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Cranial Nerve 1
Olfactory
Cranial Nerve 2
Optic
Cranial Nerve 3
Oculomotor
Cranial Nerve 4
Trochlear
Cranial Nerve 5
Trigeminal
Cranial Nerve 6
Abducens
Cranial Nerve 7
Facial
Cranial Nerve 8
Acoustic (vestibulocochlear)
Cranial Nerve 9
Glossopharyngeal
Cranial Nerve 10
Vagus
Cranial Nerve 11
Spinal accessory
Cranial Nerve 12
Hypoglossal
Which nerves are sensory?
Cranial nerves 1, 2, and 8
Olfactory, optic, and acoustic
Which nerves are motor?
Cranial nerves 4, 6, 11, and 12
Trochlear, abducens, spinal, and hypoglossal
Which nerves are mixed (carries a combination)?
Cranial nerves 3, 5, 7, 9, and 10
Oculomotor, trigeminal, facial, glossopharyngeal, and vagus
Cranial Nerve 1 Objective data
Only tested when:
Patient reports change in sense of smell
Head injury
Suspected brain lesion
Hold one nostril closed and assess sense of smell
Hold familiar aromatic substance eg. vanilla, under nostril
Patient should identify substance
Cranial nerve 2 objective data
Tested by testing visual acuity (snellen chart) and visual fields by confrontation
Use ophthalmoscope to check the ocular fundus for colour, size, and shape of optic disc
Round, bright optic disc, yellow/peach/orangish fundus
Cranial nerves 3,4,6 objective data
Check width of palpebral fissures bilaterally
Abnormal: Ptosis
Check pupils (PERRLA)
Abnormal: Unilateral dilation or nonreactivity
Check cardinal positions of gaze
Abnormal: Strabismus or Limited Movement or Nystagmus
Cranial nerve 5 motor function
Motor function
Palpate temporal and masseter muscles
Patient asked to clench teeth
Push down on chin to assess strength
Abnormal findings:
Decreased strength, asymmetry of jaw movement, pain with clenching
Cranial nerve 5 sensory function
Sensory function
-Patient closes eyes
-Touch a cotton ball to forehead, cheeks, and chin
-Ask patient to say “now” when they feel it
-Compare bilaterally
Cranial nerve 5 Corneal reflex
-Only done if patient has abnormal facial sensation or facial movement
-Patient looks forward (take out contact lenses)
-Cotton ball brought in from the side and touched lightly off the cornea
-Assess for bilateral blinking
-Abnormal: decreased or unequal sensation
Cranial nerve 7 motor function
•Facial nerve
•Motor assessment:
–Ask patient to smile, frown, close eyes tightly (against examiner trying to open them), lift eyebrows, show teeth, and puff cheeks
–Press puffed cheeks in and note if air escapes equally
•Abnormal: Unable to do movements, air leaks different bilaterally
Cranial nerve 7 sensory function
•Not tested routinely. Test when there is concern about facial nerve injury
•Assess taste of sweet, salty, and sour by applying each solution to a cotton tipped applicator and then to the tongue
•Ask patient to identify the taste
Cranial nerve 8 objective data
•Acoustic (vestibulocochlear nerve)
•Tested using the whispered voice test
–Stand 2 feet behind patient
–Cover one ear and whisper in open ear
–3 random letters or numbers
–Ok is correctly identify 3 out of 6 letters or numbers
Cranial nerve 9 and 10 objective data
Sensory function of cranial nerve 10 is usually not checked because it relates to taste in the posterior one-third of the tounge and is too difficult to test
Motor function:
Depress tongue with tongue blade and note pharyngeal movement when patient says “ahhhh” or yawns. Uvula should should rise and tonsillar pillars move medially
Check gag reflex by touching posterior pharyngeal wall with tongue blade
Take note of quality of voice
Abnormal: deviated uvula, absence of movement, lack of gag reflex, hoarseness
Cranial nerve 11 objective data
•Spinal accessory nerve
•Examine sternomastoid and trapezius muscle for equal size and strength
•Ask patient to turn head against resistance and to shrug shoulders against resistance
•Abnormal: atrophy of muscle, weakness or paralysis of muscle
Cranial nerve 12 objective data
•Hypoglossal nerve
•Inspect the tongue for any wasting or tremors
•Ask patient to stick out tongue and note if it is midline
•Ask patient to say words like “light”, “tight”, and “dynamite” and listen for annunciation of the letters “l”, “t”, “d”, and “n”
•Abnormal: deviation of tongue, atrophy of tongue, quick movements of tongue (fasciculations)