Cranial Nerve Examination

Question 1

Name all the cranial nerves

Answer 1

I. Olfactory nerve
II. Optic nerve
III. Oculomotor nerve
IV. Trochlear nerve
V. Trigeminal nerve
VI. Abducens nerve
VII. Facial nerve
VIII. Vestibulocochlear nerve
IX. Glossopharyngeal nerve
X. Vagus nerve
XI. Accessory nerve
XII. Hypoglossal nerve

Question 2

Olfactory nerve

What questions do you ask?

Answer 2

Any change in sense of smell?

Question 3

Trigeminal nerve

Where do you assess for sensation?

Motor:

Why do you get them to clench their teeth?

Answer 3

Forehead
Cheek
Jaw

Demonstrate on sternum first

To feel bulk of master and temporals bilaterally

Question 4

Trigeminal nerve

Jaw jerk:
-what does complete close of the jaw indicate?

What other reflex is done and what other nerve is involved?

Answer 4

UMN lesion

Corneal reflex

Facial nerve

Question 5

Facial nerve

What do you inspect on the face at rest?

Answer 5

Asymmetry

Forehead wrinkles
Nasolabial folds
Angles of the mouth

Question 6

Facial nerve

What you assess when you get the patient to:

• Raise eyebrows
• Close their eyes and you try and open them
• Blow out cheeks
• Smile
• Grimace

What else do you need to ask about? - 2

Answer 6

Asymmetry

Power

Power

Asymmetry

Asymmetry

Taste in the anterior tongue
Increased loud noises - weak stapedius

Question 7

Glossopharyngeal and vagus nerves:

What would you find at the uvula and palate in a CN10 lesion?

Answer 7

Symmetry - deviation of uvula

Uvula deviates away from lesion
Palate not rising on affected side

Question 8

Glossopharyngeal and vagus nerves:

What would damage to the recurrent laryngeal nerve (CN10) present as? - 2

What do you get patients to do to test these?

What do you get the patient to say?

What else do you do?

Answer 8

Hoarseness of the voice
Impaired swallowing or cough

Gag reflex
Ask patient to cough
Swallow some water

British constitution

Puff out cheeks and listen for air escaping from nose

Question 9

Accessory nerves:

What do you ask patients to do and what are you assessing for?

Answer 9

Shrug shoulders
Resist you pushing down
(trapezius)

Turn head and against resistance
(SCD)

Weakness

Question 10

Hypoglossal nerve:

What do you look for on tongue?

Which way does tongue deviate if there is a lesion?

How do you assess power?

What can they also say?

Answer 10

Fasciculations (minor ones can be normal)
Wasting

Deviates towards lesion

Place your finger on the patient’s cheek and ask to push their tongue against it

Yellow lorry