NEUROLOGICAL

EXAMINATION

Cranial Nerve
Assessment
CRANIAL NERVE I
(Olfactory Nerve)

• Sensory nerve
▫ Carries impulses for sense of smell
• Origin/Course:
▫ Arise from olfactory receptors in
the nasal mucosa
▫ Synapse with olfactory bulb (which
in turn send fibers to olfactory
cortex)
• Key point: test each side with a mild
agent.
▫ Subject is asked to sniff and
identify aromatic substances(e.g.,
soap, tobacco, coffee, vanilla)
▫ Ammonia should not be used.
• Clinical Application: Anosmia
Cranial Nerve II
(OPTIC NERVE)
 CRANIAL NERVE II
(Optic Nerve)
• Sensory nerve
▫ Carries impulses for vision.
• Origin/Course
▫ Fibers arise from retina of the
eye and form optic nerve.
▫ Two optic nerves form the optic
chiasma by partial crossover of
fibers.
▫ Fibers continue to the optic
cortex as the optic tracts.
• Key Points
▫ Central Vision--Test visual acuity
 Snellen chart / E chart ( far
vision )
 Rosenbaum pocket card ( near
vision )
▫ Peripheral Vision--Test gross
visual fields (finger
confrontation)
• Clinical Application
▫ Visual field defects
CRANIAL NERVE III
(Oculomotor Nerve)
• Mixed, primarily motor
• Motor function
▫ supplies four (4) of six extra-ocular muscles (SR,
IR, MR & IO)
▫ Eyelids—elevates/opens eye
▫ Internal eye muscles (circular muscles, and radial
muscles of the iris); controlling lens shape and
pupil size.
▫ Sensory function
 Muscle sense (proprioception)
• Origin/Course
▫ Motor portion—fibers run from the midbrain to the
eye.
▫ Sensory portion—consists of fibers from
proprioceptors in eyeball muscles to the midbrain.
• Key Points
▫ Examine pupil’s size, shape, and size equality.
▫ Convergence is tested, as is the ability to follow
moving object.
• Clinical Application
▫ Strabismus (sign)
▫ Diplopia (symptom)
▫ Ptosis
▫ Loss of accommodation for near vision.
CRANIAL NERVE IV
(Trochlear Nerve)

• Mixed, primarily motor

▫ Motor function
 Movement of the eyeball (SO)
▫ Sensory function
 Muscle sense (proprioception)
• Origin/Course
▫ Motor portion—Fibers run from the midbrain to the eye
(superior oblique muscles)
▫ Sensory portion—Consists of fibers from the
proprioceptors in superior oblique muscles and
terminate in midbrain.
• Key Points
▫ Ability to follow moving object.
• Clinical Application
▫ Strabismus
▫ Diplopia
CRANIAL NERVE V
(Trigeminal Nerve)
• Mixed
▫ Motor Function—Chewing
▫ Sensory Function—Conveys
sensations for touch, pain, and
temperature & muscle
proprioception.
• Origin/Course
▫ Motor Portion—Originates in
pons to muscles of mastication
(digastric and mylohyoid)
▫ Sensory Portion
 Ophthalmic Branch—fibers
from the skin over the eyelid,
eyeball, lacrimal glands, nasal
cavity, side of the nose,
forehead, and anterior half of
the scalp.
 Maxillary Branch—contains
fibers from mucosa of nose,
palate, parts of pharynx, upper
teeth,
CRANIAL NERVE V
(Trigeminal Nerve)
• Key Points
▫ Test for the sensation of the face.
▫ Corneal reflex test
▫ Motor branch may be tested by asking the subject to
open mouth agains resistance and move jaw from side
to side.
• Clinical Application
▫ Paralysis of muscle for mastication.
▫ Loss of sensation
▫ Trigeminal Neuralgia (Tic Douloureux)
CRANIAL NERVE VI
(Abducens Nerve)

• Mixed, primarily motor

▫ Motor Function—Movement of
the eyeball
▫ Sensory Function—Muscle
sense (proprioception)
• Origin/Course
▫ Motor Portion—Originates in
pons to lateral rectus muscle
▫ Sensory Portion—Fibers from
proprioceptors in lateral rectus
muscle and ends in pons.
• Key Points
▫ Test for ability to move eyes
• Clinical Application
▫ Eye deviation (towards
medial/nasal side of the face)
CRANIAL NERVE VII
(Facial Nerve)

• Mixed
▫ Motor Function—Facial expression and secretion of
saliva and tears.
▫ Sensory Function—Muscle sense and taste (anterior
two-third of tongue)
• Origin/Course
▫ Motor Portion
 Originates in pons to facial, scalp, and neck muscles.
 Parasympathetic fibers are distributed to lacrimal, sublingual,
sub-mandibular, nasal, and palatine glands.
CRANIAL NERVE VII
(Facial Nerve)
• Sensory Portion
▫ Arise from taste buds on the anterior two-thirds of tongue to
pons up to the thalamus for relay to gustatory areas in the
parietal lobe of the cerebral cortex.
▫ Also contains proprioception of muscles of the face and scalp.
• Key Points
▫ Test for sense of taste on anterior two-third of tongue.
▫ Test muscles for facial expression (smile).
▫ Test tearing with ammonia fumes.
• Clinical Application
▫ Bell’s Palsy
▫ Loss of taste on the anterior two-third of tongue]
▫ Inability to close eyes, even during sleep.
CRANIAL NERVE VIII
(Vestibulo-Cochlear Nerve)
• Sensory
▫ Cochlear Branch Function—Conveys impulses associated with hearing.
▫ Vestibular Branch Function—Conveys impulses associated with
equilibrium
• Origin/Course
▫ Cochlear Branch
 Arises from spiral organ/organ of corti (inner ear), nuclei in medulla,
and ends in the thalamus.
 Fibers synapse with neuron that relay impulses to auditory areas in
temporal lobe of cerabral cortex.
▫ Vestibular Branch
 Arises from semi-circular canals, saccule, utricle (inner ear), and
forms vestibular ganglion, fibers end in pons and cerebellum
• Key Points
▫ Hearing is checked by air and bone conduction using tuning fork.
 Weber’s Test
 Rinne’s Test
• Clinical Application
▫ Conductive hearing defect/loss
▫ Sensorineural hearing defect/loss
WEBER’S TEST
RINNE’S TEST
CRANIAL NERVE IX
(Glossopharyngeal Nerve)
• Mixed
▫ Motor Function—Secretion of saliva
▫ Sensory Function—Taste, regulation of blood pressure,
proprioception.
• Origin/Course
▫ Sensory Portion
 Arises from taste buds on posterior one-third of the tongue and
carotid sinus, up to the medulla
 Also contains fibers from somatic sensory receptors on posterior
one-third of the tongue and proprioceptors in swallowing
muscles supplied by motor portion.
• Key Points
▫ Gag and swallowing reflexes
▫ Subject is asked to speak and cough
▫ Posterior one-third of tongue tested for sense of taste.
• Clinical Application
▫ Difficulty of swallowing (Dysphagia)
▫ Reduced secretion of saliva
▫ Loss of sensation in the throat
▫ Loss of taste in posterior third of the tongue.
CRANIAL NERVE X
(Vagus Nerve)

• Mixed
▫ Motor Function
 Smooth muscle contraction and relaxation;
 Secretion of digestive fluids.
▫ Sensory Function
 Sensation from visceral organs supplied.
• Origin/Course
▫ Motor Portion
 Originates in medulla, and terminates in muscles of airways, lungs,
esophagus, heart, stomach, small intestine, large intestine and gall
bladder.
 Parasympathetic fibers innervate involuntary muscles and glands of the
GIT
▫ Sensory Portion
 Arises essentially from structures supplied by motor fibers.
• Key Points
▫ Tested in common with cranial nerve IX, since they both serve muscles of
the throat.
• Clinical Application
▫ Difficulty of swallowing (dysphagia)
▫ Paralysis of vocal cords
▫ Interrupts sensation from many organs.
CRANIAL NERVE XI
(Accessory Spinal Nerve)

• Mixed, primarily motor

▫ Motor Function
 Cranial portion mediates swallowing movement.
 Spinal Portion mediates movement of the head
▫ Sensory Function
 Muscle sense (proprioception)
• Origin/Course
▫ Motor Portion
 Cranial portion—originates from medulla to voluntary muscles of
pharynx, larynx, and soft palate.
 Spinal portion—originates from anterior gray horn of first cervical
segment of SC, supplies SCM and trapezius muscles.
▫ Sensory Portion
 Consists fibers from proprioceptors in tongue muscles and end in
medulla.
• Key Points
▫ SCM and trapezius muscles are checked for strength.
CRANIAL NERVE XII
(Hypoglossal Nerve)
• Mixed
▫ Motor function—movement of tongue during speech and
swallowing
▫ Sensory Function—Muscle sense (proprioception)
• Origin/Course
▫ Motor Portion—from medulla to muscles of the tongue
▫ Sensory Portion—Consists proprioceptors in tongue muscles and
ends in medulla.
• Key Points
▫ Subject is asked to stick out tongue and check for any
abnormalities.