1. Assess cranial nerve (CN) I (olfactory). With eyes the signicant nding is loss of sense of smell (anosmia).

closed, patient is asked to identify familiar odors (coffee, tobacco). Each nostril is tested separately. 2. Assess CN II (optic). Assess vision using a Snellen eye Signicant ndings include visual eld defects chart. Assess visual elds. Perform ophthalmoscopic (hemianopias) and decreased visual acuity or blindness. Examination. 3. Assess CN III (oculomotor). Test for eye movement toward Signicant ndings include dysconjugate gaze; gaze the nose; inspect for conjugate movements and weakness or paralysis; double vision; dilated pupil, nystagmus. Evaluate papillary size and test for pupillary with or without impaired pupillary reaction to light; reactivity to light; inspect ability to open eyelids and inability to open the affected eyelid. 4. Assess CN IV (trochlear). Test for upward eye movement; Signicant ndings include dysconjugate gaze, gaze inspect for conjugate movements and nystagmus. Weakness or paralysis, and double vision. 5. Assess CN V (trigeminal). Have patient close the eyes. Touch Signicant ndings include impaired or absent cotton to forehead, cheeks, and jaw. Sensitivity to corneal reex, facial numbness, and jaw weakness. Supercial pain is tested in these same three areas by using the sharp and dull ends of a broken tongue blade. Alternate between the sharp point and the dull end. Patient reports sharp or dull with each movement. If responses are incorrect, test for temperature sensation. Test tubes of cold and hot water are used alternately. While patient looks up, lightly touch a wisp of cotton against the temporal surface of each cornea. A blink and tearing are normal responses. Have patient clench and move the jaw from side to side. Palpate the masseter and temporal muscles, noting strength and equality. 6. Assess CN VI (abducens). Test for lateral eye movement; Signicant ndings include dysconjugate gaze, inspect for conjugate movement. Gaze weakness or paralysis, and double vision. 7. Assess CN VII (facial). Observe for symmetry while patient Signicant ndings include facial weakness, inability performs facial movements: smiles, whistles, elevates to completely close the eyelid, and impaired taste. Eyebrows, frowns, tightly closes eyelids against resistance (examiner attempts to open them). Observe face for accid paralysis (shallow nasolabialfolds). Have patient extend tongue. Test ability to discriminate between sugar and salt. 8. Assess CN VIII (acoustic). Perform whisper or watch-tick test. Signicant ndings include decreased hearing or Test for lateralization (Weber test). Test for air and bone deafness and impaired balance. Conduction (Rinne test). Assess standing balance with eyes closed (Romberg test). 9. Assess CN IX (glossopharyngeal). Assess patients ability to Signicant ndings include difculty swallowing swallow and discriminate between sugar and salt on (dysphagia) and impaired taste. Posterior third of the tongue.

10. Assess CN X (vagus). Depress a tongue blade on posterior Signicant ndings include weak or absent gag reex, tongue, or stimulate posterior pharynx to elicit gag reex. Difculty swallowing, aspiration, hoarseness, and Note any hoarseness in voice. Check ability to swallow. Slurred speech (dysarthria).Have patient say ah 11. Assess CN XI (spinal accessory). While patient shrugs Signicant ndings include weak or absent shoulder shoulders against resistance, palpate and note strength shrug and inability to turn the head to the side. Of trapezius muscles. As patient turns head against opposing pressure of the examiners hand, palpate 12. Assess CN XII (hypoglossal). While patient protrudes the Signicant ndings include difculty swallowing and tongue, note any deviation or tremors. Test the strength slurred speech. Of the tongue by having patient move the protruded tongue from side to side against a tongue depressor