Cranial Nerve Exam Diagnoses (Updated Fall 2025 - CN Group 1)

Amyotrophic Lateral Sclerosis (ALS) - Bulbar Onset

- Drooling

- Breathy

- AMRS and SMRs are effortful and hard to get out.

- MPTs are normal

- Primitive reflexes are not normal [swipe up]

- "AMRS, SMRs, and primitive reflexes are not WNL. MPTs are within normal limits."

- Cue: "Oh, sorry! I just keep drooling!" [wipe face]

Amyotrophic Lateral Sclerosis (ALS) - Spinal Onset

- Curled up arms and hands --> Walk in like that and keep them like that the whole time.

- AMRs, SMRs, and MPTs are Short/Breathy

- Primitive reflexes are not normal [swipe up]

- "AMRS, SMRs, MPTs, and primitive reflexes are not WNL."

Anosmia

- NOT DAMAGE

- If unable to smell in either nostril, when clinician asks "Have you ever been able to smell?", client says "no"

- "My whole life I have never been able to smell."

Apraxia

- Irregular/inconsistent AMRs and SMRs (e.g., AMRs = "pe, pi, po;" SMRs = "pe, ki, to")

- MPTs are normal length, but hard to initiate. Change the sound (e.g., "Ahhh, ahhh, eee")

- Primitive reflexes are normal

- "AMRs, SMRs, and MPTs are not WNL. Primitive reflexes are WNL."

- Cue: "Planning what to say is hard"

Ataxia

- Choppy or slurred speech

- Large tongue, sticks out

- Cue: "My tongue is too big for my mouth"

- Speak and walk like a drunk (not actually drunk) - think need a taxi

- AMRs - big breath after each "puh (breath) puh (breath) puh (breath)"

- SMRs - big breath after each "puh (breath) tuh (breath) kuh (breath)"

- MPTs are normal

- Primitive reflexes are normal

- "AMRs and SMRs are not WNL. MPTs and primitive reflexes are WNL."

Bilateral Abnormal Reflexes

- Pull hands up on both sides

- "Primitive reflexes are not WNL"

- Do not give as a diagnosis if the patient has a diagnosis in which abnormal primitive reflexes are expected (i.e., Parkinson's, Huntington's, Bulbar ALS, and Spinal ALS).

Unilateral Abnormal Reflexes

- No damage, just not WNL.

- Pull hand up on damaged side (e.g., can't smell on right, pull right hand up)

Workplace Accident

- Patient says "yes" to accident/trauma question

- Cue: "I used to work in a factory"

Ptosis

- Droopy on eye with Oculomotor damage --> client pulls down on affected eye

- Cue: "My eye is so droopy."

- Unilateral or bilateral

- Damage to CN 3 (report the damage and diagnosis)

Foix Chavany Marie Syndrome (fwah-shah-vuh-nee muh-ree)

- Cannot speak

- Cannot feel entire face

- Paralysis of face - cannot do any motor movements

- Client's jaw hangs open

- NO TALKING

- Write, "I was born this way" on the board

- Bilateral UMN damage to CN 5 trigeminal --> whole face weak (report both damage and diagnosis)

Trigeminal Neuralgia

- Painful face - most likely entire face or half of face (unilateral or bilateral)

- Bi or uni damage to sensory portion of CN 5 trigeminal (hurts where the damage is for finger swipes)

- Cue: "OWWW, it really hurts when you touch my face."

- Clinician should touch the person's body (tap shoulder) after to determine if it's neuralgia (whole body) or trigeminal neuralgia (just face).

Bell's Palsy

- Patient will say, "I woke up like this," and "My face is droopy on this side."

- Droopy face, potentially hearing impaired.

- Sudden onset

- LMN damage to the motor portion of CN 7 facial (report as both damage and diagnosis)

- It is rarely bilateral

Presbycusis

- Can hear but difficult due to old age --> Patient will say "I can't hear well. I'm really old."

- Possible damage to CN 8 vestibulocochlear (Burda could pair the diagnosis with damage or not. If she does, report both damage and diagnosis).

Vestibular Schwannoma/Acoustic Neuroma

- Damaged hearing and balance and tingly on side of damage

- Cue: "I've had pressure and ringing in my ears for 3 months."

- Damage to CN 8 vestibulocochlear (will be paired with damage; report both damage and diagnosis).

Pharyngeal Neuralgia

- Hurts to swallow and breathe on side of damage --> patient will say, "It hurts so bad to swallow on this side." [gesture to side that hurts]

- ONLY swallow hurts. Cough, grunt, and gag are fine/normal.

- Just a diagnosis, not damage.

Stroke to CN 10 LMN Recurrent Laryngeal Branch

- Breathy voice

- Answer yes to all questions (voice, heart, gag)

- Die after 2nd gag - Patient will grab throat, stick out tongue, and die (close eyes)

- Clinician will say "Call 911" someone in crowd responds "Got it," and clinician will say "Patient has expired, but for the purpose of this exam, we will continue."

- Bilateral damage to LMN of CN 10 Vagus at recurrent laryngeal branch (report both damage and diagnosis).

- In conclusion --> "Refer to the morgue"

Glossectomy

- No tongue --> Patient will say "I don't have a tongue"

- In conclusion - "Exam was inconclusive due to patient not having a tongue."

- Do whole exam anyway --> possible diagnosis of a glossectomy

- Refer on

Alcoholism

- Act drunk and way too interested in alcohol --> Patient says, "Wanna go to the hill later?"

Altered smell

- Smelling something other than what is presented --> Patient says "I smell tacos"

- Most commonly with Cranial nerve I Olfactory

- Diagnosis (report separately from damage)

Aneurysm

- Patient says, "I am having the worst headache of my life."

- Patient slumps in chair with eyes open --> Do not die (meaning do not close eyes) unless Dr. Burda tells you too.

- Clinician calls 911 and continues

Asthma

- Patient brings "inhaler" up to their mouth and breathes in [shake it and quick inhale]

Auditory Hallucinations

- Hears things that aren't there --> Patient says, "Do you hear that cow?"

Being a Doctor

- Comes in with a stethoscope around neck and acts really rude --> Patient says, "Do you see my stethoscope? I could do so much better."

Being a Mathematician

- Patient comes in with Abacus and talks about math.

- Cue: "I love math"

Being an SLP

- Acts like they know how to do things better in the exam

- Cue: "I've been in this profession for 15 years, and I could do it way better."

Bifid Uvula

- Patient has a double uvula --> Patient says, "Look at the thing in the back of my mouth. It is so cool!"

Bilingualism

Fluent in 2 languages --> speak in English and another language [maybe stick to Spanish; "Hola"]

Broca's Aphasia

- Choppy speech and short sentences due to stroke.

- Patient says, "I talk short"

- Use sentences with only content words

Broken Arm

- Comes in room with an arm sling/traffic cone

Caffeine Addiction

- Patient continually asks for caffeinated beverage

- Patient says, "Do you have an energy drink?"

Cerebrovascular Accident

- Big stroke causing slurred speech, weak arm, droopy face.

- Patient grabs arms and falls to the ground, alive (eyes open)

- Do not die unless Dr. Burda tells you to

- Clinician says, "Call 911" and someone in crowd says "got it"

Chronic Obstructive Pulmonary Disease

- Moves shoulders when breathing

- "I smoke 12 packs a day"

COVID-19

- No taste or smell

- Has cold (answer "yes" to cold question for CN 1 olfactory)

- Patient says, "I took a tequila shot at the bar and I could not taste it."

- Not damage to CN 1 Olfactory

Deaf

- Patient cannot hear anything and has normal balance

- Clinician must write the whole test out (write main stuff on the board)

- Patient comes in saying, "I can't hear anything."

- Not damage (can walk and touch nose fine), however, it may be paired with damage (cannot walk and touch nose fine)

Delusional

- Patient thinks they are a superhero --> Patient says, "Look, I'm Spider-Man."

Dementia

- May think they are younger than they are.

- Holding stuffed animal

- "I'm just not a sharp as I used to be"

Dental Trauma

- Complains of gums and teeth pain --> Patient says, "My gums hurt so much. I can't chew."

Dissociative Identity Disorder

- Patient has multiple names --> Patient may say "Anna smells lemons, but Kara smells hot dogs"

- Example --> "This is Allie. Now this is Kayleigh."

Drunk

- Walks and talks drunk and is actually drunk --> Patient says, "I just came from the bars and now I am super hungover"

Dysarthria

- Slow and imprecise speech - Sounds like a robot/monotonous

- AMRs and SMRs are slow/imprecise/robotic

- MPTs are pretty short

- Primitive reflexes are normal

- "AMRs, SMRs, and MPTs are not WNL. Primitive reflexes are WNL."

- Cue: "Sorry, I sound like a robot"

Echolalia

- Repeat exactly what the clinician says --> Do mainly in intro

Facial Blindness

- Cannot recognize faces (even people they know) --> Patient says, "What's your name again? I have trouble with faces"

Fall Risk

- Patient in wheelchair and wearing a helmet --> Patient says, "My grandkids think I need a wheelchair, but I don't think so."

Foreign Accent Syndrome

- Woke up and now talking in accent --> Patient says, "I woke up and now I talk like this. I've never even been there before"

- Stick to one accent only (However, be prepared with a couple of accent options, as Burda required someone last semester to use an accent other than what they practiced)

Parosmia (Funky Smells)

- Patient says, "It smells really weird in here."

- Patient says "yes" to smoker, trauma, and chemicals, not to cold.

- Diagnosis (report separately from damages)

Grumpy

- In a really bad mood, but cooperates --> Patient says, "I'm in such a bad mood."

Gunshot wound

- Squint eye on damaged side --> Patient says, "My face looks like this because I went hunting this weekend."

Hemiballism

- Flailing limbs on one side of body (balling it up).

- Pretend you're shooting a basketball the whole time.

HaNDL

- Numbness in one whole side of body, so hit one side of body to wake it up.

- Patient says, "Sorry, this side of my body just keeps falling asleep/is numb."

Huntington's

- Dance-like moves in arms and legs (flailing)

- Twitch shoulders and legs

- AMRs and SMRs are slow and irregular (breaks in between)

- MPTs have voice stoppages

- Primitive reflexes are not normal [swipe up]

- "AMRs, SMRs, MPTs, and primitive reflexes are not WNL."

Huntington's Face

- Primitive reflex on face not normal - face twitches on the "swipe tap"

- Only face twitches - scrunch your nose a lot

Hypersensitivity to smell

- Patient says, "Your perfume is so strong."

Hypersensitivity to Sound

- Patient says, "You are talking sooo loud"

Hypersensitivity to touch

- Patient says, "You are pushing/touching my SO HARD"

- Hard = hypersensitivity; Hurts = neuralgia

Idiopathic Tremor

- Patient spontaneously shakes a body part (body part assigned by Burda)

- "My ____ just starts shaking sometimes."

Impulsivity

- Overly excited about random things --> Patient jumps up and claps hands and asks, "Do you want to go outside?"

Incontinence

- Patient pees pants and tells clinician --> "Oh, sorry! I just peed."

- Clinician wipes up urine for client, takes off gloves, washes hands, and puts new ones on.

Laryngeal Spasm

- Patient says, "I just ate Mexican and now my throat is burning."

Left/right neglect

- Ignores affected half of body (e.g., right hair up and right shoe on, but left hair down and left shoe off = left neglect)

- If you have long hair, perhaps try to remember to bring a hair tie to the exam (Burda did not provide one last semester)

Lethargy

- Complains of being tired and lacks enthusiasm --> Patient says, "I'm so tired. Do we have to do this now?"

- DO NOT FALL ASLEEP

Lice

- Patient says, "My head really itches."

Lyme's Disease

- Nausea, extreme exhaustion, sound and light sensitivity, fevers.

- Patient says, "Can you dim the lights? They are so bright." Or "Do you see this tick bite I got?"

- If the patient has Lyme's disease, they will also have trigeminal neuralgia, but not the other way around.

Malingering

- Inconsistent test results

- Gives wrong answers, being trouble

- Might start malingering halfway through the test

- Gives a different name/mentions name --> Patient says, "I am Taylor Swift."

- Conclusion - "Patient presents with signs and symptoms consistent with malingering. Therefore, the test is deemed inconclusive. I would refer to the psychiatrist."

-

Meniere's Disease

- Unsteady and dizziness

- Tinnitus and ears feel full --> Patient says, "My ears feel full and muffled."

Migraine

- Light, sound, and noise sensitivity

- Headaches --> Patient will say, "I took Excedrin because I have a horrible headache."

- Keep separate from headache!

Moebius Syndrome

- Patient has no emotion and cannot blink - like a statue

- Patient uses monotone voice and stares in distance

- Patient says, "I am just so happy; you just can't tell" or "I haven't blinked in years"

Motor Impairment

- Patient is in a wheelchair or uses a walker

- Patient does not say anything about wheelchair or walker

Multiple Sclerosis

- Hunched over and has pain in legs --> Patient says, "My legs hurt all the time." [rubs legs]

Myasthenia Gravis

- Voice is at normal volume at first, but then loses volume and sounds breathy after a while and then sounds better after they breathe again --> Patient says, "My voice gets really tired quickly, but then it gets better."

Myocardial Infarction

- DO NOT SAY HEART ATTACK

- Chest pain and shortness of breath

- Patient grabs chest and falls to the ground with their eyes open (still alive) --> Patient says, "My heart"

- Answer yes to heart problems if CN 10 vagus

- Do not die (eyes closed) unless Dr. Burda tells you to

- Clinician says "Call 911" and someone in crowd says "got it."

Narcolepsy

- Falls asleep multiple times during exam and SNORE

- Clinician then taps them on shoulder to wake them up

Neuralgia

- Pain all over the body --> Patient says, "OW" anytime the body is touched

- Clinician touches various body parts and ask if they hurt

- Not damage

Neuroleptic Malignant Syndrome

- Patient has a reaction to drugs (peeing) --> Patient says, "I took some pills and just peed (once)"

- Pee pants only one time

Nicotine Addiction

- Patient says, "Do you have a vape?"

Non-compliant

- Refuses and doesn't want to do anything --> Patient says, "No, I don't want to."

- The patient does it/complies after the clinician asks again

Normal Pressure Hydrocephalus

- Trouble walking/lifting feet --> Patient says, "It's so hard to walk, it's like my feet are stuck in glue."

Nystagmus

- Eyes dart back and forth --> Patient says, "Do you see my eyes going back and forth?"

Obsessive Compulsive Disorder

- Obsessed with repetitions (focus on doing everything in threes)

- Patient taps chair and says "1, 2, 3" before sitting down. Patient keeps saying "1, 2, 3" while tapping randomly.

Olfactory Hallucinations

- Patient smells peanut butter

- Diagnosis. May be paired with damage, but treat them separately (do not smell peanut butter during smell test if there is damage).

Opioid Addiction

- Patient says, "Can you write me a prescription for more pills?"

Overactive Gag

- Patient gags a lot and throws up --> Patient says, "Sorry, I just threw up."

- Clinician cleans it up, removes gloves, washes hands, and puts on new gloves.

- NOT damage to CN 9 glossopharyngeal

Parkinson's

- Shake hands and shuffle feet/small steps

- Slow/soft speech

- AMRs and SMRs are slow with soft voice

- MPTs are long enough with a tremoring quality

- Primitive reflexes are not normal [swipe up]

- "AMRs, SMRs, MPTs, and primitive reflexes are not WNL."

Perseveration

- Continually talks about a topic --> Patient says, "I love coffee. Coffee. Coffee. Coffee. Coffee."

- Could perseverate over any topic (but we'll stick to coffee unless Burda says otherwise)

- Also could be "obsession" but that would more than likely be something random that you didn't study (e.g., Spencer and Anna doing barbies).

Post Concussion Syndrome

- Had past concussions and has headaches now --> Patient says, "I played soccer and now I have headaches."

Pregnancy

- Pretend you are pregnant/in labor

- Worry about your baby

- Cue: "I'm 3 months along" [rub belly]

Progressive Supranuclear Palsy

- Client looks up the entire time and repeats last word of sentences --> Patient says, "I feel good good. I see your hands hands."

- Say, "Yes yes" to touching head, neck, or shoulders question and to double vision question for CN 3, 4, and 6.

- Damage to CN 4 trochlear and report as diagnosis

- Just diagnosis for any other cranial nerve

Pseudobulbar Affect

- Excessive mood swings --> Patient says, "OOO, I love your hair... Ugh, I don't like your shirt."

- One extreme to the next

Pushing Professional Boundaries

- Being overly friendly with clinician

- Wants to hug clinician --> Patient says, "Can I have a hug?"

Seizures

- Patient whole body shaking and slumps in chair, but is alive (eyes open)

- Only die (eyes closed) if Dr. Burda tells you to

- Clinician says, "Call 911" and someone in crowd says "got it."

Shadow Smells

- Smelling things that aren't there --> Patient says, "I smell a campfire."

Shadow Voices

- Hearing things (hallucinations) that are not there and then pick a fight with person (who is not there) --> Patient says, "Jimmy! Shut up!"

- Conclusion - refer to a psychiatrist

Shingles

- Painful and blustery rash on scalp --> Patient says, "It hurts to brush my hair."

- Can be unilateral or bilateral

- Damage if presented with CN 7 facial and diagnosis with other CNs

Short-Term Memory Loss

- Forgets what they are doing and why they are there --> Patient says, "What were we doing again? Why am I here?"

Slow Movements

- Walk in slow motion and all movements are slow - do the "debby ryan"

- Speech is fine

Stiff Person Syndrome

- In wheelchair with legs straight out (keep legs out the whole time)

- Muscle spasms causing joints to hurt and constipation.

Tactile Agnosia

- Has to be touching an item to know what it is --> Patient says, "Can you hand me that item? I see there's something there, but I don't know what it is." SLP gives client item, and patient says what it is, "Oh yes, it's an (item)"

- Bring it up to vision after touching it, then be able to identify it.

Tinnitus

- Patient says, "My ears are ringing."

- Ringing just started

Tourette's

- Uncontrollable repetitive movements and sounds such as blinking eyes or shrugging shoulders.

- Swears often --> Patient says, "shit****" or "crapshoot"

- As patient, do not mess up clinician

- As clinician, do not laugh or smile

Tracheostomy Tube

- Breathy voice until covers tube in throat (wearing tube)

- Can only talk if you cover the hole

Transient Ischemic Attack

- Mini stroke

- Slurred speech, droopy face, arm weakness

- Grab arm (only once), slouch in chair, do not fall to the floor, and still alive (eyes open).

- Clinician says, "Call 911" and someone in crowd says, "got it."