Cranial Nerve Examination

Cranial nerve examination INSPECTION 1. Hi My name is, I’m ayear medical student. 2. I’m going to examine the nerves of your face. Is that alright with you? 3. Before I start, could I please have your name and date of birth? Thank you 4. The initial inspection is whether the patient is well. 5. I’m observing the face and the eyes for any asymmetry, looking out for Ptosis (3rd), Squint, Facial droop (7th). 6. To see if there’s an abnormality with your tongue, could you please repeat red lorry, yellow lorry. Thank you (articulation of words 5,7,10,12) 1st cranial nerve (Olfactory) 1. Have you noticed any recent change in your sense of smell? 2. Usually, to test the impairment of smell, I would ask the patient to smell a different item with each nostril. 2nd Cranial nerve (Optic) 1. I’m to examine the second cranial nerve and this involves acuity, fields, fundi and pupils. 2. I’ll start with visual acuity. Do you wear glasses at all? 3. I would use a Snellen Eye chart for this, standing at 6m away. 4. Could you please cover your right eye and read this line please? 5. Could you repeat this with your other eye? 6. To check for colour vision, I would use Ishihara plates. 7. I’m now going to check for your visual fields. Could you look at the bridge of my nose? Could you cover your right eye (cover your left eye), and look at my eye and tell me when you see this moving into your vision. (put ur hand behind him and wiggle ur finger into his vision from the top right corner first, bottom right corner first. 8. Now could you please cover your same eye with your other hand ie your right eye. (u do the same) and tell me when you see my finger moving into ur vision. (start wiggling ur finger in the top left corner and bottom left corner.) 9. I’m going to examine the fundus of your eyes. 10. I will have to darken the room and use my ophthalmoscope to look into your eye, would you want a chaperone during this examination? 11. Could you please stare at this point please. 12. (closing your left eye, use your right eye to examine the patient’s right eye) I’m looking for a red reflex. 13. I’m going to slowly move in towards your eye to see your optic disk. 14. (inspect the 4 quadrants) 15. Repeat this for the other eye. 16. I’m going to check your papillary reactions to light. 17. I’m going to shine a light in your left eye. Could you look straight ahead. 18. I’m going to shine a light in your other eye. 19. Could you please put you hand on the bridge of your nose, and im going to shine a light in your left eye and then right eye to check for consensual reflex. 20. If there was a Relative Afferent Pupillary Defect I would swing the torch to both eyes.

Extraocular Movements (III, IV and VI)

21. I’m going to assess eye movements. Could you please look at my finger. (do a H shape) This is to check for nystagums. 22. To check for convergence, could you please look at my finger (and move your finger to the bridge of their nose) Examine 5th cranial nerve (trigeminal) Branches of this nerve include ophthalmic, maxilallary and mandibular: 23. Could you please open your mouth and clench your teeth. (feel for the massetter muscles) You could relax now. 24. I’m going to use this stick to investigate pain sensation. (on their sternum), could you feel this..this sharp and this is blunt. With your eyes closed, could you please tell me whether you feel sharop or blunt everytime I touch your face. 25. Use the cotton wool technique and tuning fork for temperature. 26. To examine the corneal reflex, could you look to your left handside (touch the cornea with cotton) Examine the 7th cranial nerve: 26. observe the patient for any facial asymmetry 27. Could you please raise your eyebrows, close both eyes while I try to open tem, smile, could you frown. Could you show your teeth, could you puff out your cheeks. Examine 8th nerve: vestibular cochlear 28. I’m going to check for hearing. I’m going to rub my fingers on either side of you ear, could you please tell me when and on which side you hear the rubbing. 29. I’m going to put this tuning fork behind your ear, that would be your position 1, and I would put it in front of your ear, position 2. could you please tell me where you hear the loudest. 30. (Using 512 Hz) I’m going to put this on your forehead, please tell me where the sound is coming from? 31. If it was heard louder on the one that ws deaf in webber’s test, then its conductive deafness and if its not louder on the deaf side, then its sensorineural. Examine 10th nerve 32. Could you please say your name for me to listen to your voice. 33. I would also ask the patient to swallow water at this point. 34. Could you please say ‘Ah’ (it will deviate away from the lesion) 35. I would at this point stimulate gag reflex. Examine 11the nerve. 36. Could you turn around, you look for atrophy and asymmetry of the muscles.

37. Could you please shrug shoulders and I’m going to push your shoulders down, could you push away from me. 38. I’m going to put your hand on you left handside, could you try turning to the left while I push it to the right. I’m going to do this on the other side, so could you please turn right, while I push it to the left. Cranial nerve 12 39. Could you please open mouth open. 40. could you please stick your tongue out. 41. Thank you, that will be the end of my examination.