Question 72

Question 1

cranial nerve exam

Answer 1

• Rule out a stroke – FAST. In a stroke upper motor neurone lesion spares upper
• Introduce yourself to the patient by name and role
• CN I – Olfactory (smell) – ask pt if smell has altered and test
• CN II – Optic nerve (sight) – ask patient about any changes to sight and test visual acuity (Snellen chart)
• CN III – Occulomotor (all other eye muscles) - test with eye movements to all 9 points
• CN IV – Trochlear (SO4) – test with eye movements to all 9 points
• CN V – Trigeminal (sensory to facial skin and oral mucosa, motor to MoM) – test sensation in ophthalmic, maxillary and mandibular divisions bilaterally, offer corneal reflex and ask patient to clench teeth
• CN VI – Abducens (LR6) - test with eye movements to all 9 points
• CN VII – Facial (motor to muscles of facial expression, sensory to EAM and stapedius, taste to ant 2/3 tongue) – can patient raise eyebrows, screw up eyes, blow out cheeks, smile, pout
• CN VIII – Vestibulocochlear (hearing and balance) – can patient hear normally, cover one ear and whisper numbers then get patient to repeat
• CN IX – Glossopharyngeal (stylopharyngeus and taste to post 2/3 tongue) – ask pt to say ahhh and observe deviations of uvula and movements of soft palate (injury can lead to altered gag reflex)
• CN X – Vagus (structures in neck, thorax and abdomen) – ask pt to say ahhh and observe deviation of uvula. Offer to test gag reflex
• CN XI – Spinal accessory (SCM and trapezius) – can patient shrug shoulders
• CN XII – Hypoglossal (motor to tongue muscles) – ask patient to protrude tongue, look for symmetry in movement and bulk. Tongue deviates to side of lesion