cranial nerve examination

cranial nerve examination

1. neurology cranial nerves examination Dr mohamed rizk khodair lecturer of neurology October 6 university [email protected] كلية الطب والجراحة

2. Cranial nerves

3. Pathway of smell From the receptors in the olfactory mucosa , the fibers of olfactory nerve pierce the cribriform plate of the ethmoid bona and run in the olfactory groove to relay in the olfactory bulb , a new set of fibers travels in olfactory tract to terminate in the olfactory sensory area in the uncus of the temporal lobe of both sides

4. 1- Olfactory nerve examination Familiar substance (mint - coffee ) . Non irritant . Each nostril alone . Close the eye

5. Lesion in olfactory : Anosmia: unilateral traumatic , inflammatory , neoplastic : foster Kennedy syndrome ( ipsilateral optic atrophy due to direct pressure on optic nerve, contralateral papilledema due to increase ICT, ipsilateral anosmia may occur due to pressure on the olfactory. NB : Unilateral lesion of uncus doesn’t cause anosmia as the sense of smell is bilaterally represented . Bilateral : ENT , hysterical , hereditary Parosmia : ( perverted sense of smell ) يشم الراويح متغيرة common in hepatitis and pregnancy Olfactory hallucination : perception of smell usually unpleasant in absence of stimulus , due to central olfactory affections ( temporal lobe epilepsy)

6. 2-optic nerve

7. How to examine Visual acuity Color vision Visual field Fundus examination

8. Visual acuity Snellen chart . Counting finger 6 m to 30 cm Hand movement Perception of light

9. Color vision (ishihara color plates)

10. Field of vision Confrontation test

11. Cranial Nerves: Optic Pupil, acuity, Field, Fundi By Confrontation test → Uniocular vision → Binocular vision

12. Ocular motility

13. Cranial Nerves: Conjugate Eye Movements

14. Oculomotor nerve palsy

15. Trochlear nerve palsy

16. Abducent nerve palsy

17. Partial or complete ptosis

18. Pupil : Size , shape , symmetry Response to direct or indirect light reflex (ll,lll) Accommodation reaction (ll,lll) Ciliospinal reflex Normal comment : Round regular reactive . Causes of miosis : Horner syndrome (congenital or acquired ), pontine lesion, opiate toxicity Causes of mydriasis : diminution of vision , drug , compression of 3 rd CN

19. Each eye separate Both eyes together Spontaneous or with fixation Horizontal or vertical or rotatory Unilateral or bilateral If it has rapid and slow phase ( direction of nystagmus is that of rapid phase) Nystagmus

20. Trigeminal nerve sensory Pain , touch , Both side of the face Ophthalmic , maxillary , mandibular branches The inner & outer part of the face

21. Motor examination of 5 th Nerve : Inspection : temporalis and masseter palpation : temporalis , masseter pterygoid : with and without resistance unilateral : jaw is deviated to diseased side bilateral : inability to open mouth Reflexes : Superficial reflexes : corneal & conjunctival reflexes (5&7) Pathological reflexes : Jaw reflexes (5 th &5 th ) normally : absent or minimally exaggerated : bilateral UMNL above pons

22. Cranial Nerves: Trigeminal: reflexes

23. Facial nerve : How to examine Muscle power Frontalis , orbicularis oculi Orbicularis oris , buccinators , retractor anguli Reflexes : Corneal reflex (5 th & 7 th ) Glabellar reflex (7 th &7 th ) Taste sensation

24. Facial nerve : Upper half of face Inspection : 1) lack of forehead corrugations 2) dribbling of tears Palpitation : Inability of elevate eyebrows properly Eye can be easily opened by examiner Glabber reflex Normally : blinking bilateral (bilateral contraction of orbicularis oculi ) blinking stops after 2-3 contraction ( due to habituation ) Abnormally : lost in LMNL , exaggerated in UMNL , persistent in parkinsonism Lower half of face Inspection : obliterated nasolabial fold Deviation of the mouth to the healthy side Dribbling of saliva , dropping of angle of mouth Palpitation : inability to blow the check , inability to whistle , inability to show teeth properly

25. Vestibulocochlear CN : Cochlear : test for acuity of hearing Rinne’s test : using vibrating tunining fork on mastoid process Weber test : place tuning fork in the middle of head .

26. 9 th , 10 th , 11 th (cranial accessory) CNS : Inspection : base of uvula , soft palate Palpation : use torch and tongue depressor and say ah and see the uvula Reflexes : palatal reflex (5 th & 10 th ) : normally stimulation of soft palate leads to its elevation . pharyngeal ( gag ) reflex(9 th & 10 th ): normally stimulation of posterior pharyngeal wall lead to local contraction and gag reflex Exaggerated : in pseudobulbar palsy Lost : in true bulbar palsy

27. Spinal accessory : Inspection : shoulder , head Palpation : trapezius : ask patient to turn head rt and left , tested by asked patient to turn his chin against resistant Unilateral lesion : head is tilted to disease side Sternomastoid : inspect shoulder depression , tested by elevation of shoulder against resistance

28. Inspection : tongue fasciculation ,tongue corrugation , wasting , abnormal movement Palpitation : without resistant & with resistant Hypoglossal Nerve

29. Thank you [email protected]