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Examination of the cranial

nerves

Jan 21 2016

Examination of central nervous system


Exam of higher centres: conscious state,
speech, memory, intellect etc.
Exam of the cranial nerves, I-XII
Exam of the trunk and limbs: motor system
and sensory system, gait etc.

1st nerve
Ask if noticed any change in smell/taste
If yes, test each nostril with different
scents

2nd,3rd,4th and 6th nerves


Optic Nerve: Visual acuity, visual field, pupillary reflex,
Fundoscopy

Oculomotor, trochlear, abducens nerve


Pupils: size, inequality in shape, Direct and
consensual LR, Reaction to convergence
(accommodation)
Ptosis, lid lag
Squint/nystagmus at rest and when following
examiners finger
Eye movements to all quadrants

th
5

Nerve

Feel the mastication muscles and test for deviation of the


mandible during attempts to lower the jaw against
resistance
Test for sensory loss (pinprick, light touch) in all 3
divisions of the 5th nerve
Corneal reflex (N.B. both 5th and 7th nerves are involved)

7th Nerve
Inspection for facial asymmetry
Test for facial weakness in the upper and
lower face
Test taste sensation on anterior two-thirds
of the tongue

8th Nerve
Test for hearing loss, Use Rinne and
Weber test to determine whether the loss
is conductive or neurosensory.
Otoscopy

9th and 10th nerves


9th: Test gag reflex at the posterior
pharyngeal wall bilaterally
10th: Looking for soft palate movement and
any deviation of uvula in response to
saying aaah

11th Nerve
Look for wasting of the trapezius and
Stenocleidomastoid muscles and test the
muscle power by asking the patient to
shrug his shoulder against resistance and
turn his head to either side against
resistance

12th Nerve
Looking for tongue atrophy and
fasciculation
Look for deviation of the tongue on
forward protrusion

Upper motor neuron : The first order


neuron that starts in the motor cortex of
the brain and terminates within the
medulla or within the anterior horn of
spinal cord.
Lower motor neuron: The motor neurons
connecting the brainstem and spinal cord
to muscle fibers.

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