1. The document discusses various reflexes and cranial nerves in the human body. It provides details on different types of reflexes including infant, superficial, deep tendon and pathological reflexes. 2. It then describes the 12 pairs of cranial nerves, their origin, function and how to test for dysfunction. The cranial nerves discussed are olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, accessory and hypoglossal nerves. 3. The document provides guidance on clinically evaluating various reflexes and testing different cranial nerves to identify any abnormalities.

2. Reflexes and cranial nerves
by
Dr.Hafiz Muhammad Asad Ullah

3. “Reflexes”

4. Reflex:
“A reflex is a muscle reaction that is
happens automatically in response
to stimulation .”
• Certain sensation or movements produce
specific muscle responses.
• Infant reflex
• Superficial reflex
• Deep reflexes
• Normal reflexes
• Abnormal reflex

5. Infant reflexes include:
Grasp
reflex
Rooting
reflex
Stepping
reflex
Planter
reflex
Gag reflex
Parachute
reflex
Babinski
reflex

6. Some reflex which last into
adulthood are:
Blinking
reflex
Yawn
reflex
Sneeze
reflex
Gag
reflex
Cough
reflex

7. Dysfunction of
These include
infectious
disease like
AIDs , syphilis
etc
Over medications or
addictive substances
ingested by mother
like Alcohol ,
cigarette etc
Emotional
trauma.
If trauma
occurs in the
neurosenorimo
tor .
It can cause
maturation
&
integration
of primary
infant motor
.
Congenital disorder Trauma or stress

8. Deep tendon reflex:
Biceps
reflex
Triceps
reflex
Brachior
adialis
reflex
Patellar
reflex
Achilles
reflex

10. Superficial reflexes:
Gag reflex
Planter
reflex
Blinking
reflex

11. Abdominal
reflex
Scapular
reflex

12. Pathological reflexes:
chaddock’s
reflex
Babinski reflex
Gordon’s reflex
Schaffer’s
reflex
Hoffman’s
reflex
Clonus reflex

13. Babinski reflex:
Elicitation:
 Stroking of lateral aspect of sole of
foot.
Positive response:
 Extension of big toe & fanning of
four small toes.
Pathology:
 Pyramidal tract lesion, organic
hemiplegia.

14. Clonus reflex:
Elicitation:
 Clonus is tested by inducing stretch in
gastrocemius muscle.
Positive sign:
 Subsequent beating of the foot.
Pathology:
 Condition is seen in patients of
multiple sclerosis, stroke or spinal
cord damage.

15. Hoffman’s reflex:
Elicitation:
 Flicking of terminal phalanx of index
middle or ring finger.
Positive sign:
 Reflex flexion of terminal phalanx of
thumb.
Pathology:
 Increased irritability of sensory nerves In
tetany.

16. Chaddock’s reflex:
Elicitation:
 Stroking of lateral side of foot beneath
lateral malleolus.
Positive response:
 Same as in Babinski.
Pathology:
 Pyramidal tract lesion.

17. Schaffer’s reflex:
Elicitation:
 Pinching of Achilles tendon in
middle third.
Positive sign:
 Flexion of foot & toes.
Pathology:
 Organic hemiplegia.

18. Gordon’s reflex:
Elicitation:
 Squeezing of calf muscle firmly.
Positive sign:
 Same as in Babinski.
Pathology:
 Pyramidal tract lesion.

19. Cranial nerves

21. Cranial nerves:
 There are twelve pairs of cranial nerve in our body.
 They are called cranial nerve because these nerves
originates directly from the brain, inside the cranium.
 Cranial nerve may be sensory, motor both somatic or
parasympathetic or have mixed function.

22. 1. Olfactory nerve:
Origin:
Cerebral hemisphere
Innervation:
Nasal mucous membranes
Function:
Sense of smell
Dysfunction:
Anosmia

23. Clinical evolution:
Use non-noxious
aromatic
substances like
coffee, lemon ,
garlic.
Test each nostril
separately.
Mark if any
abnormality
noted.
Normal
findings:
• Patient identify
correctly all odors.

24. 2- Optic nerve:
Type:
Sensory
Function:
vision
Tested by:
a) Visual acuity
b) color vision
c) Visual field

25.  Visual acuity:
Near vision Snellen chart
Far vision Jaegers chart
Color vision:
Color matching
Visual field:
Confrontation test
Dysfunction:
Visual loss
Cortical blindness
Hemianopia
Blurred vision or complete blindness

26. 3-Oculomotor:
 Type:
motor nerve
 Function:
innervate extrinsic eyes muscle &
ciliary muscle.
Dysfunction:
 loss of accommodation reflex.
 Bilateral or ipsilateral.
 unable to look up, down & medially

27. 4-Trochlear nerve:
 Type:
Motor
 Origin:
Midbrain
 Innervates:
Superior oblique muscle
Function:
down & inward movement of eye.
 Dysfunction:
Loss of movement of eye inward & downward

28. 6- Abducens nerve:
 Origin:
Pons
 Innervation:
Lateral rectus muscle
 Function:
Outward & lateral movement of eye.
 Dysfunction:
Loss of lateral eye movement, dysconjugate gaze.

29. (3-Oculomotor 4-trochlear And 6abducens):
Important:
These three nerves operate as a unit & should be tested & evaluated
together.
Clinical Test:
 Observe for eye opening & symmetry.
 Pupil size & shape.
 Consensual response(present or absent).
 Direct light response.
 Accommodation
Test:
 Extraocular eye movement.

30. 5-Trigeminal nerve:
 Origin:
pons
 Type:
motor ; sensory
Branches:
Three branches of nerve:
 Ophthalmic
 Maxillary
 mandibular

31. Trigeminal: (continue)
Motor innervation to:
 Masseter & temporal muscle
Sensory innervation to:
 Skin & mucous membrane in heads;
 teeth , tongue , external auditory canal & cornea.
Function:
 Chewing movement by innervation of masseter, temporal & pterygoid
muscle.
 Corneal & sneeze reflex.
 Sensation of face , scalp & teeth.

32. Test: (trigeminal)
Masster
muscle
strength
Temporal
muscle
strength
Facial
sensation
Corneal
reflex
Temperature
sensation

33. 7-Facial nerve:
 Origin:
Pons & medulla
 Type:
Motor
 Function:
 Facial expression.
 Taste(anterior 2/3 of tongue.
 Salivary & lacrimal gland innervation.

34. Clinical evolution:
(motor function)
 Observe for facial symmetry.
 Flattening of nasolabial fold.
Ask patient to:
 wrinkle forehead
 Puff cheeks
 Smile
 Show teeth
 Close eyes against resistance & whistle.

35. Clinical evolution:
(sensory function)
 Test each side of tongue separately
 Test for sweet (tip of tongue)
 Sour (sides of tongue)
 Salty (over most of tongue)
Possible abnormalities:
 Bells palsy
 Ramsay hunt syndrome.

36. 8-vestibulocochlear nerve:
Origin:
Pons & medulla
Innervation:
 Cochlear ear
 Vestibular ear
Function:
 Hearing & sense of balance.
Test:
1. Rinne’test
2. Weber’s test

37. Vestibulocochlear nerve:

38. Vestibulocochlear nerve:

39. 9-Glossopharyngeal nerve:
10- Vagus nerve:
Origin:
Medulla
Type:
Motor , sensory
Function:
 Swallowing movement & salivary secretion.
 Gag & swallow reflex
 Sensation in pharynx & larynx.
 Automatic innervation of heart , lungs, esophagus &
stomach.

40. Dysfunction: (9 or 10)
Loss of taste;
neuralgia.
Loss of gag
& swallow
reflex.
Loss of
carotid sinus.
Oculocardiac
reflex.

41. Clinical evolution:
 Test:
 Throat movement
 Gag reflex
 vocalization

44. 11-Accessory nerve:
Type:
Motor
Function:
Innervates to sternocleidomastoid &
trapezius muscle.
Dysfunction:
Muscle weakness
Test:
 Shoulder movement
 Neck muscle strength

45. Accessory nerve:

46. 12-Hypoglossal nerve:
Type:
Motor
Function:
Innervates tongue muscle
Test:
 Tongue movement
 Tongue strength
 Observe tongue at rest