cranial nerve exam e-book · 4th cranial nerve: trochlear nerve for this we ask the patient to move...

Cranial Nerve Exam

CRANIAL NERVE TESTSSymptoms and Function

By Raphael Rettner D.C. www.chirovideo.com

Version 1.00May, 2009

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About the Author

Dr. Raphael Rettner is a Palmer College of Chiropractic West graduate and has been in practice since 1982. Dr. Rettner is one of the most highly skilled and respected chiropractors in the United States. He has made numerous radio and T.V. appearances, is the author of Vegetarian Cooking for People with Allergies and has produced several DVDs including: End P.M.S Now!, The Ultimate Diet, and Twelve Causes of an Unstable Spine. He has studied both force and non-force techniques such as Advanced Biostructural Correction, Applied Kinesiology, Biophysics, Gonstead, S.O.T. and over a dozen others. With a combination of creative thinking and an insatiable quest for knowledge, Dr. Rettner has developed several new and exciting chiropractic techniques. Since 1994 he has taught these in his Applied Trigger Points seminar to chiropractors all across the United States, Australia, Canada and England.

You can reach Raphael at [email protected]


mailto:[email protected]

mailto:[email protected]

Table of Contents............................................................................................................Introduction 5

.............................................................................Chapter 1: Cranial Nerve Tests: 6

.............................................Chapter 2: Cranial Nerve Symptoms and Function 17

...........................................................................................................Resources: 25


Introduction

The cranial nerve exam is part of the neurological examination. It is used to identify problems with the cranial nerves by physical examination. In chapter one I clearly explain each cranial nerve test. In chapter two I cover the most common symptoms and functions related to each of the twelve cranial nerves.


Chapter 1: Cranial Nerve Tests:

1st Cranial Nerve:Olfactory Nerve-For this test what we did was to take a cotton ball and some alcohol and then occlude one nostril and place it under the nostril. “Do you smell that?” Now occlude the other nostril. “Do you smell that?”


2nd Cranial nerve:Optic Nerve In The first test I checked for perimetry. “I want you tell me when you first see this pen.” “I see it.” Normal is 180 degrees.


3rd Cranial nerve: Oculomotor Nerve The first test that we did for the 3rd cranial nerve was the pupilolight reflex. For this I shined a light into one eye and checked for constriction. If the constriction wasnʼt even, that may indicate functional hypoadrenia.

The second test was the consensual reflex. For this one I shined a light into one eye and look at the other one for constriction.


The next test was for distance accommodation. For this we blocked one eye and brought the pen close to the other eye. The pupil should constrict as we come closer.

Then we ask the patient to look inferior and lateral.


4th Cranial nerve: Trochlear Nerve For this we ask the patient to move their eyes superior and obliquely.

5th Cranial nerve: Trigeminal Nerve I tested the facial sense by taking a soft brush and touching the forehead, the cheek and the jaw. “Do you feel that?” Then you can fake it a few times to see if theyʼre actually feeling it. Itʼs good to test on both sides.


Next, I tested the strength of the masseter muscle. “Open your jaw please. Now close it against my resistance.” Weʼre checking for weakness here.

6th Cranial nerve: Abducens Nerve For this I did the lateral rectus test. “Just follow my finger as it moves from side to side.”


7th Cranial nerve: Facial Nerve For this I tested the muscles of expression. “Smile, frown and now wrinkle your forehead.”


8th Cranial nerve: Acoustic Nerve The first section I tested was the cochlear section which has to do with hearing. The first test I did was the Rinne Test. What I did first was take a tuning fork, hit it against my side and touch the patientʼs mastoid process of the temporal bone. “Please tell me when you stop hearing that.” “O.K.” Now place it against the ear, “Do you still hear that?” “Yes.” In this case, the air conduction was longer than the bone conduction, which is normal. If the bone conduction were longer than the air conduction that would be a positive test.


The next test is the Weber Test. For that one, again I hit the tuning fork and place it on top of the patientʼs skull. “Tell me which side is loudest.” “Theyʼre both the same.” Since theyʼre the same that test is normal. If one side was louder, that would be a positive test.

Next I tested the vestibular section. “Please stand up, close your eyes and stand on one foot.” Weʼre checking for loss of balance here. As we can see sheʼs losing balance, which is a positive test.


9th Cranial nerve: Glossopharangeal Nerve For this test I touched the patientʼs soft palate with a tongue depressor and checked for a gag reflex. Itʼs positive if thereʼs no gag reflex.

10th Cranial nerve: Vagus Nerve As the patient says “ah” the uvula should rise evenly. “Say ah please.” “Ah” It ʻs positive if the uvula rises to the side opposite of innervation.


11th Cranial nerve: Spinal Accessory Nerve For this test, the patient shrugged her shoulders against resistance. I checked for the strength of the muscle.

12th Cranial nerve: Hypoglossal Nerve The patient sticks out her tongue and moves it from side to side. Note for any restrictions in motion.


Chapter 2: Cranial Nerve Symptoms and Function


Resources:

▪ The Neurological Exam ▪ The Essentials of Clinical Examination

Handbook, University of Toronto Medical Society


http://icarus.med.utoronto.ca/neuroexam/

http://icarus.med.utoronto.ca/neuroexam/

cranial nerve exam e-book · 4th cranial nerve: trochlear nerve for this we ask the patient to move...

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