






Study with the several resources on Docsity
Earn points by helping other students or get them with a premium plan
Prepare for your exams
Study with the several resources on Docsity
Earn points to download
Earn points by helping other students or get them with a premium plan
Community
Ask the community for help and clear up your study doubts
Discover the best universities in your country according to Docsity users
Free resources
Download our free guides on studying techniques, anxiety management strategies, and thesis advice from Docsity tutors
A detailed guide on how to perform a cranial nerves examination. It covers various aspects of the examination, including the positioning of the examiner and patient, essential steps, and the assessment of different areas. The document also mentions the nerves involved and the muscles tested.
Typology: Schemes and Mind Maps
1 / 12
This page cannot be seen from the preview
Don't miss anything!
(Patient is seated.) Cranial Nerves:
Any abnormality or problem with this screening test of visual fields, or a complaint of visual loss, prompts retesting of visual fields one eye at a time (see Addendum later). Failure of the patient to recognize both simultaneously moving fingers suggests visual extinction from a parietal lobe lesion.
Note: The examiner should be testing his/herself at the same time and comparing his/her answer to the patients – assuming the examiner has normal visual fields!
Motor System: Examiner should inspect muscles for asymmetry, atrophy and fasciculations while testing muscle tone and strength.
The patient is asked to relax. The examiner supports the patient’s elbow, and grasping the patient’s hand passively flexes and extends the wrist, elbow and shoulder through a moderate range of motion. With practice, this can be combined into a single, smooth movement. Normal resistance is felt as mild resistance to passive stretching, which is felt evenly throughout the entire ROM at each joint in each extremity. Abnormal tone is either
decreased or increased (which is divided into “clasp-knife” spasticity or “lead pipe” rigidity)
Reflexes: Examiner elicited the following deep tendon reflexes bilaterally and graded with 0-4 scale : 0=absent reflex, no response 1=diminished, low normal (brought out with reinforcement = Jendrassik maneuver) 2=normal, average 3=brisker than average, possibly but not necessarily indicative of disease 4=hyperactive with clonus
Patient is sitting, relaxed, limbs are symmetrically positioned Examiner holds reflex hammer between their thumb and index finger Examiner swings the reflex hammer briskly (quick and direct) using a rapid wrist movement
If the reflexes appear asymmetrical, this may be due to the patient’s poor posture or tenseness. Retest the reflexes in the supine position on the examination table.
Examiner bilaterally tested the following reflexes:
Sensory System:
Gait/Station (Patient is standing)
Addendum The above is a screening Neurological Examination. Additional testing is indicated if certain abnormalities are detected on the screening examination, or if the patient has specific complaints in certain areas: Cranial Nerves CN1 and CN7: Olfaction or smell and taste should be tested if the patient complains of abnormalities with either. With the eyes closed, the patient should identify “coffee” or “soap” when these are held under each nostril. With the eyes closed, the patient should identify “sweet” or “salty” when these solutions are swabbed onto either side of the tongue. CN2: Visual acuity should be measured if the patient complains of visual impairment, or abnormalities are noted on the visual field or ophthalmoscopic examination. Distant visual acuity is ideally tested several feet away on a Snellen wall chart. If unavailable, a pocket screener is used as described below, although near visual acuity is often decreased due to presbyopia: Examiner tested visual acuity in each eye separately (CN2) ¾ a pocket screener is used ¾ it is held at a distance of 12-14 inches from patient’s face ¾ checked in each eye separately (cover one eye) ask patient to cover their eye with the palm of their hand and not with their closed fingers (patients can open up their fingers and peek!)
¾ record the acuity as the line at which the patient can read ≥ half the letters correctly 20/200 means the patient can read at 20 feet what a normal patient can read at 200 ft. ¾ if a patient has contacts in or wears glasses, they should stay on during the test CN2: Visual fields should be more accurately examined one eye at a time if the patient complains of visual impairment, or there are abnormal signs from the visual examination, including visual field screening with both eyes at the same time: ¾ The examiner and patient face one another (as for the visual field screening, described earlier), but one eye is covered (e.g., examiner’s left eye, patient’s right eye). ¾ The examiner wiggles his/her index finger in the periphery of the visual field of the patient’s open eye, asking the patient to “say ‘yes’ when you see the wiggling finger.” (superior, inferior, nasal and temporal quadrants should be tested, always compared to those of the examiner). The finger is initially placed peripherally, and gradually moved closer to the center of vision. ¾ The test is similarly repeated for the visual field of the other eye. CN2 and 3: Accommodation and convergence should be tested if the patient complains of blurry or double vision, or there are abnormalities involving the pupillary light reflex or eye movements (gaze): ¾ Examiner checked for accommodation and convergence (CN2 and 3) This is usually done during the test for the cardinal positions of gaze Both eyes are open Examiner asks patient to follow their finger or other object (pencil/penlight) as examiner moves from about 12 inches away to about 2- 3 inches away in the patients midline (toward the patient’s nose) The patient’s pupils should constrict as the eyes converge CN5 and 7: Corneal reflex should be tested if the patient complains of facial numbness. Explain the test to the patient, and have the patient look laterally toward the left, with their eyelids wide open (or lightly held open by the examiner). Using a wisp of cotton, approach the patient’s right eye from the right side, and lightly touch the cornea, observing a bilateral eye blink. (Contact lenses must be removed for this test.) Repeat again, with patient looking to the right, and lightly touching the left cornea. CN5: Motor division (Masseter and temporalis muscles) should be checked if the patient complains of trouble speaking, chewing or swallowing: ¾ Examiner assessed motor division of CN5 (Trigeminal nerve) Examiner places their right and left finger pads at two places on the patient: