IH

1. َّ‫الر‬ ِ‫من‬ْ‫ح‬َّ‫الر‬ ِ‫هللا‬ ِ‫م‬ْ‫س‬ِ‫ب‬ِ‫مم‬ ِ‫ح‬
Cranial nerves assessment
Islamic hospital
Paediatric department
Waqar Qabba’a

2. Cranial nerves :
Like spinal nerves, cranial nerves are bundles of sensory or
motor fibers that innervate muscles or glands; carry impulses
from sensory receptors, or show a combination of these fiber
types.
They are called cranial nerves because they emerge through
foramina or fissures in the cranium and are covered by tubular
sheaths derived from the cranial meninges.
There are twelve pairs of cranial nerves, which are numbered I to
XII, from rostral to caudal, according to their attachment to the
brain and penetration of the cranial dura. Their names reflect
their general distribution or function.

4. I. Olfactory: smell
II. Optic: vision
III. Oculomotor: eyelid and eyeball movement
IV. Trochlear: motor for vision (turns eye downward and laterally)
V. Trigeminal: chewing, face and mouth touch and pain
VI. Abducens: motor to lateral eye muscles
VII. Facial: controls most facial expressions , taste, secretion of tears & saliva
VIII. Vestibulocochlear: sensory for hearing and balance (aka Acoustic, Auditory)
IX. Glossopharyngeal: sensory to tongue, pharynx, and soft palate; motor to
muscles of the the pharynx and stylopharyngeus
X. Vagus Nerve: sensory to ear, pharynx, larynx, and viscera; motor to pharynx,
larynx, tongue, and smooth muscles of the viscera, 2 parts: superior
laryngeal branch and recurrent laryngeal branch
XI. Spinal Accessory Nerve: motor to pharynx, larynx, soft palate and neck
XII. Hypoglossal Nerve: motor to strap muscles of the neck, intrinsic and
extrinsic muscles of the tongue
Main function

5. Mnemonics
One Of Our Trained Teacher Asked For A Good
Vehicle And Horse
U have I nose (I olfactory)
&
II eyes (II optic )
‘’ LR6 – SO4 – Rest 3 ‘’

8. Make sure that nasal passages are intact &
patent by inspection

9. Parosmia- altered sense of smell

10. In optic nerve u examine 6
things :
1-inspection
2-visual acuity
3-color vision
4-visual field
5-pupillary reflex
6-funduscopy
By inspection look for pupil
symmetry & for their size ,
normally 3-5 mm,proptosis,
lid lag, periorbital
appearance , eye lid margin
,conjunctiva, sclera, cornea

11. -Using Snellen chart or LogMar
chart
-let the patient wear the glasses if
he has one
-put the chart 6 metres from the
patient

14. Visual field
-Set 1 meter from the patient where your eyes and his eyes are at level ,ask the patient
to look into your eyes during this examination.
-here you will have to examine the : homonymous defects , peripheral fields , central
fields , sensory in attention & blind spot .
- homonymous defects :
Extend your hand to the midway between you & the patient, starting from outside your
field of vision, move your hand while wiggling your fingers in an X direction-from all
sides obliquely
Ask the patient to tell you as soon as he sees it moving
-sensory in attention :
One finger at first then both , during that ask the patient what he noticed
-periphral fields :
Test each eye separately by asking the patient to cover one eye , you cover the
corresponding eye , test the 4 quadrant of visual field separately moving your finger
inward until the patient says that he sees it moving , compared with yours

16. -Pupillary reflexes :
afferent is the optic and efferent is the
occulomotor
To light
To accommodation

17. Examine for inspection ,
movement & reflexes .

30. For examination start with :
1-inspection :
For asymmetry or differences in blinking or eye closure , drooping of
the face , forehead wrinkles , nasolabial folds , deviation of the mouth
Notice if there is Bell’s Palsy :
LMN syndrome with sudden onset of paralysis of ipsilateral facial
muscles
Inflammatory injury, infection or degenerative disease
2-movement – later
3-taste : anterior 2 thirds
4-lacrimation : schrimer tear test
5-corneal reflex : efferent

31. • Upper Motor Neuron Disease
• Unilateral paresis of muscles of lower half of
face
• Muscles above bilaterally innervated
• Bilateral lesion can cause paralysis of upper
and lower muscles bilaterally
• Lower Motor Neuron Disease
• Injury near pons can cause lower motor
neuron disease
• Unilateral Paralysis of all facial muscles,
stapedial muscle and taste in 2/3 of tongue

35. Flaring of nostrils
Ask him to whistle

39. Sensorineural loss

40. Tests for vestibular function (for equilibrium, vertigo
or dizziness, nystagmus)
:
1- dix-Hallpike test
2-oculocephalic test ‘’Doll’s eyes ‘’
3-vestibule-ocular reflex

43. Listen for pt voice assess any dysphonia
,dysarthria or hoarseness of voice
Cough ,in vagal lesion it’s bovine
Puff out cheeks & feel for air scape from thenose