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NSC 832

Cranial Nerve Assessment

Why do now and not with Neuro?

� By time get to chest should have done all of General assessment,

� Hair/skin

� HEENT

� Thyroid

� Lymph nodes

� Cranial Nerves I-XII (often just do CN II-XII)

Cranial Nerves

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Cranial Nerve Name Mnemonic

1 I Olfactory On Oh

2 II Optic Old Oh

3 III Oculomotor Olympus Oh

4 IV Trochlear Towering To

5 V Trigeminal Tops Touch

6 VI Abducens A And

7 VII Facial Finn Feel

8 VIII Acoustic And A

9 IX Glossopharyngeal German Good

10 X Vagus Viewed Vein

11 XI Spinal Accessory Some A

12 XII Hypoglossal Hops H

CN Name Sensory

Motor

Function

I Olfactory Sensory Smell

II Optic Sensory Sight

III Oculomotor Motor EOMs, pupil constriction

IV Trochlear Motor EOMs (downard and

inward)

V Trigeminal Sensory

Motor

Pin/soft 3 areas

Mastication muscles

VI Abducens Motor EOMs (lateral)

CN Name Sensory Motor

Function

VII Facial SensoryMotor

Taste anterior tongueFacial muscles

VIIIAcoustic(Vestibulocochlear)

Sensory Hearing

IXGlosso-pharyngeal

Sensory

Motor

Posterior tongue tasteSwallow, Gag reflex

X Vagus Motor Uvula lifts in midline

XI (Spinal)

Accessory

Motor Shoulder muscles

XII Hypoglossal Motor Tongue muscle

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Cranial Nerve Assessment

� Have patient seated

� 12 pairs of Cranial Nerves

� Have all equipment needed to test CN I-XII.� Alcohol or other smelly stuff

� Ophthalmoscope

� Otocsope

� Eye cover

� Tuning fork

� Safety pin or Q-tip in half

� Tongue blade

CNI Olfactory Sense of Smell

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CNII Optic Visual Acuity

Cranial Nerves III IV VI

� III—Oculomotor- pupillary constriction, eyelid elevation, & most EOMs

� IV—Trochlear- downward & inward EOM

� VI—A bducens- lateral gaze EOM

Cranial Nerves III IV VIExamine together

� PERRLA � Pupils Equal, Round, React to Light, Accommodation.

� Extraocular movements (EOMs)

� Convergence

� Cover-uncover test

� Hirschberg’s test

� Visual fields by confrontation

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Hirschberg's test

Does light shine in both eyes on the same part of the iris/pupil?

CN V Trigeminal Motor & Sensory Components

� Motor: temporal & masseter muscle

� Sensory: maxillary, mandibular, & ophthalmic tracts

� Corneal reflex

CN V Trigeminal Motor & Sensory Components

� Motor—Clench teeth, palpate masseter and temporal muscles

� Sensory—Pin/soft sensation in 3 areas� Temperature sensation if abnormal

� Corneal Reflex

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TRIGEMINAL NERVE DISTRIBUTION

CNVII Facial Nerve

� Motor: Facial movements of facial expression, closing eye, & closing mouth

� Sensory: tastes on anterior 2/3 of tongue

CN VII Facial Nerve

� Raise both eyebrows

� Frown

� Close both eyes against resistance

� Smile

� Puff out cheeks

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CNVIII Acoustic Cranial Nerve

� Hearing

� Weber On top

� Lateralization

� Rinne tests

� Whispered word

� Close other ear

CN IX Glossopharyngeal-GAG

� Motor: palate, pharynx, & larynx are tested with Vagus

� Say Ah (vagus—X) and test gag reflex (IX)

� Sensory: taste of posterior tongue

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CN X Vagus

�Motor exam : test of pharynx & palate strength or weakness

� “AH”

�Quality of voice

CN XI Spinal Accessory Nerve

�Test of SCM & part of Trapezius

�Shrugs shoulders & turns head against resistance

CN XII Hypoglossal Cranial Nerves

� ROM & strength of tongue

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Terminology

� CN II-XII intact

� PERRLA and equal convergence

� EOMs intact

� Cover test negative.

� Hirschberg negative