CRANIAL NERVES

(I) Olfactory Sensory Smell

• Anosmia – absence of smell
(II) Optic Sensory Visual acuity, visual field
• Presbyopia – impaired near vision due to hardening of the lens
• Myopia – nearsightedness
• Hyperopia – farsightedness
• Visual field – normal reading distance is 12”-18”
(III) Oculomotor Motor
(IV) Trochlear Motor Pupillary reactions, extraocular movements
(VI) Abducens Motor

• Ptoris – weak eye muscles

• Nystagmus – rhythmic oscillation
• Strabismus – lack of muscle coordination
• Diplopia – double vision

Jaw movements, facial sensation, corneal reflex

(V) Trigeminal Both
Speech and voice
• Motor – temporal and masseter muscles contract bilaterally
• Deep sensation
o Absence may indicate lesions in trigeminal, facial, …
• Light sensation
• Corneal reflex – illicit blinking
o Absence may indicate lesions in trigeminal and motor part of facial
(VII) Facial Both Facial expressions/movements
• Movements must be symmetrical
• Abnormal
o Bell’s palsy
o Paralysis of the lower part of the face
(VIII) Auditory/vestibulocochlear Sensory Hearing and balance
• Whispered voice
• Weber’s test
o Conductive hearing – external and middle ear
o Sensorineural hearing – inner ear
o Lateralization – sound heard on one ear only
• Rinne’s test – AC>BC
(IX) Glossopharyngeal Both Swallowing and rise of the palate, gag reflex
Swallowing and rise of the palate, gag reflex
(X) Vagus Both
Speech and voice
• Motor – soft palate rises, uvula remains in midline
o Abnormal
▪ Soft palate does not rise = bilateral lesion of CN X
▪ Unilateral rising of soft palate and deviation of uvula to the normal side = unilateral
lesion of CN X
• Gag reflex – absence may be due to aspiration
(XI) Accessory Motor Trapezius, sternocleidomastoid
• Trapezius – symmetrical, strong
o Abnormal – asymmetrical, drooping
• Sternocleidomastoid – ease of movement, wide range of motion
o Abnormal – muscle weakness, muscle atrophy, uneven shoulders
Tongue
(XII) Hypoglossal Motor
Speech and voice
• Note for atrophy, tremors, and paralysis
• Normal
o Movement is symmetrical and smooth
o Bilateral strength is apparent
o Tongue is midline
• Abnormal
o Fasciculation – involuntary muscle contraction