Neurological Examination – Cranial nerves (1-7)

1. Neurological Examination – Cranial nerves (1-7) Zohaib Iqbal – FY1 Qasim Shoaib – FY1

2. Olfactory Nerve • Ask patient to smell!

3. Optic Nerve • 1. Fundi • 2. Visual Fields • 3. Pupillary Reflexes (Light reflex and Accommodation) • 4. Visual Acuity

4. Visual Fields

5. Pupillary Reflexes 1 LGB Both Edinger – westphal nuclei Optic nerve Pre-tectum 3rd nerve Retina Superior colliculus Ciliary Ganglion Iris and ciliary muscles hypothalamus

6. Pupillary Reflex 2 Anisocoria Normally Reacts to light Pupil Large Doesn’t react to light Normal Accommodation Afferent pupillary defect Slow Accommodation Holmes – Adie Pupil NO Accommodation With ptosis: 3rd nerve palsy

7. Pupillary Reflex 3 Senile Miosis Elderly Reacts to light Pupils Small With ptosis Anhydrosis enopthalmus Horners syndrome Doesn’t react to light Normal Accommodation Argyll – Robertson NO Accommodation Miotic drugs

8. Occulomotor, Trochlear, Abducens Which eye sees false image DIPLOPIA Where is it widest apart? Laterally All other directions Downwards and medially Parallel images Images at an Angle 6th nerve palsy 4th nerve Palsy Eye deviated down and out?? Other causes NO YES Pupil Dilated?? YES NO Surgical 3rd Medical 3rd

9. Trigeminal Nerve • Trigeminal: • Sensory • Opthalmic • Maxillary • Mandibular • Motor • Muscles of Mastication • Corneal Reflex • Failure of either side of face to contract = V1 lesion • Failure of one side of the face to contract = 7th nerve lesion Trigeminal Brainstem Facial

10. Facial Nerve 1 • FACE, TASTE, EARS And TEARS • LMN weakness – All facial muscles are affected • UMN weakness – The forehead is preserved

11. Facial nerve 2 Face symmetrical? YES NO Bilateral weakness- Forehead same as face? YES Forehead stronger than Lower face? Unilateral UMN YES Bilateral LMN NO NO YES Forehead strength equals lower face? Unilateral LMN Bilateral weakness- Forehead stronger than face? YES Bilateral UMN

12. Any Questions??????