CRANIAL NERVE EXAMINATION :

CRANIAL NERVE I - OLFACTORY NERVE : ASK IF ANY CHANGE IN SENSE OF SMELL

OBSERVED
CRANIAL NERVE II - OPTIC NERVE :
- CHECK FOR PUPIL SIZE , SHAPE AND SYMMETRY .
- CHECK VISUAL ACUITY BY MAKING PATIENT STAND 6M AWAY FROM THE
SNELLEN CHART AND RECORD IT FOR 6/6 WHERE NUMERATOR IS DISTANCE
BETWEEN THE CHART AND PATIENT ON BOTH EYES . THE EYE BEING NOT
TESTED TO BE CLOSED WITH PALM OF HAND .
- CHECK FOR PUPILLARY REFLEXES BY SHINING LIGHT ON TO EACH EYE AND
OBSERVE FOR ANY CONSTRICTION ON THE EYE LIGHT SHONE ON TO ( DIRECT
) OR ON THE OTHER EYE ( CONSENSUAL PUPILLARY REFLEX ) . PERFORM ON
BOTH EYES .
- CHECK FOR RELATIVE AFFERENT PUPILLARY DEFECT WITH SWINGING LIGHT
TEST . SWITCH LIGHT BETWEEN TWO EYES RAPIDLY . AND OBSERVE IF THEY
WILL DILATE WHEN LIGHT IS SHONE ON THEM .
- CHECK ACCOMODATION REFLEX BY ASKING THE PATIENT TO FOCUS ON A
DISTANT OBJECT AND WITCH TO OBJECT PLACED IN FRONT OF THEM . TO
OBSERVE FOR CONSTRICTION AND CONVERGENCE .
- CHECK COLOR VISION WITH ISHIHARA PLATES .
- CHECK VISUAL INATTENTION , POSITIONING YOURSELF IN FRONT OF PATIENT
AND ASK HIM TO REMAIN FOCUSED TO YOUR FACE , AND STATE WHEN THEY
SAY MOVEMENT OF YOUR HANDS .
- CHECK VISUAL FIELD BY ASKING PATIENT TO CLOSE ONE EYE WHILE YOU
COVER OPPOSITE EYE AND SIT IN FRONT OF THE PATIENT AND ASK THEM TO
STATE YOUR MOVEMENTS.
CRANIAL NERVE III ,IV,VI - OCULOMOTOR , TROCHLEAR , ABDUCENS NERVES :
- INSPECT PTOSIS , ASK HIM TO LET YOU KNOW IF THERE IS ANY DOUBLE VISION
WHILE HE FOLLOWS YOUR FINGER IN ASSESSING THE MOVEMENTS H
'SHAPED .DOUBLE CHECK IF HE HAD ANY DOUBLE VISION .
CRANIAL NERVE V - TRIGEMINAL NERVE :
- ASSESS SENSATION ON BOTH SIDES OF FACE WITH COTTON WOOL AND
NEUROTIP AND CHECK IF THEY FELT SAME ON BOTH SIDES . FEEL THE
MUSCLES OF MASTICATION BY ASKING PATIENT TO CLENCH THE JAW . ASK
PATIENT TO OPEN THE MOUTH AND ASK HIM NOT TO LET YOU CLOSE IT .
- CHECK FOR CORNEAL REFLEX BY TAKING CONSENT AND EXPLAINING
PROCESS OF TOUCHING THE EDGE OF CORNEA OF THE EYE .
- CHECK FOR JAW REFLEX BY PUTTING THE FINGER ON PATIENT’S CHIN AND
HIT ON FINGER TO OBSERVE FOR BRISK CLOSURE OF MOUTH .
CRANIAL NERVE VII - FACIAL NERVE :
- ASSESS MOVEMENTS OF FACIAL EXPRESSIONS . ( ASK PATIENT TO RAISE
EYEBROWS , CLOSE EYES TIGHT AND RESIST TO OPEN IT , PUSHING LIPS ,
SMILE )
- INSPECT EXTERNAL AUDITORY MEATUS .
- CHECK IF THERE ARE ANY CHANGES IN TASTE OR HEARING HIGHER THAN
USUAL.
CRANIAL NERVE VIII : VESTIBULOCOCHLEAR NERVE :
- EXPLAIN GROSS ASSESSMENT OF HEARING TO PATIENT , THAT YOU WILL
WHISPER A WORD FROM 15 CM DISTANCE ON BOTH SIDE
- PERFORM RINNE TEST BY PLACING VIBRATING TUNING FORK ON BONE
BEHIND THE EAR .
- PERFORM WEBER TEST BY PLACING THE TUNING FORK IN THE MIDDLE OF
HEAD IN FRONT
- PERFORM TURNING TEST BY ASKING PATIENT TO MARCH BY CLOSING EYES .
CRANIAL NERVE IX , X - GLOSSOPHARYNGEAL , VAGUS :
- CHECK FOR SOFT PALATE AND UVULA SYMMETRY
- CHECK FOR BOVINE COUGH
- ASK PATIENT TO TAKE A SIP OF WATER AND OBSERVE ANY COUGH WHILE
SWALLOWING .
CRANIAL NERVE XI - ACCESSORY NERVE :
- ASSESS THE POWER OF SHOULDERS
- ASK PATIENT TO SHRUG HIS SHOULDER AND RESIST FROM PUSHING THE
DOWN .
- ASK PATIENT TO TURN HIS HEAD TO SIDES AGAINST HAND RESISTANCE
TOWARDS BOTH SIDES .
CRANIAL NERVE XII - HYPOGLOSSAL NERVE :
- ASK PATIENT TO OPEN MOUTH AND INSPECT TONGUE
- ASK PATIENT TO PROTRUDE TONGUE OUT AND LOOK FOR DEVIATION
- ASK PATIENT TO PUSH TONGUE AGAINST YOUR FINGERS OVER CHEEKS FOR
WEAKNESS .

UPPER LIMB NEUROLOGIC EXAMINATION;

UPPER LIMB EXAMINATION :

HI I AM ___________ FROM MD5 WINDSOR UNIVERSITY SCHOOL OF MEDICINE .CAN I CHECK

WITH YOU NAME AND AGE PLEASE ?

TODAY I'M HERE TO PERFORM AN NEUROLOGICAL EXAMINATION ON YOUR UPPER LIMB .

THIS WILL INVOLVE TESTING SENSATION , MOVEMENTS AND I WILL NEED YOU TO EXPOSE
YOUR ARMS APPROPRIATELY TO PERFORM THIS EXAMINATION .
SO , DO I HAVE YOUR CONSENT ? AND ALSO I WANT YOU TO UNDERSTAND THAT OUR
CONVERSATION HERE IS GOING TO BE CONFIDENTIAL .
BEFORE WE START , ARE YOU EXPERIENCING ANY PAIN ? OKAY PLEASE LET ME KNOW IF YOU
FEEL UNCOMFORTABLE ANYTIME THROUGHOUT THE EXAMINATION .
I WOULD LIKE TO START BY LOOKING AT YOUR ARMS .( I DON’T SEE ANY SCARS WASTING OF
MUSCLE , INVOLUNTARY MOVEMENTS , FASCICULATION OR TREMORS )
- COULD YOU PLEASE BRING YOUR ARMS STRAIGHT IN FRONT OF YOU ?
NOW I WOULD LIKE TO ASSESS TONE OF YOUR MUSCLES IN YOUR ARMS .CAN YOU PLEASE
GET FLOPPY FOR ME ?
I AM CHECKING FOR YOUR RIGHT SHOULDER , NOW WRIST AND FINGERS . LET ME DO
IT FOR THE OTHER HAND .
- OKAY NOW I WOULD LIKE TO TEST POWER IN YOU MUSCLES . CAN YOU PLEASE
BRING YOUR ARMS UP LIKE A CHICKEN FOR ME ? GREAT ! DON’T LET ME PUSH
THEM DOWN .
- CAN YOU PLEASE FOLD YOUR ELBOWS ? DON’T LET ME PUSH THEM IN . DON’T
LET ME PULL THEM OUT .
- GREAT. NOW CAN YOU BRING YOUR ARMS OUT AND COCK THEM WRIST ?
DON’T LET ME PUSH IT DOWN . DON’T LET ME PULL IT UP .
- CAN YOU SPREAD YOUR FINGERS OUT ? DON’T LET ME PUSH THEM DOWN .
CAN YOU WIDE YOUR INDEX , DON’T LET ME PUSH THEM THEM IN . ! CAN YOU
BRING YOUR THUMB UP ? DON’T LET ME PUSH IT DOWN .
NOW I AM MOVING TO TEST YOUR REFLEXES .PLEASE GET YOUR ARMS FLOPPY FOR ME .
- IM CHECKING FOR YOU BICEPS REFLEX BY TAPPING ON YOUR TENDON WITH A
TENDON HAMMER BY PLACING A FINGER OVER IT . NOW ON THE OTHER HAND . NOW I
AM CHECKING FOR TRICEP REFLEX . ON THE OTHER HAND TOO .
- I WILL NOW CHECK FOR SUPINATOR REFLEX .
I WILL NOW CHECK YOUR SENSATION WITH COTTON WOOL AND NEUROTIP . PLEASE CLOSE
YOUR EYES AND LET ME KNOW WHEN YOU CAN FEEL .
I WILL NOW CHECK YOUR VIBRATORY SENSE BY PLACING THIS TUNING FORK OVER YOUR
THUMB . PLEASE LET ME KNOW WHEN IT STOPS.
KEEP YOUR EYES CLOSED. TELL ME IF I BENT YOU THUMB DOWN OR BROUGHT IT UP .
NOW TOUCH MY FINGER AND THEN TOUCH YOUR NOSE BACK AND FORTH REPEATEDLY !
CAN YOU CLAP YOUR HANDS ONE OVER THE OTHER RAPIDLY ?
THANK YOU THIS COMPLETES THE EXAMINATION .

LOWER LIMB NEUROLOGICAL EXAMINATION ;

HI I AM ___________ FROM MD5 WINDSOR UNIVERSITY SCHOOL OF MEDICINE .CAN I CHECK

WITH YOU NAME AND AGE PLEASE ? WASHING MY HANDS .
TODAY I'M HERE TO PERFORM AN NEUROLOGICAL EXAMINATION ON YOUR LOWER LIMB .
THIS WILL INVOLVE TESTING SENSATION ,ASKING YOU TO WALK , MOVEMENTS AND I WILL
NEED YOU TO EXPOSE YOUR LEGS APPROPRIATELY TO PERFORM ,SO I AM GONNA NEED YOU
ROLL YOUR PANTS UP FOR THIS EXAMINATION .
SO , DO I HAVE YOUR CONSENT ? AND ALSO I WANT YOU TO UNDERSTAND THAT OUR
CONVERSATION HERE IS GOING TO BE CONFIDENTIAL .
BEFORE WE START , ARE YOU EXPERIENCING ANY PAIN ? OKAY PLEASE LET ME KNOW IF YOU
FEEL UNCOMFORTABLE ANYTIME THROUGHOUT THE EXAMINATION…

I AM GONNA START THIS BY LOOKING FROM END OF THE BED..

- COULD YOU SWING YOUR LEGS OUT OF B ED PLEASE?
- CAN YOU NOW STAND UP WITH FOLDED HANDS
- PLEASE WALK TOWARDS THE DOOR , THAT WAY . NOW TURN AROUND .
- COULD PLEASE WALK WITH ONE FOOT IN FRONT OF OTHER.
- NOW CAN YOU WALK ON YOUR TIP TOE .
CAN YOU STAND WITH FEET TOGETHER ,HANDS BY SIDE AND EYES CLOSED . I AM HERE TO
HOLD YOU , IF YOU FEEL UNSTEADY
I WILL NOW ASSESS TONE OF YOUR LEGS, RELAX AND LEAVE CONTROL OVER ME
LIFTING YOUR LEGS , MOVING YOUR ANKLE .
NOW I WILL CHECK STRENGTH OF YOUR LEGS .
CAN YOU LIFT YOUR LEG ? STOP ME PUSHING IT DOWN
DON'T LET ME PULL IT UP
CAN YOU BEND YOUR KNEE , DON'T LET ME PUSH IN , DON'T LET ME PULL OUT
- NOW DON'T LET ME PUSH YOUR TOE DOWN , DON'T LET ME PUSH THEM UP
- PUSH YOUR FOOT AGAINST MY HAND !
I WILL NOW TEST SOME REFLEXES
- I AM CHECKING FOR KNEE JERK
- NOW FOR ANKLE JERK TAPPING WITH TENDON HAMMER
- I WILL NOW RUB OVER YOUR PLANTAR SURFACE IT MIGHT BE TICKLISH .
COULD YOU PLEASE CLOSE YOUR EYES FOR ME TILL I ASK YOU TO OPEN ! NOW, I WOULD
LIKE TO TEST YOUR SENSATION WITH COTTON WOOL AND THEN FOLLOWED BY A NEURO TIP .
PLEASE LET ME KNOW WHEN YOU CAN FEEL IT !
NOW I WILL PLACE A TUNING FORK ON YOU FOOT LET ME KNOW WHEN YOU CAN STOP
FEELING THE VIBRATION . ON THE OTHER SIDE AS WELL!
I WOULD NOW LIKE TO KNOW IF I AM PUSHING YOUR TOE UP OR DOWN ! YOU CAN OPEN
YOUR EYES . THANK YOU
NOW CAN YOU PLEASE TOUCH YOUR RIGHT KNEE WITH LEFT TOES AND TAKE THEM DOWN
TILL ANKLE . COULD YOU DO THE SAME ON OTHER LEG .
OKAY NOW , COULD YOU TAP YOUR FEET TO MY HANDS RAPIDLY ?

THANK YOU THIS COMPLETES OUR EXAMINATION !!