12 CRANIAL NERVES & THEIR FUNCTIONS

I. Olfactory Nerve
II. Optic Nerve
III. Oculomotor Nerve
IV. Trochlear Nerve
V. Trigeminal Nerve
VI. Abducens Nerve
VII. Facial Nerve
VIII. Vestibulocochlear Nerve
IX. Glossopharyngeal Nerve
X. Vagus Nerve
XI. Accessory Nerve
XII. Hypoglossal Nerve
PROPER ASSESSMENT OF CN I – OLFACTORY NERVE :

1. Have client sit in a comfortable position

at your eye level
2. Ask the client to clear the nose to
remove any mucus
3. Close eyes, occlude one nostril, and
identify a scented
4. object that you are holding such as
soap, coffee, or
5. vanilla
6. Repeat procedure for the other nostril

NORMAL:
• Client correctly identifies scent presented to each
nostril
• Some older clients’ sense of smell may be decreased
PROPER ASSESSMENT OF CN II – OPTIC:

VISUAL ACUITY
• Use a Snellen chart to assess vision in each eye
NEAR VISION
• Ask the client to read a newspaper or magazine
paragraph to assess near vision
VISUAL FIELDS
• Assess visual fields of each eye by confrontation
RETINA & OPTIC DISC BY OPHTHALMOSCOPE
• Use an ophthalmoscope to view the retina and
optic disc of each eye
PROPER ASSESSMENT OF CN II – OPTIC:

NORMAL FINDINGS:
• Client has 20/20 vision OD (right eye) and OS (left eye) –
(distance vision)
• reads print at 14 inches without difficulty DEVIATION FROM NORMAL:
• normal peripheral vision • Lesions of the optic nerve
• optic disc • Lesions of the parietal cortex
❑ 1.5 mm • Papilledema
❑ round or slightly oval • Optic atrophy
❑ well-defined margins
❑ creamy pink with paler physiologic cup
PROPER ASSESSMENT OF CN II – CN III, IV, VI –
OCULOMOTOR, TROCHLEAR, ABDUCENS

• ABNORMAL EYE MOVEMENTS

1. INSPECT MARGINS OF THE EYELIDS OF
❑ cerebellar disorders
EACH EYE
❑ increased ICP
• Assess extraocular movements
❑ paralytic strabismus
• Assess pupillary response to light
• PUPIL ABNORMALITIES
NORMAL
❑ Oculomotor nerve paralysis
• Eyelid covers about 2 mm of the iris
❑ Argyll Robertson pupils
• The six cardinal fields
❑ Narcotics abuse
• Bilateral illuminated pupils constrict
❑ CN III damage
simultaneously
❑ Lesions of the sympathetic nervous
• Pupil opposite the one illuminated constricts
system
simultaneously
❑ PNS or CNS dysfunction
DEVIATIONS FROM NORMAL
❑ CN V lesion
• Ptosis
✓ myasthenia gravis
PROPER ASSESSMENT OF CN V – TRIGEMINAL

TEST MOTOR FUNCTION DEVIATIONS FROM NORMAL

• Ask the client to clench the teeth while
you palpate the temporal and
masseter muscles for contraction
NORMAL
• Temporal and masseter muscles
contract bilaterally
• Inability to feel and correctly identify
facial stimuli
• Lesions of the trigeminal nerve,
spinothalamic tract or posterior
columns

TEST SENSORY FUNCTION

NORMAL
• Correctly identifies sharp and dull
stimuli and light touch to the forehead,
cheeks, and chin
PROPER ASSESSMENT OF CN V – TRIGEMINAL:

TEST CORNEAL REFLEX

NORMAL:
• Eyelids blink bilaterally
DEVIATIONS FROM NORMAL
• Absent corneal reflex
• Lesions of the trigeminal nerve, motor part of
cranial nerve VII (facial)
PROPER ASSESSMENT OF CN VII – FACIAL:

TEST MOTOR FUNCTION

NORMAL:
• Smiles, frowns, wrinkles forehead, shows teeth,
puffs out cheeks, purses lips, raises eyebrows, and
closes eyes against resistance
• Movements are symmetric
DEVIATIONS FROM NORMAL
• Inability
• Bell's Palsy
• Central lesion that affects the upper motor neurons
• Stroke
PROPER ASSESSMENT OF CN VII – FACIAL:

TEST SENSORY FUNCTION

NORMAL:
• Identifies correct flavor
DEVIATIONS FROM NORMAL
• Inability to identify correct flavor on anterior two-
thirds of the tongue
• Impairment of cranial nerve VI
PROPER ASSESSMENT OF CN VIII – ACOUSTIC /
VESTIBULOCOCHLEAR

TEST THE HEARING ABILITY IN EACH EAR

• Weber and Rinne tests
NORMAL:
• Client hears whispered words
• Weber test: Vibration heard equally well in both ears
• Rinne test: AC > B
DEVIATIONS FROM NORMAL
• Vibratory sound lateralizes to good ear in
sensorineural loss
• Air conduction is longer than bone conduction
PROPER ASSESSMENT OF CN IX, X –
GLOSSOPHARYNGEAL, VAGUS:

1. Test motor function

2. Test gag reflex
3. Check ability to swallow
NORMAL FINDINGS:
1. Uvula and soft palate rise bilaterally and
2. symmetrically on phonation
3. Gag reflex intact
4. Swallows without difficulty
5. No hoarseness
DEVIATIONS FROM NORMAL
1. Soft palate does not rise
2. lesions of cranial nerve IX or X
3. Dysphagia or hoarsenes
4. Neurologic disorder
PROPER ASSESSMENT OF CN XI – SPINAL ACCESSORY

• Ask the client to shrug the

shoulders against resistance to
assess the trapezius muscle
NORMAL:
• Symmetric
• Strong contraction of the
trapezius muscles
DEVIATIONS FROM NORMAL
• Asymmetric or drooping
• Paralysis or muscle weakness
• Torticollis
Ask the client to turn the head against
resistance, first to the right then to the
left, to assess the sternocleidomastoid
muscle

NORMAL:
• Strong contraction of
sternocleidomastoid muscle on
the side opposite the turned
face
DEVIATIONS FROM NORMAL:
• Atrophy with fasciculations
PROPER ASSESSMENT OF CN XII – HYPOGLOSSAL

ASSESS STRENGTH AND MOBILITY OF

TONGUE
NORMAL
• Symmetric and smooth, and bilateral
strength is apparent
DEVIATIONS FROM NORMAL
• Fasciculations and atrophy of the tongue
• Peripheral nerve disease
• Deviation to the affected side
• Unilateral lesion
LEVEL OF CONSCIOUSNESS

STUPOROUS
• Requires
vigorous
ALERT stimulation
(shaking, COMATOSE
• Follows
shouting) for a • Does not
commands in a
response respond
timely fashion
appropriately to
LETHARGIC either verbal or
• Appears painful stimuli
drowsy, may
drift off to sleep
during
examination
 GLASLOW COMA SCALE:

MOST INTEGRAL
EYE OPENING MOST APPROPRIATE
MOTOR RESPONSE
RESPONSE: VERBAL RESPONSE:
(ARM)

Obeys verbal command 6

Oriented 5
Spontaneous Opening 4 Localized Pain 5
Confused 4 Withdraws from Pain
To Verbal Command 3 4
Inappropriate Words 3 Flexion (decorticate rigidity)
To Pain 2 3
Incoherent 2 Extension (decerebrate rigidity) 2
No Response 1
No response 1 No response 1
 APRAXIA
• Inability to carry out learned sequential
movements or commands
AGNOSIA
CIRCUMLOCUTION
• Visual Agnosia
• Inability to name object verbally, so patient
• Tactile Agnosia
talks around object or uses gesture to
• Auditory Agnosia
define it
ASTEREOGNOSIS
DYSARTHRIA
• Inability to correctly identify objects
• Defective speech; inability to articulate
AKINESIA
words; impairment of tongue and other
• Complete or partial loss of voluntary
muscles needed for speech
muscle movement
DYSPHASIA
APHASIA
• Impaired or difficult speech
• Absence or impairment of ability to
communicate through speech, writing, or
signs
DYSPHONIA
• Difficulty with quality of voice; hoarseness
NEOLOGISMS
• Made-up, nonsense, meaningless words
PARAPHRASIA
• Loss of ability to use words correctly and
coherently; words are jumbled or misused
TREMORS
• Involuntary movement of part of body
INTENSION TREMOR
• Involuntary movement when attempting
coordinated movements
FASCICULATION
• Involuntary contraction or twitching of muscle
fibers
4+ Hyperactive, very brisk, clonus,
abnormal and indicative of a disorder BRACHIORADIALIS REFLEX
1. Flex elbow with palm down
3+ More brisk or active than normal but
not indicative of a disorder
2. Find the tendon above the
radius
2+ Normal usual response 3. Strike with the hammer (flat)
4. Repeat on the other side
5. Evaluates spinal levels C5 & C6
1+ Decreased and less active than
normal

0 No response
BICEPS REFLEX
TRICEPS REFLEX
1. Partially bend arm at elbow with
1. Ask client to hang arm freely
palm up
support it w/non dominant hand
2. Place your thumb over the biceps
2. Find tendon above the
tendon
olecranon process
3. Strike your thumb with the pointed
3. Tap it with the hammer (flat)
side of the reflex hammer
4. Repeat on the other side
4. Repeat on the other sid
5. Evaluates the function of spinal
5. Evaluates the function of spinal
levels C6, C7, and C8
levels C5 and C6
PATELLAR REFLEX
1. Both legs hang freely off the side of
the examination table
2. Find the patellar tendon (below
patella)
3. Strike with hammer (flat)
4. Repeat on the other side
5. Gently flex the knee and strike the
patella (client’s who cannot sit up)
6. Evaluates the function of spinal
levels L2, L3, and L4
ACHILLES REFLEX
1. Both legs hang freely off the side of the
examination table, dorsiflex the foot
2. Strike the Achilles tendon with hammer
(flat)
3. Repeat on the other side
4. Flex one knee and support that leg
against the other leg, dorsiflex the foot,
tap the tendon using the flat side
(client’s who cannot sit up)
5. Evaluates the function of spinal levels
S1 and S2
 ABDOMINAL REFLEX
1. Lightly stroke the abdomen on
each side, above and below the
umbilicus
PLANTAR REFLEX 2. Evaluates the function of spinal
1. Stroke lateral aspect of the sole levels T8, T9, and T10 with the
from heel to ball of foot upper abdominal reflex
2. Use the end of the hammer 3. Spinal levels T10, T11, and T12
3. Repeat on the other side with the lower abdominal reflex
4. Evaluates the function of spinal
levels L4, L5, S1, and S2
Normal: Flexion of toes
Deviations from normal: Toe adduction –
(+) BABINSKI
CREMASTERIC REFLEX
1. Lightly stroke the inner aspect of the
upper thigh
2. Evaluates the function of spinal levels
T12, L1, and L2
NORMAL: Scrotum elevates on stimulated
side
DEVIATIONS FROM NORMAL: Absence of
reflex may indicate motor neuron disorder
TEST FOR MENINGEAL IRRITATION
1. Supine
2. Place hands behind the patient’s head
and flex the neck forward until the chin
touches the chest
NORMAL: Neck is supple
DEVIATIONS FROM NORMAL: Pain in the
neck and resistance to flexion
BRUDZINSKI’S SIGN
1. As you flex the neck watch the clients hips and knees in reaction to your
maneuver
NORMAL: Hips and knees remain relaxed and motionless
DEVIATIONS FROM NORMAL: Pain and flexion of the hips and knees are
positive Brudzinski’s signs
KERNIG’S SIGN
1. Flex the client’s leg at both hip and the knee, then straighten the
knee
NORMAL: No pain is felt
DEVIATIONS FROM NORMAL:
• Pain and increased resistance to extending the knee are (+)
Kernig’s sign
• When bilateral = suspect meningeal irritation