Cranial Nerves

Examination
dr. Astra Dea Simanungkalit, SpS

Lecturer :

Learning Objective
Identify 12 pairs of cranial nerves (CN) and
their each function
Understanding the importance of CN
examination
Know how to perform CN examination
Know how to conclude findings in CN
examination to make a topic diagnosis

Cranial Nerves
Twelve pairs of nerves that arise directly
from the brain, not from the spinal cord.
Each has its function, motor, sensory or
both.

Nerve

Component

Function

Sensory

Smell

II

Sensory

See

III

Motor

All except SO and LR, eyelid, pupil

IV

Motor

Superior Oblique (SO) muscle

Sensory, Motor

Face sensory, Mastication

VI

Motor

Lateral Rectus (LR) muscle

VII

Sensory, Motor

Face muscles

VIII

Sensory

Hearing, Balance

IX

Sensory, Motor

1/3 posterior tongue, Pharynx muscles

Sensory, Motor

Pharynx, Lung, heart, GI tract

XI

Motor

SCM muscle, trapezius

XII

Motor

Tongue

CN palsies: central component of the lesion

1st Cranial Nerve

Identify smells
Check the patency of each nostril first
Non-irritant smell
Eyes closed

2nd Cranial Nerve

Color
Visual acuity
Visual field
Pupillary reflex
Fundus/Papil

!!!! Each eye at one time !!!

2nd Cranial Nerve, Color

Ishihara test

2nd Cranial Nerve, Visual Acuity

1/60 count fingers in 1
meter
1/300 wave hand in 1
meter
1/ light in 1 meter
Reading

2nd Cranial Nerve, Visual Field

Pupillary reflex (2nd and 3rd CN)

2nd Cranial Nerve, Optic Papil

Round
Colour
Margin
Cupping
Aa:vv

3rd, 4th, 6th Cranial Nerves

Inspection of pupil: shape, diameter,
isocoria
Light reflex motor component
Palpebra Ptosis vs lagophtalmus
Eye Movement palsy will result in
diplopia
Convergence & accomodation

Eye Movement
Right eye

H Formation

Which CN involved?

5th Cranial Nerve, Sensory

Compare side to
side
Compare branch
to branch

5th Cranial Nerve, Motor

7th Cranial Nerve

Forehead has 2
innervation
Below eye only
has 1
innervation

7th Cranial Nerve

UMN (central):
before nuclear
LMN (peripheral):
after nuclear
Palsy of
central/peripheral
right/left 7th nerve

8th Cranial Nerve

Cochlear
Rinne, Weber, Swabach

sensorineural/conductiv
e
Whispering test
Finger rub test
Vestibular
Romberg test
Tandem Gait
Fukuda test
Caloric test

9th, 10th and 12th Cranial Nerve

Resting:
Uvula midline
Tongue deviation
Tongue Fasciculation or
wasting
Stick out tongue, say Ahh:
Palate/uvula rise
Tongue deviation while
protruded
Gag Reflex

12th cranial nerve

Palsy of central/peripheral right/left 12th
nerve
Central/peripheral? LMN (peripheral)
wasting, involuntary twitching
(fasciculation).
Right/left? Deviation to affected side when
protruded, deviation to normal side when
relaxed (in mouth).

11th Cranial Nerve

Which CN palsy Location of the

lesion

In unconscious patient, which CN?

Nerv
e

Component

Function

Sensory

Smell

II

Sensory

See

III

Motor

All except SO and LR, eyelid,

pupil

IV

Motor

Superior Oblique (SO) muscle

Sensory, Motor

Face sensory, Mastication

VI

Motor

Lateral Rectus (LR) muscle

VII

Sensory, Motor

Face muscles

VIII

Sensory

Hearing, Balance

IX

Sensory, Motor

1/3 posterior tongue, Pharynx

muscles

Sensory, Motor

Pharynx, Lung, heart, GI tract

Yes/No

In unconscious patient, which CN?

Nerv
e

Component

Function

Yes
/No

Sensory

Smell

No

II

Sensory

See, pupillary reflex

Yes

III

Motor

Eye movement, eyelid, pupillary reflex

Yes

IV

Motor

Eye Movement

Yes

Sensory,
Motor

Face sensory, Corneal reflex, Mastication

Yes

VI

Motor

Eye Movement

Yes

VII

Sensory,
Motor

2/3 anterior tongue, Face muscles, Corneal

reflex

Yes

VIII

Sensory

Hearing, Balance

Yes

IX

Sensory,
Motor

1/3 posterior tongue, Pharynx muscles, gag

reflex

Yes

Sensory,
Motor

Pharynx, Lung, heart, GI tract, Gag reflex

Yes

XI

Motor

SCM muscle, trapezius

No

Thank you