Neuro - Cranial Nerve Examination

Question 1

How do we do an introduction?

Answer 1

Wash hands
Your ID
Patients ID
Explanation
Consent
Do they have any pain?

Question 2

What do you do before starting?

Answer 2

A quick general inspection

Question 3

What is in the general inspection?

Answer 3

AVPU
Comfortable at rest?
Facial symmetry
Position of eyes
Ptosis – is this unilateral or bilateral?
Abnormality of speech or voice – dysarthria
Signs around the bed – e.g. hearing aid/glasses

Question 4

How do we test the olfactory nerve?

Answer 4

Ask about any changes in the sense of smell and if so is it unilateral or bilateral

Question 5

What is tested when testing the optic nerve?

Answer 5

Visual acuity
Pupillary responses
Accomodation
Visual fields
Visual inattention 
State you would do fundoscopy

Question 6

How do we test visual acuity?

Answer 6

Ask if they can see well with each eye
use a snellen chart at 6M and test each eye separately
If glasses are worn by patient make sure they wear them

Question 7

How do we test the pupillary responses?

Answer 7

Assess size and shape of pupil
Shine pen torch into each eye twice - assessing for ipsilateral and contralateral constriction (called the indirect response)

Question 8

How do we test accommodation?

Answer 8

Ask patient to focus on pen held at distance and to keep focusing on it as you move it towards them

Pupils should constrict as eyes converge

Question 9

How do we test visual fields?

Answer 9

Cover eye on same side as patient
Hold finger outside the view IN THE MIDLINE and move it in ask them to say yes when they see it
Go in from 4 corners and do each eye

Question 10

How do we test visual inattention?

Answer 10

Ask patient to look at your nose
Place hands in periphery and ask them to point at the finger that is moving
Test upper and lower peripheries

Question 11

What is after visual inattention?

Answer 11

State you would perform a fundoscopic examination for completion

Question 12

What is tested next after optic? How?

Answer 12

Occulomotor, trochlear and abducents nerves (3,4 and 6)

“I would now like to test the movements of your eyes, inspecting eyes for ptosis and abnormality of gaze”

Ask patient to keep head still and follow finger as it makes a H pattern starting in the midline in front of patient

• Ask patient to tell you if they get double vision
• Look if eyes move in paralell
• Look for nystagmus

Question 13

What is tested after CN 3,4 and 6?

Answer 13

CN 5 - trigeminal

Question 14

What 4 categorizes of the trigeminal nerve are tested?

Answer 14

Sensory
Motor
Corneal reflex
Jaw jerk reflex

Question 15

How is the sensory aspect of the trigeminal nerve tsted?

Answer 15

Cotton wool then neurotip touch ophthalmic, maxillary and mandibular areas (forehead, cheeks and lover jaw) on BOTH SIDES

Question 16

How is the motor function of trigeminal nerve tested and what branch is it specifically testing?

Answer 16

Palpate masseter muscle and ask patient to clench teeth

Ask patient to open jaw and don’t let you close it

Question 17

How is corneal reflex done?

Answer 17

Explain and get consent
Pull eyelids down
Get them to look up
Touch cornea of right eye with wisp of cotton wool
Blink response should be bilateral
Repeat for other eye

Question 18

How is jaw jerk reflex done?

Answer 18

Ask patient to open and relax jaw
Put fingers on chin (right under the lip)
Hit with hammer

Closure is pathological

Question 19

What nerve is tested after CN 5?

Answer 19

CN 7 - facial

Question 20

How is facial tested?

Answer 20

Inspect face for symmetry then ask patient to:

• wrinkle forehead then screw up eyes
• and also smile and show teeth

Show them what you mean

Ask about changes in taste

Question 21

What nerves are tested after CN 7 - facial?

Answer 21

Vestibulocochlear - 8

Question 22

How do we test CN 8?

Answer 22

Vestibular - look for nystagmus

Cochlear

• Whisper test
• Rinne’s
• Webbers

Question 23

What nerves are tested after CN8? How?

Answer 23

9 and 10 - Glossopharyngeal and Vagus

Ask patient to open mouth and say “aah” - assess if the palate moves symmetrically

Ask patient to cough and see if it sounds normal

Elicit a gag reflex - tongue depressor on side of throat

Question 24

How is cranial nerve 11 tested?

Answer 24

Ask patient to shrug shoulders and resist you pushing down – trapezius

Ask patient to turn head to one side and resist you pushing it to the other – sternocleidomastoid

Question 25

How is the hypoglossal nerve tested?

Answer 25

Open mouth and look at tongue - fasciculations, wasting or deviations

Motor - stick out tongue and move it side to side

Speech - normal speech

Question 26

How to close?

Answer 26

thank them

Wash hands