CASE SHEET – EXAMINATION OF CRANIAL NERVES

NAME:

AGE: SEX:

ADDRESS:

OCCUPATION:

GENERAL EXAMINATION:

Posture and attitude: Normal

Body build and nourishment: Moderately built and moderately nourished

Pallor: No Pallor

Icterus: No icterus

Cyanosis: No cyanosis

Clubbing: No clubbing

Lymphadenopathy: No lymphadenopathy

Edema: No edema

Skin, hair and nails: Normal

Other features:

Gait: Normal

Thyroid swelling: No thyroid swelling

Varicosity of veins: No varicosity of veins

VITAL SIGNS:

ARTERIAL PULSE:

1. RATE:
2. RHYTHM : Regular
3. VOLUME: Normal
4. CHARACTER: Normal
5. CONDITION OF VESSEL WALL: No vessel wall thickening
 6. RADIOFEMORAL DELAY: No radiofemoral delay
7. Other peripheral pulsations: All peripheral pulsations are normal and equally felt on
both sides

BLOOD PRESSURE: / mm Hg in Right arm in sitting position

RESPIRATION:
Rate:
Rhythm:
Type:
TEMPERATURE: Clinically afebrile

EXAMINATION OF HIGHER FUNCTIONS:

1. Appearance and behavior : Normal

2. Level of consciousness: Fully conscious
3. Mental and emotional state: Normal
4. Orientation to place, time and person: Fully oriented
5. Delusion and hallucination: Not present
6. Memory: Normal
7. General intelligence: Normal
8. Speech: Normal

EXAMINATION OF CRANIAL NERVES

I. OLFACTORY NERVE RIGHT LEFT

a) SENSATION OF SMELL Present and Normal Present and Normal

II. OPTIC NERVE

a) Visual acuity
Distant vision (by Snellen’s chart) 6/6 6/6
Near Vision(by Pointer’s chart) Normal Normal
b) Visual field(by Confrontation method) Normal Normal
c) Colour vision(by Ishihara chart) Normal Normal

III, IV, VI. OCULOMOTOR, TROCHLEAR AND ABDUCENT NERVE

a) Movement of eyeball
Abduction Normal Normal
Adduction Normal Normal
 Elevation Normal Normal
Depression Normal Normal
b) Squint Not present Not present
c) Ptosis Not present Not present
d) Pupil
Size Normal Normal
Shape Round and regular Round and regular
Reaction to light
Direct light reflex Present and Normal Present and Normal
Indirect light reflex Present and Normal Present and Normal
Accomodation reflex Present and Normal

V. TRIGEMINAL NERVE
a) Sensory root
Touch Present and Normal Present and Normal
Pain Present and Normal Present and Normal
Temperature Present and Normal Present and Normal
Corneal reflex Present and Normal Present and Normal
Conjuctival reflex Present and Normal Present and Normal
b) Motor root
Clenching of teeth (Temporalis, Masseter) – Equally prominent on both sides
Opening of mouth (Lateral pterygoid) - No deviation

VII. FACIAL NERVE

a) Motor root
Wrinkling of forehead Present Present
Closure of eyelids Unable to make eyes open with normal effort
while subject keeps them closed
Nasolabial fold Present Present
Angle of mouth No deviation of angle of mouth
Whistling Able to whistle
Inflating mouth and blowing Able to blowout the cheeks against resistance
and inflate mouth
History of hyperacusis Not present
b) Sensory root
Taste sensation
Anterior 2/3rd of tongue Present and normal
VIII. VESTIBULOCOCHLEAR NERVE RIGHT LEFT
a) Watch test Heard normally Heard normally
b) Tuning fork tests
1. Rinne’s test Positive Positive
2. Weber’s test Centralised
3. Schwabach’s test Normal Normal
c) Abnormal auditory sensation
1. History of tinnitus - Not present
2. History of auditory hallucination - Not present
d) Abnormal vestibular function
1. History of vertigo - No history of vertigo
2. Nystagmus- Not present Not present

IX. GLOSSOPHARYNGEAL NERVE

Taste in posterior 1/3rd of tongue - Not tested
Gag/ Pharyngeal reflex - Present and normal
Palatal reflex - Present and normal

X. VAGUS NERVE
History of nasal regurgitation - Not present
History of dysphagia - Not present
Nasal tone on voice - Not present
Position of uvula - Central
Movement of palate - Normal
Gag reflex - Present and normal
Palatal reflex - Present and normal

XI. SPINAL ACCESSORY NERVE

Trapezius - Able to shrug the shoulder
Sternocleidomastoid - Able to turn the face to the opposite side
against resistance

XI. HYPOGLOSSAL NERVE

Protusion of tongue as far as possible – No deviation of tongue
Movement of tongue from side to side and pushing cheek against resistance –
Can able to move tongue equally to both sides and pushing
cheek against resistance
Wasting of tongue - No wasting of tongue
 Fibrillation / Fasciculation - No fibrillation or fasciculation of tongue

REPORT:
On examination, the cranial nerves of the subject is found to be within normal limits.