OBJECTIVES @ a At the end of the lecture the learner should be able to > Enumerate Cranial Nerves. Lebron eat enmel Morte ee iE BN Tania » Describe assessment of cach Cranial Nerve along with abnormal findings and possible cause of lesion.CRANIAL NERVES On I Olfactory Nerve- Sensory ea (aceon Yann eal aU Rercatlonumm sca rcom yells TV Trochlear Nerve- Motor AM Deen afer NCA and Motor VI Abducent Nerve- Motor OIG Gracie YeURVema Ta CeCe y VIII Vestibulocochlear Nerve- Sensory Bb Ce Sey ian Noe a and Motor X Vagus Nerve- Sensory and Motor DRS irimcewcsce wan neem VCO Cag XII Hypoglossal Nerve- MotorI OLFACTORY ROTA, FUNCTION- Smell » Test sense of smell on each side (close off other nostrils) with the help of odour of common items such coffee, soap, cloves Ce >» Abnormal findings- anosmia (inability to detect smells), seen with frontal lobe lesion.Il OPTIC NERVE FUNCTION- Vision > Test visual acuity. > Central: Snellen eye chart; test each eye separately, test at distance of 20 ft. note the number of line which patient can clearly seem EWES 4 maaww «5 esuunes «6 [EE6 > Test peripheral vision by confrontation method . Each quadrant is checked by asking the patient to fix his gaze straight forward and therapist SiO sreeMUicoue lM Hi inl cMNM LU merNe nmr ReTon quadrant which patient has to identifield defect homonymous hemianopia. » Abnormal findings- blindness, myopia (impaired far vision), Presbyopia (impaired near vision)UUM OleOle) Mei (ene) © a FUNCTION- Pupillary reflex > Pupillary reactions is tested by having the patient stare into the distance as the examiner shines penlight obligue into each pupil. Lato Lenee lm eTitelintacor le concroaeo @ seo ta one aitoin [meh elit ieCem sey He MmSe Aci leew aUn eee) - (unequal pupils)11 AY OCCULOMOTOR, TROCHCLEAR, ABDUSENT tsa 0 FUNCTION- Extraocular Movements Z » Patient is asked to look in each direction and follows moving finger in the figure of H without moving the head . > Abnormal findings- Strabismus, double vision, impaired eye movementsExar ndings - evidence af incomitance Direction of gaze Primary pasition —_—_—eeetion of gare ~~ = Right sid nerve palsy §— “Ge Right ath nerve patsy ~~ -_ Right 6th nerve palsy Interpretation of incomitance (that Is, angle of squint varies with direction of gaze)V - TRIGEMINAL NERV FUNCTION- Sensory- Face > Test pain, light touch sensations-forehead, cheeks ,jaw simultaneously on both sides. > Test corneal reflex-touch lightly with wisp of cotton in the outer corner and blinking occurs. > Abnormal findings-loss of facial sensation, Beer maate eat!V- TRIGEMINAL NERV & 2 FUNCTION- Motor- Muscles of mastication Lacey occlecm Canny oreo celercvare enn: tieltc abel (el Com » Have patient clench teeth, or hold jaw against resistance. » Abnormal- Weakness, wasting of muscles when opened, deviation of jaw to ipsilateral Ste lemVII- FACIAL NERVE - MOTOR FUNCTION- Facial Expression > Test motor function facial muscle. Raise eyebrows, frown, show teeth, smile, close eyes tightly, puff out both cheeks. LAUT ELCe LT Tee ercecUh ASS ROm Tiel TIL mia Ce) close eye, drooping corner of mouth, Corb HitaU Taman eereo mete Cot LeelaVII- FACIAL NERVE- SENSOF FUNCTION- Taste to anterior two thirds of corre tom > Apply saline solution and sugar solution using a seen > Abnormal findings- incorrectly identifies roti toneVIII -VESTIBULOCOCHLEA NERVE SOLE a tC) Leeda URuee cere iran elena ttm reflex (VOR) MAL CHeoco Bho BRUC Coa la sen eat meas and take back to midline rapidly. Look for the movement of eyes | Pee eeI Mi ei rcmmceuaecomrertce iT yu ltTne Gaze instability with head rotation, nystagmusVIII - VESTIBULOCOCHLEAR NERVE Cochlear function » Weber Test Peake tir oad tone » Abnormal findings- Unilateral or bilateral conductive loss.IX & X - GLOSSOPHARYNGEAL AND VAGUS NERVE >» Function- Phonation and Swallowing > Listen to voice quality. » Abnormal Findings- Dysphonia: hoarseness denotes vocal cord weakness. >» Examine Swallowing function . > Abnormal findings- Dysphagia.IX & X - GLOSSOPHARYNGEAL AND VAGUS NERVE > Function- Palatal, Pharyngeal control > Have patients say ‘ah’ observe motion of soft palate and position of uvula,Abnormal findings- Palate fails to elevate-Lesion of CN 10; Asymmetrical elevation with unilateral paralysis.Gag reflex- > Stimulate back of the throat lightly ded inet tr ethereal on each side- reflex contraction of back and throat to remove the stimulus out. a ! > Abnormal findings- absent reflex. Lesion of CN 9 and possibly 10. The posterior pharynx is stimulated, fist ‘on one side then on the other side.XI -SPINAL ACCESSORY NERVE > Examine bulk of Trapeziums muscle Abnormal finding- LMN: atrophy, Beto rotates Mant osctt Estee et] er2| et (ocr) > Examine Swength of Trapeziums muscle- shrug both the shoulder against resistance Abnormal findings- inability to shrug ipsilateral shoulder, shoulder droop.Sternoceidomastoid muscle- Check for Bulk and Strength Strength - turn head each Bt Eirias enon ed checking strength of muscle on opposite side. Abnormal findings- inability to turn the head opposite side, weakness of ipsilateral sternocleidomastoid and contralateral trapezius.XII - HYPOGLOSSAL NERVE Mire meas > Listen to patient's articulation. > Abnormal findings- dysarthria. > Ask the patient to protrude tongue, move side to side . > Abnormal Findings - Impaired movements, deviation to er Lan O lon1.Ovfactory —§ Trigeminal 9. Glossopharyngea! 2.0ptic 6 Abducens. 10. Vagus 2.Qeulemotor 7. Fact 11. Spinal Accessory 8. Acoustic ‘12. Hypoglossal The Cranial NervesSUMMARY & s > 12 Cranial Nerves > Sensory or motor or sensory motor > Stimulus is followed by a response > Note abnormal findings