Saturday 23 May 2009

Cranial Nerve Examination

I - Olfactory
  • Changes in sense of smell? - blocked nose, head injury? - smell strong odours with one nostril at a time
II - Optic
  • Snellen chart - 6m away
  • Visual fields by confrontation - one eye occluded
  • Fundoscopy - ptosis, squint, exopthalmus, pupil size and irregularities, nystagmus, infection, colour
  • Light reflexes - direct and consensual
  • Accomodation reflex
II - Optic, III - Oculomotor, IV - Trochlear, VI - Abducens
  • Eye movements - H-shape pausing on edges
  • Double vision?
  • Trouble seeing the stairs as you walk down them?
V - Trigeminal
  • Facial sensation - soft touch, sharp touch/pain
  • Muscles of mastication - temporalis, masseter
  • Reflex jaw jerk
VII - Facial
  • Muscles of facial expression
  • Facial asymmetry, involuntary movements
  • Power
  • "Me me me"
  • Taste
  • Salivation
  • Dry eyes?/mouth?
V - Trigeminal, VII - Facial
  • Corneal reflex
VIII - Vestibular Cochlear
  • Examine ears
  • Hearing aid?
  • Auroscopy
  • Whisper test
  • Weber's test
  • Rinne's test
  • Arrange audiometry?
  • Vertigo? - Hallpike manoeuvre
IX - Glossopharyngeal, X - Vagus
  • Inspect palate and pharynx - pentorch
  • Say "ahh" - uvula deviation?
  • Cough
  • Swallow
  • Speech? - hoarseness
  • Gag reflex
XI - Spinal Accessory
  • Head movements
  • Sternocleidomastoid - look over shoulders against resistance, head protraction against resistance
  • Trapezius - shrug shoulders against resistance, action as if brushing hair
XII - Hypoglossal
  • Protrude tongue - deviation?
  • Movements of tongue
  • Power of tongue - in cheek against resistance
X - Vagus, XII - Hypoglossal
  • Perform tongue-twister

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