CRANIAL NERVE

ASSESSMENT
By
Prof. Israa
 CN VIII – VESTIBULOCOCHLEAR NERVE
ORIGIN: Pons and medulla
INNERVATION:
◦ Cochlear - ear
◦ Vestibular - ear
FUNCTION:
◦ Cochlear - Hearing
◦ Vestibular - Balance,
maintenance of body
position, and proprioception.
◦ Rule out for presence of
wax, pus, blood or foreign
body Before testing CRANIAL 28
 COCHLEAR NERVE
 Rinne’s test-
◦ For comparing bone and air r
conduction
◦ Tuning fork placed at the
mastoid till the sound stop
being heard
◦ Then is placed in front of
ear to be tested
◦ +ve Rinne test i.e. air and
bone both are retained
◦ -ve Rinne test i.e. air is lost
but bone is
retained(conductive
deafness)
◦ If both are lost i.e.
sensorineural deafness
◦ BERA TEST CRANIAL 29
 COCHLEAR NERVE(cont..)
 Weber's test-
◦ Evaluates lateralization
◦ Use vibrating tuning fork on
top of patient's head, ask
patient where he hears it (one
or both sides).
◦ Normally heard equally on
both the sides
◦ If one ear is occluded then it
acts like a resonating chamber
and hear more on that side
◦ Conductive deafness-
involved side
◦ Sensorineural- Uninvolved
side CRANIAL 30
 VESTIBULAR NERVE
 Look for Vertigo,
Nystagmus, loss of balance
 NYLEN-BARANY
MANEUVER
◦ Patient lie down supine
with head off the bed
◦ 45 degree extended
◦ Lateral flexion to the
same side produces
Nystagmus
• Other tests are
• caloric test(cows)
• Galvanic test
• Rotation test 31
CRANIAL
 CN VIII – VESTIBULOCOCHLEAR
NERVE
 DYSFUNCTION (Cochlear)
◦ Unilateral deafness
◦ Loss of sound appreciation
◦ Tinnitus
◦ Rinne Test) AC >BC is normal
◦ both diminished indicative of
nerve damage
◦ BC> AC middle ear disease.
Weber Test) Lateralization to good
ear is nerve damage,

◦ lateralization to bad ear

is, middle ear disease

CRANIAL 32
 CN VIII – VESTIBULOCOCHLEAR NERVE
DYSFUNCTION
(VESTIBULAR)
◦ Vertigo
◦ Balance disturbances
Vestibular branch
normally not tested
unless patient gives
history of vertigo or
balance Disturbance
history is positive, caloric
testing is done by
physician.
CRANIAL 33
CN IX- GLOSSOPHARYNGEAL NERVE
 ORIGIN-Medulla
 INNERVATION:
Mucous membranes of
tonsils, pharynx,
posterior one-third of
tongue, pharyngeal
muscles, carotid sinus
and carotid body
 FUNCTION:
Taste from posterior one-
third of tongue - Afferent
limb of gag, swallow,
and cardiac reflexes.
• DYSFUNCTION:
◦ Loss of taste;
Neuralgia CRANIAL 34
CN X – VAGUS NERVE
 ORIGIN-Medulla
 INNERVATION:
◦ Muscles of larynx, pharynx, and
soft palate.
◦ Parasympathetic innervation of
thoracic and abdominal viscera.
 FUNCTION:

◦ Muscles of larynx, pharynx, and

soft palate
◦ Sensation conveyed from the heart,
lungs, digestive tract, carotid sinus,
& carotid body
◦ Efferent limb of gag and swallow
reflex
DYSFUNCTION:
• Loss of gag & swallow reflex
• Loss of carotid sinus
• oculocardiac reflex; Dysphagia CRANIAL 35
CN IX- GLOSSOPHARYNGEAL and CN X - VAGUS
CN IX and X considered jointly, actions are seldom compared
separately; they are always tested together.
POSSITIVE FINDINGS-
Evaluate voice quality
 hoarseness or dysarthria

 Ask patient to open mouth,

say "ah", observe for
elevation of soft palate,
midline position of uvula.
 Gag reflex, bilaterally
 Swallowing
 Taste (bitter) posterior one-
 third tongue

CRANIAL 36
 CN IX- GLOSSOPHARYNGEAL
and CN X - VAGUS
 Negative Findings
 Loss of voice quality,
(dysarthria or hoarseness)

 Deviation of uvula toward

non-paralyzed side

 Swallowing difficulty or
nasal regurgitation

 Vagal irritation
(bradycardia)

CRANIAL 37
CN XI - SPINAL ACCESSORY NERVE

ORIGIN: Medulla
INNERVATION:
Sternocleidomastoid &
trapezius muscles
FUNCTION: Motor
function
Sternocleidomastoid &
trapezius
DYSFUNCTION:
Muscle weakness.

CRANIAL 38
CN XI - SPINAL ACCESSORY NERVE
• CLINICAL EVALUATION
• Palpate trapezius muscle as
patient shrugs shoulders
against resistance; evaluate
strength.
• Ask patient to turn head to
one side and push against
examiners hand or ask to flex
head against resistance,
palpate and evaluate strength
of sternocleidomastoid
muscle.
• Evaluate both right and left
side, compare for symmetry.

39
CRANIAL
CN XII –HYPOGLOSSAL Nerve
 ORIGIN: Medulla

INNERVATION:
Muscles of the tongue
except palatoglossus
FUNCTION: Movement
of the tongue
DYSFUNCTION:

Flaccid paralysis
◦ Dysphagia
◦ Dysarthria
◦ Dyspnea
◦ Difficulty chewing food CRANIAL 40