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Cranial Nerves: DR Dyan Roshinta Laksmi Dewi, SP.S SMF Saraf Rsud DR Soedarso Pontianak
Cranial Nerves: DR Dyan Roshinta Laksmi Dewi, SP.S SMF Saraf Rsud DR Soedarso Pontianak
General Characteristics:
The 12 pairs of cranial nerves are part of the
peripheral nervous system.
CLINICAL EVALUATION
Use aromatic substances,
i.e. coffee, lemon, garlic,
etc.
Test each nostril separately.
CN II - OPTIC
CLINICAL EVALUATION
VISUAL ACUITY: Snellen chart for distant
vision, newspaper or fingers for near vision.
VISUAL FIELDS: Confrontation.
FUNDI AND OPTIC DISCS:
Visualization of the termination of
the optic nerve by looking through
pupil with ophthalmoscope.
SPECIFIC DYSFUNCTIONS
Blurred vision or complete blindness.
Ipsilateral vision loss - Optic atrophy, retinal/optic nerve lesions, trauma.
Visual loss (one or both eyes) - Optic chiasm or occipital lobe lesions.
Cortical blindness - Lesion of occipital cortex bilaterally, pupil reflexes intact.
Papilledema - Optic nerve tumor, venous obstruction, chronic increased ICP.
Optic atrophy - MS, optic neuritis, increased ICP.
Scotomas- (Abnormal blind spots on visual fields) - optic neuritis or atrophy.
Hemianopia - (loss of half of visual field in one or both eyes) - Lesions of optic
chiasm, tracts, or radiations.
CN III - OCULOMOTOR
ORIGIN: Midbrain
INNERVATION: EOM's; eyelid; ciliary; and sphincter of iris.
FUNCTION: Eye movement inward (medially), upward, downward, and outward; pupil
constriction, shape and equality; elevates upper eyelid; accommodation
reflex.
DYSFUNCTION:Unable to look up, down, or medial (dysconjugate gaze); ptosis, pupil
dilatation - bilateral or ipsilateral, and loss of accommodation reflex.
CLINICAL EVALUATION
Observe for eye opening and symmetry.
Accommodation.
CLINICAL EVALUATION
MOTOR: Open jaw, check for deviation. Have patient bite down, palpate masseter
and temporal muscles. Move jaw laterally against resistance to evaluate weakness
or paralysis.
JAW JERK: Tap lower jaw with mouth open - check for slight
elevation of mandible.
CN VII- FACIAL
ORIGIN: Pons & medulla.
INNERVATION: Anterior two-thirds of tongue; facial muscles, scalp, ear, and neck.
FUNCTION: - Control of facial muscles (expressions)
- Motor limb of blink & corneal reflexes
- Secretion of salivary & lacrimal glands
- Sensation of taste, anterior two-thirds tongue.
DYSFUNCTION:
Motor = Facial asymmetry - Ipsilateral weakness/paralysis, right or left, indicative of
damage to motor nucleus or peripheral component (lower motor neuron lesion) EX:
Bell's palsy
Contralateral weakness/paralysis of lower face indicative of contralateral motor
cortex damage (upper motor neuron lesion) or hemispheric lesion, i.e. massive CVA.
Bilateral weakness or paralysis , E.g. myasthenia gravis or Guillian Barre.
MOTOR FUNCTION:
Observe for facial symmetry
Ask patient to wrinkle forehead, puff cheeks,
smile, show teeth, open eyes against
resistance, and whistle.
SENSORY FUNCTION:
Test each side of tongue separately.
Test for sweet (tip of tongue); sour (sides of
tongue); salty (over most of tongue, but
concentrated on sides).
Give sip of water between tastes.
CN VIII - ACOUSTIC
ORIGIN: Pons and medulla
INNERVATION: Cochlear - ear
Vestibular - ear
FUNCTION: Cochlear - Hearing
Vestibular - Balance, maintenance of body position, and proprioception.
DYSFUNCTION (Cochlear)
- Unilateral deafness
- Loss of sound appreciation
- Tinnitis
- (Rinne Test) AC >BC or both diminished indicative of nerve damage,
BC> AC middle ear disease.
- (Weber Test) Lateralization to good ear is nerve damage, lateralization to
bad ear is, middle ear disease.
DYSFUNCTION (VESTIBULAR)
- Vertigo
- Balance disturbances
Vestibular branch normally not tested unless patient gives history of vertigo or balance
Disturbance history is positive, caloric testing is done by physician.
CN VIII - ACOUSTIC
CLINICAL EVALUATION
HEARING: Test bilaterally, whisper or watch tick
CN IX and X considered jointly, actions are seldom compared separately; they are
always tested together.
CLINICAL EVALUATION
V Trigeminal
VI Abducens
PONS
VII Facial
VIII Acoustic
MEDULLA
IX Glossopharyngeal
X Vagus
XI Accessory
XII Hypoglossal