CRANIAL NERVES The trochlear nerve controls your superior

 CRANIAL NERVE I (Olfactory oblique muscle. This is the muscle that’s

Nerve) responsible for downward, outward, and
The olfactory nerve is typically considered inward eye movements.
the first cranial nerve, or simply CN I, that
contains sensory nerve fibers relating to the The abducens nerve controls another
sense of smell. muscle that’s associated with eye
movement, called the lateral rectus muscle.
 To test for this, ask the client to clear This muscle is involved in outward eye
the nose to remove any mucus then movement. For example, you would use it to
to close eyes, occlude one nostril, look to the side.
and identify a scented object that
you are holding such as soap, Pupillary light reflex
coffee, or vanilla. Repeat procedure  Ask the patient to fixate on a distant
for the other nostril. target
 Shine a pen torch into each eye in
FINDINGS: turn, bringing the beam in quickly
from the lateral side
  Abnormal  Observe both the direct (ipsilateral)
Normal and consensual (contralateral)
response
Client Inability to smell Pupillary accommodation – The
correctly (neurogenic anosmia) or accommodation reflex involves both
identifies identify the correct scent convergence of the eyes (requiring
scent may indicate olfactory tract adduction of both eyes) and simultaneous
presented to lesion or tumor or lesion of constriction of the eyes
each nostril. the frontal lobe. Loss of  Ask the patient to look at an object
smell may also be held at distance
congenital or due to other  Bring the object to within 10cm of
causes such as nasal the patient, asking the patient to
disease, smoking, and use follow it with their eyes
of cocaine.  Watch the pupils for equal
convergence and constriction
 CRANIAL NERVE II (Optic Nerve)  Ask the patient to look straight
Visual Acuity (VA) – Assess VA with a ahead and check for signs of
Snellen chart. Keep glasses on to correct nystagmus or ptosis
for any refractory errors Ocular movements
 Stand the patient 6m away from the  Ask the patient to keep their head
chart, covering each eye separately still and follow an object
with their hand in turn  Move the object around in an H
 Find the line of print which the formation, assessing both horizontal
patient can comfortably read and vertical gaze
 Watch the pupils to assess the eye
Visual Fields movements and any signs of
 Ask the patient to cover their left eye nystagmus
with their left hand and then cover  Checking the conjugate gaze may
your right eye with your right hand. also be warranted at this point
The patient must continue to look
straight ahead  CRANIAL NERVE V (Trigeminal
 Move your hand to the patient’s Nerve)
upper temporal visual field quadrant The trigeminal nerve is the largest of your
 Gradually move your finger to the cranial nerves and has both sensory and
centre of their vision from the motor functions.
periphery and ask the patient to The trigeminal nerve has three divisions,
inform you as soon as they see your which are:
finger moving
 Ophthalmic. The ophthalmic division
 CRANIAL NERVE III, IV, VI sends sensory information from the
(Oculomotor) upper part of your face, including
The oculomotor has two different motor your forehead, scalp, and upper
functions: muscle function and pupil eyelids.
response.
 Maxillary. This division
Muscle function. Your oculomotor nerve
communicates sensory information
provides motor function to four of the six
from the middle part of your face,
muscles around your eyes. These muscles
including your cheeks, upper lip, and
help your eyes move and focus on objects.
nasal cavity.
Pupil response. It also helps to control the
 Mandibular. The mandibular division
size of your pupil as it responds to light.
has both a sensory and a motor
function. It sends sensory
 information from your ears, lower lip, eyebrows, has
and chin. It also controls the puffs out facial paralysis or
movement of muscles within your cheeks, asymmetry of
jaw and ear and closes face such as
eyes facial droop.
 Both sensory and motor branches of without
the trigeminal nerve should be difficulty;
tested: patient can
distinguish
 Sensation requires both light touch different
and pin prick assessment tastes.
 Demonstrate to the patient what to
expect from the light touch and pin
Cranial Nerve VIII
prick sensations
 Ask the patient to close their eyes - The vestibulocochlear nerve
and gently touch the forehead, (auditory vestibular nerve), known as
cheeks, and chin regions (assessing the eighth cranial nerve, transmits
ophthalmic, maxillary, and
sound and equilibrium (balance)
mandibular branches respectively)
information from the inner ear to the
 Ensure to ask the patient to let you
know if they experience any brain.
changes in sensation either side or Procedure:
cannot feel the sensation
Motor function is checked by the muscles  Examination of cranial nerve VIII
of mastication should cover both cochlear and
 Ask the patient to clench their teeth vestibular function:
tight and palpate for the contraction
in the temporalis muscle and  Hearing can be assessed by
masseter muscle whispering a number into each ear
 Ask the patient to open their mouth, separately, making a distracting
move their jaw from side to side, noise with your fingers in the
then close their mouth contralateral ear, and asking the
patient to repeat
 CRANIAL NERVE VII
 If any hearing loss suspected,
The facial nerve (the labyrinthine segment) perform Rinne’s and Weber’s test
is the seventh cranial nerve, or simply CN
 Balance has no truly satisfactory test
VII.
for assessment
Procedure:  Formal vestibular testing can be
Testing the facial nerve involves the performed
assessment of the muscles of facial Findings:
expression:
Cranial Nerve Normal Abnormal
 Initially assess for symmetry in the Findings Findings
face at rest VIII. Patient Patient
Vestibulocochlea hears has
 Ask the patient to perform the
r (Acoustic) whispere decrease
following movements d words d hearing
▪ Raise their eyebrows or finger in one or
snaps in both ears
▪ Close their eyes tightly both and
ears; decrease
▪ Blow out their cheeks patient d ability to
▪ Smile can walk walk
upright upright or
These movements should also be able to be and maintain
completed against the examiner’s maintain balance.
resistance balance.

Findings:
 Cranial Nerve IX
Cranial Normal Abnormal
Nerve Findings Findings - The glossopharyngeal nerve, CN IX,
VII. Patient Patient has is the ninth paired cranial nerve. In
Facial smiles, decreased ability this article, we shall look at the
raises to taste. Patient anatomical course of the nerve, and
 the motor, sensory and ▪ Findings:
parasympathetic functions of its
terminal branches. Cranial Nerve Normal Abnormal
Findings Findings
Procedure: XI.Accessory Patient Patient
shrugs has
 CN IX and CN X nerves can be shoulders inability to
assessed together: and turns shrug
head side shoulders
 Ask the patient to cough (assessing
to side or turn
CN X)
against head
 The soft palate should move resistance. against
upwards centrally resistance.

 Ask the patient to open the mouth

wide and say ‘ah’, using a tongue  Cranial Nerve XII
depressor to visual the palate and - The Hypoglossal Nerve is the 12th
posterior pharyngeal wall (assessing
Cranial Nerve (Cranial Nerve XII). It
CN IX and X)
is mainly an efferent nerve for the
 Testing of the gag reflex should not tongue musculature.
be performed unless bulbar
Procedure:
impairment is suspected, as it is
uncomfortable to the patient. The hypoglossal nerve is a purely motor
branch to the muscles of the tongue:
Findings:
 Ask the patient to open their mouth
Cranial Nerve Normal Abnormal and inspect the tongue for any
Findings Findings
wasting or fasciculation
IX. Gag Gag reflex
Glossopharyngea reflex is is not  Ask the patient to protrude the
l present. present; tongue and move from side to side
patient
has Cranial Nerve Normal Abnormal
dysphagia Findings Findings
. XII. Hypoglossal Tongue Tongue is
is midline not midline
X. Vagus Patient Slurred and can or is weak.
swallow speech or be
s and difficulty moved
speaks swallowin without
without g is difficulty.
difficulty. present.

 Cranial Nerve XI

- The accessory nerve is the eleventh

paired cranial nerve. It has a purely
somatic motor function, innervating
the sternocleidomastoid and
trapezius muscles.
Procedure:
The accessory nerve is a purely motor
branch to the trapezius and
sternocleidomastoid muscles:
▪ Sternocleidomastoid can be
assessed by asking the patient to
turn their head to each side, against
the examiners resistance
▪ Trapezius can be assessed by
asking the patient to shrug their
shoulders, against the examiners
resistance