Cranial Nerve Flashcards
1
Today ive been asked to examine your cranial nerve which are the nerves that supply your face and neck, is that ok
2
SMELL - only do if says CN1
“have you noticed any changes to your smell at all”
3
CN2 (Optic)
How many fingers holding up/Snellens
- Visual acuity
“I’d now like to assess your visual acuity, do you normally wear glasses? if you could cover one eye with the palm of your hand. id like you to tell me how many fingers im holding up…….. Perfect, id now like you to cover the other eye and do the same.”
4
Light Test
“I’d now like to assess your pupils, which will involve me shining a bright light into your eye. Is that ok?”
5
Focus (accommodation reflex)
“just look on the wall in front of you…. now look at the pen” - hold the pen near to the person
6
Visual Fields
Sit opposite, 1m apart, cover your eye and cover their eye directly opposite. Keep looking IN MY EYE. Bring index finger into view diagonally and towards the centre of your visual field. All 4 quadrants, both eyes = 8 wiggles
Then: (both eyes open)
“If you could keep looking into my eyes, id like you to point to the finger you see moving.” wiggle finger in 4 corners ensuring finger is in the midline
Do: upper R, L, BOTH
Do: bottom Both, L, R
Need to do 6 wiggles on this one
7
EYE MOVEMENTS - CN 3,4,6
H Test
“I’d now like to assess your eye movements. first of all, have you got any double vision at all?”
“keep your head perfectly still and id like you to follow my finger…… did you have any double vision at all”
8
CN 5 (Trigeminal)
Sensation
“I’m now going to start with some cotton wool. this is what the cotton wool feels like. can you feel that? …. if you could now close your eyes and let me know when you can feel the cotton wool on your face.”
“did it feel the same on both sides”
9
Motor - cn 5 controls chewing muscles
“im now going to feel some of the muscles around your face”
- clench jaw and feel temporal muscles
- clench jaw and feel jaw
- open mouth and dont let me close it
“clench jaw for me… and relax. clench jaw for me…and relax. open your mouth and dont let me close it”
10
Remember for 5:
- Sensation
- Clench (jaw and temporal)
- Open mouth and dont let me close
11
CN 7 (Facial)
- Raise eyebrows
- close eyes as tight as you can and don’t let me open them
- puff out cheeks and don’t let me push them in
- purse your lips for me
- and show me all your teeth like you’re smiling
12
CN8 (hearing)
Cover the opposite ear with your hand and whisper a number to the patient. Ask them to repeat it
If abnormal then do:
Rinnes test
“I’m now going to use the tuning fork to assess your hearing. I’m now going to place the tuning fork behind your ear. id like you to let me know when you can hear it and stop hearing it”
twang it, then put it on mastoid bone…“can you hear that”… “let me know when it stops”… when it stops put it by the ear… “can you hear that”.
should be loudest in the ear than the bone
Webers test
Forhead - “can you hear it loudest in your right ear, your left ear or in the middle” - should be middle
14
CN 9 and 10
- Open mouth wide and assess whether the uvula is in the midline at REST
- and now go ARGHHHH
- Ask if any difficulty swallowing
- “if you could cough for me”
15
CN 11
- Shrug shoulders
- Head turning
“Turn head to right and dont let me stop you.. and do the right”
16
CN12 (TONGUE ONE)
“I’d now like to examine your tongue”
- Inspect tongue
- Protrude tongue
- Tongue against cheek - push against it
