CRANIAL NERVES

CRANIAL ORIGIN/EXIT SENSORY FXN MOTOR FXN SCREENING TEST

NERVE
CN 1: Olfactory Origin:Uncus Smell ---  Test senses of smell
Nerve Exit: Cribiform plate o Affected:Anosmia on each side
of ethmoid bone -> Use common,
non-irritatble
odors (lemon, oil,
coffee, cloves,
tobacco)
CN 2: Optic Nerve Origin:Diencephalon Vision ---  Visual Activity
Exit: Optic canal  Central Vision
Snellen eye
Chart (20ft
dist.)
 Peripheral Vision
 Confrontation
Test
 Pupillary Light
Reflex (Sensory)
CN 2 & 3 Pupillary Reflex  Pupillary Light
 CN 2- SENSORY Reflex
 CN 3- MOTOR  N: Bilat, response
 PERRLA- PUPIL EQUAL ROUND  Test pupillary
REACTIVE TO LIGHT reactions
 Check pupil size
CN 3: Oculomotor Origin: Midbrain --- EOM:SR, IR, MR, IO o Pupillary Light
Nerve Exit: Supraorbital  Affected: Reflex (motor)
Fissure STRABISMUS o Accommodation
Levator palpebrae Reaction
superioris: eye opening  Object is near 
o Affected: PTOSIS pupil Constrict
Parasympathetic:  Object is far 
EDINGER WESTPHAL- pupil Dilate
iF BUNDLE: CILIARY  PERRLA- pupil
GANGLION equal round
o Affected: reactive to light
ANISOCORIA and
accommodation

CN 4: Trochlear Origin: Midbrain --- Superior Oblique

Nerve Exit: Supraorbital o Affected:
Fissure VERTICAL
DIPLOPIA

CN 3, 4, 6 EOM  Test saccadic and

pursuit eye
movement
 Test extraocular
movements
CN 6: Abducens Origin: Pons --- Lateral Rectus
Nerve Exit: Supraorbital o Affected:
Fissure HORIZONTAL
DIPLOPIA
CN 5: Trigeminal Origin:Pons o Sensory of face Muscles of  Test pain and
Nerve Exit: o General mastication sensation:forehead
 OPTHALMIC: sensation of o Lateral Pterygoid – , cheeks, jaw
SUPRAORBITA tongue – ant 2/3 protrude mandible,  Test corneal blink
L FISSURE (via lingual nerve open jaw reflex
 MAXILLARY: brach of o Medial Pterygoid –  Palpate temporalis
FORAMEN mandibular close jaw and masseter ->
 ROTUNDUM division) o Masseter – close apply resistance
 MANDIBULAR: o Sensation of jaw, strongest  Jaw Jerk reflex
FORAMEN cornea (Corneal muscle (also affected in
OVALE Blink Reflex) o Temporalis – close myesthenia
 CN 5: sensory jaw; postural gravis)
 CN 7 - motor muscle (contracts
all the time)
CN 7: Facial Origin:Pons Chorda Tympani  Posterior Auricular Branch  Test motor function
Nerve Exit: (stylomastoid foramen) – of the facial
stylomastoid
MIXED SENSORY MOTOR
o Internal acoustic o Sensory: Taste AFFECTATION
muscles
meatus - nerve sensation of the o suprahyoids; also  Apply saline/sugar
to stapedius, tongue – ant 2/3 seen in the triangles of solution to anterior
Pathway: chorda tympani the neck tongue
Pons
o Parasympathetic:
(nerve to  Nerve to
↓ Submandibular stylohyoid
Greater Petrossal
stapedius:
HYPERACUSIS) ganglion – sup  Nerve to posterior
Nerve  Geniculate
salivatory nucleus digastric
Ganglion o Stylomastoid
(parasympathetic) foramen -  Innervating Terminal Branch (facial
↓
1st exit: internal acoustic Posterior submandibula canal) – PURE MOTOR
auricular branch r et sublingual AFFECTATION
meatus
o Cervical Branch
↓ (nerve to salivatory  Platysma
2 branches: Nerve to stylohyoid,
stapedius, Chorda
gland o Temporal Branch
Tympani nerve to  Frontalis
↓ posterior  Orbicularis Oculi
2nd exit: Stylomastoid digastric)  Corrugator
Foramen Supercilli
o Facial canal -
↓ o Zygomatic Branch
Branch: Posterior (temporal,  Orbicularis Oculi
Auricular Branch, zygomatic, o Buccal Branch
Chorda tympani (taste buccal,  Risorius
sensation of tongue)  Buccinator
↓
mandibular,
cervical)  Levator Labii
3rd exit: Facial canal: 5 Superioris
terminal branches  Levator Anguli
Oris
 Nasalis
 Orbicularis Oris
o Mandibular Branch
 Mentalis
BELL’S PALSY
3 Synkinetic Movement – d/t aberrant
regeration
***If all three are present, it is called as Marcus
Gunn Phenomenon
o Marin Amat – pseudoptotic eye closes after
max mouth opening
o Bell’s phenomenon – attempts to close
pseudoptotic eye → eyeball rolls upward
o Marcus Gunn – deviates the jaw towards
the N side → pseudoptotic eye further
opens
Lesion at the facial canal
o Pure motor affectation
Lesion at the stylomastoid foramen
o Motor and sensory affectation (sensory on
tongue)
CN 8: Origin: Pons Vestibular Nucleus ---  Vestibular
Vestibulocochlear Exit: Internal acoustic o Connected to
function
Nerve meatus bestibular
apparatus  Test balance: VSR
o 3 SCC  Test eye-head
o 2 otolith organs coordination:
(saccule, utricle) VOR
Cochlear Nucleus  Cochlear function
o Connected to  Weber’s test
spiral ganglion
o Organ of corti
 Rinne’s test
o Medial geniculate
body – thalamus
Affected:
HYPOACUSIS
(hearing loss)
CN 9: Optic Nerve Origin: Medulla Sensory: Swallowing - Nucleus Apply saline/sugar
Exit: Jugular o Genral sensation of ambiguus solution to posterior
foramen and taste sensation o Stylopharyngeus 1/3 tongue
to posterior 1/3 of
tongue
o Sensation of Uvula
o Afferent of gag
reflex
Parasympathetic:
o Otic ganglion – inf
salivatory nucleus
(parotid gland)
o Sensory
parasympathetic
 Sensory of the
ear – nucleus
solitarius (CN 7,
9, 10)
 Carotid sinus –
controls BP
CN 10: Vagus Origin: Medulla Sensory: o Efferent of gag  Examine
Nerve Exit: Jugular o Taste from reflex swallowing;
foramen epiglottis o Motor of uvula  observe uvula
o Sensory – o Muscle of pharynx and soft palate for
any asymmetry
Parasympathetic + larynx
(tongue
 Sensation of o Muscle for depressor)
the ear – swallowing –  Uvula deviation is
nucleus nucleus of contaminated to
solitaries (CN Ambiguus; except: CN 10 affectation
7, 9, 10) stylopharyngeus
Parasympathetic: o Palatoglossus –
o Carotid sinus muscle of the
o Heart tongue
o Lungs
o GI tract
CN 9, 10 o Phonation o Listen to voice
o Swallowing equally
o Palatal and pharynx control Gag reflex o Examine for
dysphagia
o Have patient say
“ah” -> observe of
 soft palate
o Motion et position
of uvula
o Stimulate back of
throat lightly
CN 11: Accessory Origin:Medulla --- o SCM (C2,C3) o Neck rotation
Nerve Exit: Jugular  Bilateral: neck o Shoulder shrug
foramen flexion
 Unilateral:
ipsilat lat flex,
contralat
rotation
o Trapezius (C3,
C4)
CKC
 Bilat: neck
extension
 Unilat: ipsilat
lat flex,
contralat
rotation
OKC
 Upper traps:
scapular
elevation
(shrug)
 Middle traps:
scapular
retraction
 Lower traps:
scapular
depression
 All fibers:
scapular
upward
rotation
CN 12: Origin: Medulla --- Intrinsic muscles o Listen to patient’s
Hypoglossal Exit: Hypoglossal o Shapes the tongue articulation
Nerve Canal Extrinsic muscles o Examine tongue
o Palatoglossus movement\
(CN10)-Elevate o Tongue deviation
o Genioglossus – is ipsilateral to the
Protrude CN 12 affection
o Hypoglossus –
Depress
o Styloglossus –
Curls
CN 1 Oh Olfactory Some Sensory

CN 2 Oh Optic Says Sensory

CN 3 Oh Oculomotor Marry Motor

CN 4 To Trochlear Money Motor

CN 5 Touch Trigeminal But Both Sensory & Motor

CN 6 And Abducens My Motor

CN 7 Feel Facial Brother Both Sensory & Motor

CN 8 A Acoustic / Vestibulocochlear Says Sensory

CN 9 Girl’s Glossopharyngeal Big Both Sensory & Motor

CN 10 Vagina Vagus Breast Both Sensory & Motor

CN 11 Ah Accessory Matters Motor

CN 12 Heaven Hypoglossal More Motor

CRANIAL NERVE SCREENING TEST
I  Examine olfactory acuity using non-noxious odors such as lemon, oil, coffee,
cloves, or tobacco

II  Examine visual acuity using a Snellen chart; both central and preipheral vision is
tested

III, IV, VI  Determine equality and size of pupils

 Reaction to light
 Presence of strabismus (loss of ocular alignment)
 Ability of eye to follow a moving target without head movement
 Presence of ptosis of eyelid (eyelid droops over the eye)

V  Sensory tests of face (sharpidull discrimination, light touch)

 Examine taste on anterior 2/3 of tongue
 Open and close jaw against resistance
 Jaw jerk reflex

VII  Examine any asymmetry of face at rest and during voluntary contraction

VIII  Weber Test auditory acuity -> vibrating tuning fork placed on vertex of skull or
forehead -> patient indicate on which side the tone is louder
 Rinne Test (conductive hearing loss) -> vibrating tuning fork on mastoid process,
then near external ear canal -> note hearing acuity
 Rub fingers together at a distance and gradually bring toward patient, note
distance when first heard
 Alter volume of conversation

IX  Examine taste on posterior 1/3 of tongue

 Examine gag reflex

X  Examine swallowing
 Observe uvula and soft palate for any asymmetry (tongue depressor)

XI  Examine strength of the sternocleidomastoid and trapezius muscles

XII  With tongue protruded, examine ability to move tongue rapidly from side to side