cord disorders and paraplegia .
spinal cord disorders  and  paraplegia .spinal cord disorders  and  paraplegia .
spinal cord disorders and paraplegia .
 
Cranial nerve examination
Cranial nerve examinationCranial nerve examination
Cranial nerve examination
 
Physiology (sensory examination tests)
Physiology (sensory examination tests)Physiology (sensory examination tests)
Physiology (sensory examination tests)
 
Forgotten reflex testing
Forgotten reflex testingForgotten reflex testing
Forgotten reflex testing
 
Clinical examination of cranial nerves
Clinical examination of cranial nervesClinical examination of cranial nerves
Clinical examination of cranial nerves
 
Cranial nerve examination
Cranial nerve examinationCranial nerve examination
Cranial nerve examination
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .
 
Cranial nerve-examination.ppt
Cranial nerve-examination.pptCranial nerve-examination.ppt
Cranial nerve-examination.ppt
 
Cranial nerve examination
Cranial nerve examinationCranial nerve examination
Cranial nerve examination
 
Superfacial reflex
Superfacial reflex Superfacial reflex
Superfacial reflex
 
Oculomotor nerve
Oculomotor nerveOculomotor nerve
Oculomotor nerve
 
Pons anatomy and syndromes
Pons anatomy and syndromesPons anatomy and syndromes
Pons anatomy and syndromes
 
Sensory disturbances
Sensory disturbancesSensory disturbances
Sensory disturbances
 
Cranial nerves examination....
Cranial nerves examination....Cranial nerves examination....
Cranial nerves examination....
 
Brainstem syndrome vinod (1)
Brainstem syndrome vinod (1)Brainstem syndrome vinod (1)
Brainstem syndrome vinod (1)
 
peripheral neuropathy (introduction and Gillian barre syndrome .pptx
peripheral neuropathy (introduction and Gillian barre syndrome .pptxperipheral neuropathy (introduction and Gillian barre syndrome .pptx
peripheral neuropathy (introduction and Gillian barre syndrome .pptx
 
Repetitive nerve stimulation test
Repetitive nerve stimulation test Repetitive nerve stimulation test
Repetitive nerve stimulation test
 
Examination of cranial nerve
Examination of cranial nerveExamination of cranial nerve
Examination of cranial nerve
 
Cranial nerve examination
Cranial nerve examinationCranial nerve examination
Cranial nerve examination
 

Similar to cranial nerve examination

7cranialnerveexamination 131127045058-phpapp01-converted
7cranialnerveexamination 131127045058-phpapp01-converted7cranialnerveexamination 131127045058-phpapp01-converted
7cranialnerveexamination 131127045058-phpapp01-converted
Kanika Arora
 
cranial nerves .ppt
cranial nerves .pptcranial nerves .ppt
cranial nerves .ppt
aneesshahzad3
 
cranial nerves and their examination ppt
cranial nerves and their examination pptcranial nerves and their examination ppt
cranial nerves and their examination ppt
mehakkataria4
 
Cranial nerves - trigeminal and vestibulocochlear nerves
Cranial nerves - trigeminal and vestibulocochlear nervesCranial nerves - trigeminal and vestibulocochlear nerves
Cranial nerves - trigeminal and vestibulocochlear nerves
Chetan Ganteppanavar
 
CRANIAL NERVE EXAMINATION.pptx
CRANIAL NERVE EXAMINATION.pptxCRANIAL NERVE EXAMINATION.pptx
CRANIAL NERVE EXAMINATION.pptx
Nerusu sai priyanka
 
Cranial nerve examination
Cranial nerve examinationCranial nerve examination
Cranial nerve examination
Pritom Das
 
Cranial nerve examination
Cranial nerve examinationCranial nerve examination
Cranial nerve examination
Gagan Gupta
 
Nervous system exam part 1
Nervous system exam part 1Nervous system exam part 1
Nervous system exam part 1
MUHAMMAD HOSSAIN
 
facialnerveexamination-2-191110162124.pdf
facialnerveexamination-2-191110162124.pdffacialnerveexamination-2-191110162124.pdf
facialnerveexamination-2-191110162124.pdf
revathypanchatcharam
 
Facial nerve examination . Cranial nerve 7
Facial nerve examination . Cranial nerve 7Facial nerve examination . Cranial nerve 7
Facial nerve examination . Cranial nerve 7
Chetan Ganteppanavar
 
cranial-nerve-examination-converted-part-1.docx
cranial-nerve-examination-converted-part-1.docxcranial-nerve-examination-converted-part-1.docx
cranial-nerve-examination-converted-part-1.docx
MUATAZ1
 
CRANIAL NERVE EXAMINATION
CRANIAL NERVE EXAMINATIONCRANIAL NERVE EXAMINATION
CRANIAL NERVE EXAMINATION
Jude Paul
 
Cranial Nerves.ppt
Cranial Nerves.pptCranial Nerves.ppt
Cranial Nerves.ppt
SchoolofOptometryPun
 
Cranial nerves
Cranial nervesCranial nerves
Cranial nerves
MHKseven
 
Cranial nerve assessment..Simple and Easy to perform for medics and Physiothe...
Cranial nerve assessment..Simple and Easy to perform for medics and Physiothe...Cranial nerve assessment..Simple and Easy to perform for medics and Physiothe...
Cranial nerve assessment..Simple and Easy to perform for medics and Physiothe...
pawan1physiotherapy
 
Applied neurosciences
Applied neurosciencesApplied neurosciences
Applied neurosciences
Ahmed Khalafalla
 
Facial nerve
Facial nerveFacial nerve
Facial nerve
Srinivas Kinjarapu
 
4151fb4f-e2a7-4fb0-a1f7-31482095aa13.ppt
4151fb4f-e2a7-4fb0-a1f7-31482095aa13.ppt4151fb4f-e2a7-4fb0-a1f7-31482095aa13.ppt
4151fb4f-e2a7-4fb0-a1f7-31482095aa13.ppt
ssuser618949
 
Cranial nerves examination
Cranial nerves examinationCranial nerves examination
Cranial nerves examination
Mohamed Ahmed Tarek
 
Cranial Nerve Clinical Examination IX TO XII
Cranial Nerve Clinical Examination IX TO XIICranial Nerve Clinical Examination IX TO XII
Cranial Nerve Clinical Examination IX TO XII
KhushbooGarg61
 

Similar to cranial nerve examination (20)

7cranialnerveexamination 131127045058-phpapp01-converted
7cranialnerveexamination 131127045058-phpapp01-converted7cranialnerveexamination 131127045058-phpapp01-converted
7cranialnerveexamination 131127045058-phpapp01-converted
 
cranial nerves .ppt
cranial nerves .pptcranial nerves .ppt
cranial nerves .ppt
 
cranial nerves and their examination ppt
cranial nerves and their examination pptcranial nerves and their examination ppt
cranial nerves and their examination ppt
 
Cranial nerves - trigeminal and vestibulocochlear nerves
Cranial nerves - trigeminal and vestibulocochlear nervesCranial nerves - trigeminal and vestibulocochlear nerves
Cranial nerves - trigeminal and vestibulocochlear nerves
 
CRANIAL NERVE EXAMINATION.pptx
CRANIAL NERVE EXAMINATION.pptxCRANIAL NERVE EXAMINATION.pptx
CRANIAL NERVE EXAMINATION.pptx
 
Cranial nerve examination
Cranial nerve examinationCranial nerve examination
Cranial nerve examination
 
Cranial nerve examination
Cranial nerve examinationCranial nerve examination
Cranial nerve examination
 
Nervous system exam part 1
Nervous system exam part 1Nervous system exam part 1
Nervous system exam part 1
 
facialnerveexamination-2-191110162124.pdf
facialnerveexamination-2-191110162124.pdffacialnerveexamination-2-191110162124.pdf
facialnerveexamination-2-191110162124.pdf
 
Facial nerve examination . Cranial nerve 7
Facial nerve examination . Cranial nerve 7Facial nerve examination . Cranial nerve 7
Facial nerve examination . Cranial nerve 7
 
cranial-nerve-examination-converted-part-1.docx
cranial-nerve-examination-converted-part-1.docxcranial-nerve-examination-converted-part-1.docx
cranial-nerve-examination-converted-part-1.docx
 
CRANIAL NERVE EXAMINATION
CRANIAL NERVE EXAMINATIONCRANIAL NERVE EXAMINATION
CRANIAL NERVE EXAMINATION
 
Cranial Nerves.ppt
Cranial Nerves.pptCranial Nerves.ppt
Cranial Nerves.ppt
 
Cranial nerves
Cranial nervesCranial nerves
Cranial nerves
 
Cranial nerve assessment..Simple and Easy to perform for medics and Physiothe...
Cranial nerve assessment..Simple and Easy to perform for medics and Physiothe...Cranial nerve assessment..Simple and Easy to perform for medics and Physiothe...
Cranial nerve assessment..Simple and Easy to perform for medics and Physiothe...
 
Applied neurosciences
Applied neurosciencesApplied neurosciences
Applied neurosciences
 
Facial nerve
Facial nerveFacial nerve
Facial nerve
 
4151fb4f-e2a7-4fb0-a1f7-31482095aa13.ppt
4151fb4f-e2a7-4fb0-a1f7-31482095aa13.ppt4151fb4f-e2a7-4fb0-a1f7-31482095aa13.ppt
4151fb4f-e2a7-4fb0-a1f7-31482095aa13.ppt
 
Cranial nerves examination
Cranial nerves examinationCranial nerves examination
Cranial nerves examination
 
Cranial Nerve Clinical Examination IX TO XII
Cranial Nerve Clinical Examination IX TO XIICranial Nerve Clinical Examination IX TO XII
Cranial Nerve Clinical Examination IX TO XII
 

More from Mohamed Rizk Khodair

Dementia (Alzheimer & vasular dementia).
Dementia (Alzheimer & vasular dementia).Dementia (Alzheimer & vasular dementia).
Dementia (Alzheimer & vasular dementia).
Mohamed Rizk Khodair
 
Primary headache and facial pain. (2024)
Primary headache and facial pain. (2024)Primary headache and facial pain. (2024)
Primary headache and facial pain. (2024)
Mohamed Rizk Khodair
 
epilepsy and status epilepticus for undergraduate.pptx
epilepsy and status epilepticus  for undergraduate.pptxepilepsy and status epilepticus  for undergraduate.pptx
epilepsy and status epilepticus for undergraduate.pptx
Mohamed Rizk Khodair
 
cerebrovasular disease(ischemic, ICH & SAH).pptx
cerebrovasular disease(ischemic, ICH & SAH).pptxcerebrovasular disease(ischemic, ICH & SAH).pptx
cerebrovasular disease(ischemic, ICH & SAH).pptx
Mohamed Rizk Khodair
 
introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)
Mohamed Rizk Khodair
 
Myasthenia gravis
Myasthenia gravisMyasthenia gravis
Myasthenia gravis
Mohamed Rizk Khodair
 
movement disorder for physiotherapy .pptx
movement disorder for physiotherapy .pptxmovement disorder for physiotherapy .pptx
movement disorder for physiotherapy .pptx
Mohamed Rizk Khodair
 
SAH
SAHSAH
ataxia
ataxia ataxia
myopthies.pptx
myopthies.pptxmyopthies.pptx
myopthies.pptx
Mohamed Rizk Khodair
 

More from Mohamed Rizk Khodair (10)

Dementia (Alzheimer & vasular dementia).
Dementia (Alzheimer & vasular dementia).Dementia (Alzheimer & vasular dementia).
Dementia (Alzheimer & vasular dementia).
 
Primary headache and facial pain. (2024)
Primary headache and facial pain. (2024)Primary headache and facial pain. (2024)
Primary headache and facial pain. (2024)
 
epilepsy and status epilepticus for undergraduate.pptx
epilepsy and status epilepticus  for undergraduate.pptxepilepsy and status epilepticus  for undergraduate.pptx
epilepsy and status epilepticus for undergraduate.pptx
 
cerebrovasular disease(ischemic, ICH & SAH).pptx
cerebrovasular disease(ischemic, ICH & SAH).pptxcerebrovasular disease(ischemic, ICH & SAH).pptx
cerebrovasular disease(ischemic, ICH & SAH).pptx
 
introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)
 
Myasthenia gravis
Myasthenia gravisMyasthenia gravis
Myasthenia gravis
 
movement disorder for physiotherapy .pptx
movement disorder for physiotherapy .pptxmovement disorder for physiotherapy .pptx
movement disorder for physiotherapy .pptx
 
SAH
SAHSAH
SAH
 
ataxia
ataxia ataxia
ataxia
 
myopthies.pptx
myopthies.pptxmyopthies.pptx
myopthies.pptx
 

Recently uploaded

TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...
Donc Test
 
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
Oleg Kshivets
 
CBL Seminar 2024_Preliminary Program.pdf
CBL Seminar 2024_Preliminary Program.pdfCBL Seminar 2024_Preliminary Program.pdf
CBL Seminar 2024_Preliminary Program.pdf
suvadeepdas911
 
Aortic Association CBL Pilot April 19 – 20 Bern
Aortic Association CBL Pilot April 19 – 20 BernAortic Association CBL Pilot April 19 – 20 Bern
Aortic Association CBL Pilot April 19 – 20 Bern
suvadeepdas911
 
Efficacy of Avartana Sneha in Ayurveda
Efficacy of Avartana Sneha in AyurvedaEfficacy of Avartana Sneha in Ayurveda
Efficacy of Avartana Sneha in Ayurveda
Dr. Jyothirmai Paindla
 
The Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic PrinciplesThe Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic Principles
MedicoseAcademics
 
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
Post-Menstrual Smell- When to Suspect Vaginitis.pptxPost-Menstrual Smell- When to Suspect Vaginitis.pptx
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
FFragrant
 
Muscles of Mastication by Dr. Rabia Inam Gandapore.pptx
Muscles of Mastication by Dr. Rabia Inam Gandapore.pptxMuscles of Mastication by Dr. Rabia Inam Gandapore.pptx
Muscles of Mastication by Dr. Rabia Inam Gandapore.pptx
Dr. Rabia Inam Gandapore
 
TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd...
TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd...TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd...
TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd...
Donc Test
 
Adhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.comAdhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.com
reignlana06
 
Top-Vitamin-Supplement-Brands-in-India List
Top-Vitamin-Supplement-Brands-in-India ListTop-Vitamin-Supplement-Brands-in-India List
Top-Vitamin-Supplement-Brands-in-India List
SwisschemDerma
 
Identifying Major Symptoms of Slip Disc.
 Identifying Major Symptoms of Slip Disc. Identifying Major Symptoms of Slip Disc.
Identifying Major Symptoms of Slip Disc.
Gokuldas Hospital
 
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptxEar and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Dr. Rabia Inam Gandapore
 
Netter's Atlas of Human Anatomy 7.ed.pdf
Netter's Atlas of Human Anatomy 7.ed.pdfNetter's Atlas of Human Anatomy 7.ed.pdf
Netter's Atlas of Human Anatomy 7.ed.pdf
BrissaOrtiz3
 
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdfCHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
rishi2789
 
Histololgy of Female Reproductive System.pptx
Histololgy of Female Reproductive System.pptxHistololgy of Female Reproductive System.pptx
Histololgy of Female Reproductive System.pptx
AyeshaZaid1
 
CHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdfCHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdf
rishi2789
 
Abortion PG Seminar Power point presentation
Abortion PG Seminar Power point presentationAbortion PG Seminar Power point presentation
Abortion PG Seminar Power point presentation
AksshayaRajanbabu
 
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptxVestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Dr. Rabia Inam Gandapore
 
LOOPS in orthodontics t loop bull loop vertical loop mushroom loop stop loop
LOOPS in orthodontics t loop bull loop vertical loop mushroom loop stop loopLOOPS in orthodontics t loop bull loop vertical loop mushroom loop stop loop
LOOPS in orthodontics t loop bull loop vertical loop mushroom loop stop loop
debosmitaasanyal1
 

Recently uploaded (20)

TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...
 
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
 
CBL Seminar 2024_Preliminary Program.pdf
CBL Seminar 2024_Preliminary Program.pdfCBL Seminar 2024_Preliminary Program.pdf
CBL Seminar 2024_Preliminary Program.pdf
 
Aortic Association CBL Pilot April 19 – 20 Bern
Aortic Association CBL Pilot April 19 – 20 BernAortic Association CBL Pilot April 19 – 20 Bern
Aortic Association CBL Pilot April 19 – 20 Bern
 
Efficacy of Avartana Sneha in Ayurveda
Efficacy of Avartana Sneha in AyurvedaEfficacy of Avartana Sneha in Ayurveda
Efficacy of Avartana Sneha in Ayurveda
 
The Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic PrinciplesThe Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic Principles
 
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
Post-Menstrual Smell- When to Suspect Vaginitis.pptxPost-Menstrual Smell- When to Suspect Vaginitis.pptx
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
 
Muscles of Mastication by Dr. Rabia Inam Gandapore.pptx
Muscles of Mastication by Dr. Rabia Inam Gandapore.pptxMuscles of Mastication by Dr. Rabia Inam Gandapore.pptx
Muscles of Mastication by Dr. Rabia Inam Gandapore.pptx
 
TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd...
TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd...TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd...
TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd...
 
Adhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.comAdhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.com
 
Top-Vitamin-Supplement-Brands-in-India List
Top-Vitamin-Supplement-Brands-in-India ListTop-Vitamin-Supplement-Brands-in-India List
Top-Vitamin-Supplement-Brands-in-India List
 
Identifying Major Symptoms of Slip Disc.
 Identifying Major Symptoms of Slip Disc. Identifying Major Symptoms of Slip Disc.
Identifying Major Symptoms of Slip Disc.
 
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptxEar and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
 
Netter's Atlas of Human Anatomy 7.ed.pdf
Netter's Atlas of Human Anatomy 7.ed.pdfNetter's Atlas of Human Anatomy 7.ed.pdf
Netter's Atlas of Human Anatomy 7.ed.pdf
 
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdfCHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
 
Histololgy of Female Reproductive System.pptx
Histololgy of Female Reproductive System.pptxHistololgy of Female Reproductive System.pptx
Histololgy of Female Reproductive System.pptx
 
CHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdfCHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdf
CHEMOTHERAPY_RDP_CHAPTER 1_ANTI TB DRUGS.pdf
 
Abortion PG Seminar Power point presentation
Abortion PG Seminar Power point presentationAbortion PG Seminar Power point presentation
Abortion PG Seminar Power point presentation
 
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptxVestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
 
LOOPS in orthodontics t loop bull loop vertical loop mushroom loop stop loop
LOOPS in orthodontics t loop bull loop vertical loop mushroom loop stop loopLOOPS in orthodontics t loop bull loop vertical loop mushroom loop stop loop
LOOPS in orthodontics t loop bull loop vertical loop mushroom loop stop loop
 

cranial nerve examination

  • 1. neurology cranial nerves examination Dr mohamed rizk khodair lecturer of neurology October 6 university Mohamedrizk.med@edu.edu.eg ‫والجراحة‬ ‫الطب‬ ‫كلية‬
  • 3. Pathway of smell From the receptors in the olfactory mucosa , the fibers of olfactory nerve pierce the cribriform plate of the ethmoid bona and run in the olfactory groove to relay in the olfactory bulb , a new set of fibers travels in olfactory tract to terminate in the olfactory sensory area in the uncus of the temporal lobe of both sides
  • 4. 1- Olfactory nerve examination Familiar substance (mint - coffee ) . Non irritant . Each nostril alone . Close the eye
  • 5. Lesion in olfactory : Anosmia: unilateral traumatic , inflammatory , neoplastic : foster Kennedy syndrome ( ipsilateral optic atrophy due to direct pressure on optic nerve, contralateral papilledema due to increase ICT, ipsilateral anosmia may occur due to pressure on the olfactory. NB : Unilateral lesion of uncus doesn’t cause anosmia as the sense of smell is bilaterally represented . Bilateral : ENT , hysterical , hereditary Parosmia :( perverted sense of smell ) ‫متغيرة‬ ‫الراويح‬ ‫يشم‬ common in hepatitis and pregnancy Olfactory hallucination : perception of smell usually unpleasant in absence of stimulus , due to central olfactory affections ( temporal lobe epilepsy)
  • 7. How to examine • Visual acuity • Color vision • Visual field • Fundus examination
  • 8. Visual acuity • Snellen chart . • Counting finger 6 m to 30 cm • Hand movement • Perception of light
  • 9. Color vision (ishihara color plates)
  • 11. Cranial Nerves: Optic Pupil, acuity, Field, Fundi By Confrontation test → Uniocular vision → Binocular vision
  • 13. Cranial Nerves: Conjugate Eye Movements
  • 18. Pupil : Size , shape , symmetry Response to direct or indirect light reflex (ll,lll) Accommodation reaction (ll,lll) Ciliospinal reflex Normal comment : Round regular reactive . Causes of miosis : Horner syndrome (congenital or acquired ), pontine lesion, opiate toxicity Causes of mydriasis : diminution of vision , drug , compression of 3rd CN
  • 19. Each eye separate Both eyes together Spontaneous or with fixation Horizontal or vertical or rotatory Unilateral or bilateral If it has rapid and slow phase ( direction of nystagmus is that of rapid phase) Nystagmus
  • 20. Trigeminal nerve sensory Pain , touch , Both side of the face Ophthalmic , maxillary , mandibular branches The inner & outer part of the face
  • 21. Motor examination of 5th Nerve : Inspection : temporalis and masseter palpation : temporalis , masseter pterygoid : with and without resistance unilateral : jaw is deviated to diseased side bilateral : inability to open mouth Reflexes : Superficial reflexes : corneal & conjunctival reflexes (5&7) Pathological reflexes : Jaw reflexes (5th&5th) normally : absent or minimally exaggerated : bilateral UMNL above pons
  • 23. Facial nerve : How to examine Muscle power Frontalis , orbicularis oculi Orbicularis oris , buccinators , retractor anguli Reflexes : Corneal reflex (5th& 7th) Glabellar reflex (7th&7th) Taste sensation
  • 24. Facial nerve : Upper half of face Inspection : 1) lack of forehead corrugations 2) dribbling of tears Palpitation : Inability of elevate eyebrows properly Eye can be easily opened by examiner Glabber reflex Normally : blinking bilateral (bilateral contraction of orbicularis oculi ) blinking stops after 2-3 contraction ( due to habituation ) Abnormally : lost in LMNL , exaggerated in UMNL , persistent in parkinsonism Lower half of face Inspection : obliterated nasolabial fold Deviation of the mouth to the healthy side Dribbling of saliva , dropping of angle of mouth Palpitation : inability to blow the check , inability to whistle , inability to show teeth properly
  • 25. Vestibulocochlear CN : Cochlear : test for acuity of hearing Rinne’s test : using vibrating tunining fork on mastoid process Weber test : place tuning fork in the middle of head .
  • 26. 9th , 10th , 11th (cranial accessory) CNS : • Inspection : base of uvula , soft palate • Palpation : use torch and tongue depressor and say ah and see the uvula • Reflexes : • palatal reflex (5th& 10th ) : normally stimulation of soft palate leads to its elevation . • pharyngeal ( gag ) reflex(9th& 10th): normally stimulation of posterior pharyngeal wall lead to local contraction and gag reflex Exaggerated : in pseudobulbar palsy Lost : in true bulbar palsy
  • 27. Spinal accessory : Inspection : shoulder , head Palpation : trapezius : ask patient to turn head rt and left , tested by asked patient to turn his chin against resistant Unilateral lesion : head is tilted to disease side Sternomastoid : inspect shoulder depression , tested by elevation of shoulder against resistance
  • 28. Inspection : tongue fasciculation ,tongue corrugation , wasting , abnormal movement Palpitation : without resistant & with resistant Hypoglossal Nerve