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The Cranial Nerves

The Cranial Nerves. 5. 3. 3. 8. 8. 2. 2. 6. 1. 6. Clinical Assessment. 4. 4. 9 10. 12. The “FACE” of Cranial Nerves. J Carley MSN, MA, CNE Fall 2009. I Olfactory II Optic III Oculomotor IV Trochlear V Trigeminal. VI Abducens VII Facial VIII Acoustic

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The Cranial Nerves

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  1. The Cranial Nerves 5 3 3 8 8 2 2 6 1 6 Clinical Assessment 4 4 9 10 12 The “FACE” of Cranial Nerves J Carley MSN, MA, CNE Fall 2009

  2. I Olfactory II Optic III Oculomotor IV Trochlear V Trigeminal VI Abducens VII Facial VIII Acoustic IX Glossopharyngeal X Vagus XI Spinal Accessory XII Hypoglossal Cranial Nerves

  3. Cranial Nerves • When assessing the cranial nerves, there are 3 items the examiner must know: • Function (Motor, Sensory, Mixed) • Testing • Signs of Dysfunction

  4. Cranial Nerves O OO T T A F A G V S H • CN I – Olfactory Nerve • Function: special sensory • Testing: • Use 2-3 vials of familiar odors • Test one nostril at a time with patient’s eyes closed • Use least irritating scent first and allow the patient to rest in between vials • Signs of Dysfunction: anosmia

  5. Cranial Nerves O OO T T A F A G V S H • CN II – Optic Nerve • Function: special sensory • Testing: • Snellen Eye chart • Fundus Exam • Visual fields via confrontation • Pupillary Light reflex • Signs of Dysfunction • Blindness • Loss of pupillary constriction (sensory)

  6. Cranial Nerves O OO T T A F A G V S H • CN III – Occulomotor Nerve • Function: somatic & visceral motor • Testing: • Six Cardinal Fields of Gaze • Pupillary Light reflex: (motor) • Accommodation • Signs of Dysfunction: • Eye turned down & out w/ ptosis • Mydriasis, Loss of accommodation, Diplopia

  7. Cranial Nerves O OO T T A F A G V S H • CN IV – Trochlear Nerve • Function: somatic motor • Testing: • Six Cardinal Fields of Gaze • Signs of Dysfunction: • Vertical diplopia • Excycodeviation of the eye

  8. Cranial Nerves O OO T T A F A G V S H • CN V – Trigeminal Nerve • Function: • Branchial motor – mastication • General Sensory – sensory to the face

  9. Cranial Nerves O OO T T A F A G V S H • CN V – Trigeminal Nerve • Testing: • Sharp & light touch over the three divisions • Corneal Blink Reflex (sensory) • Clinch teeth & Jaw Jerk • Signs of Dysfunction: • Weakness • Hemianesthesia • Absent Corneal Blink Reflex

  10. Cranial Nerves O OO T T A F A G V S H • CN VI – Abducens Nerve • Function: somatic motor • Testing: • Six Cardinal Fields of Gaze • Signs of Dysfunction: • Horizontal diplopia • Medial deviation of the eye

  11. Cranial Nerves O OO T T A F A G V S H • CN VII – Facial Nerve • Function: • Branchial motor – facial muscles • Visceral motor – glandular fcn • General Sensory – skin of the auricle • Special Sensory - taste

  12. Cranial Nerves O OO T T A F A G V S H • CN VII – Facial Nerve • Testing: • Branchial motor component: facial expression • Special Sensory: taste to the anterior 2/3 of tongue • Signs of Dysfunction: • Hemiparesis • Dry eye • Lagophthalmos • Dry mouth • Loss of taste

  13. Cranial Nerves O OO T T A F A G V S H • CN VIII – Acoustic (Vestibulocochlear) Nerve • Function: special sensory • Testing: hearing tests: Rinne, Weber, Audiology, whisper, fingertips • Signs of Dysfunction: • Vertigo • Nystagmus • Disequilibrium • Sensorineural deafness

  14. Cranial Nerves O OO T T A F A G V S H • CN IX – Glossopharyngeal Nerve • Function: • Branchial Motor – elevation of pharynx during swallowing & speech • Visceral Motor – parotid gland fcn • Visceral Sensory – communication between carotid body & sinus • General Sensory - tongue • Special Sensory - taste

  15. Cranial Nerves O OO T T A F A G V S H • CN IX – Glossopharyngeal Nerve • Testing: • Branchial Motor: swallowing • General Sensory: gag reflex • Special sensory: taste of posterior 1/3 of tongue

  16. Cranial Nerves O OO T T A F A G V S H • CN IX – Glossopharyngeal Nerve • Signs of Dysfunction • Dysphagia • Dry mouth • Loss of taste • Loss of gag reflex • TYPICALLY, IX and X are tested together

  17. Cranial Nerves O OO T T A F A G V S H • CN X – Vagus Nerve • Function: • Branchial Motor – deglutition & phonation • Visceral Motor – smooth muscles of the thoracic & abdominal viscera • Visceral Sensory – thoracic & abdominal viscera • General Sensory – external ear • TYPICALLY, IX and X are tested together

  18. Cranial Nerves O OO T T A F A G V S H • CN X – Vagus Nerve • Testing: • Branchial motor: swallowing, gag reflex, soft palate elevation with uvula remaining while saying “Ah” • Signs of Dysfunction: • Dysphagia • Hoarseness • Uvula deviation

  19. Cranial Nerves O OO T T A F A G V S H • CN XI – Spinal Accessory Nerve • Function: somatic motor • Testing: Resisted shoulder elevation & head rotation • Signs of Dysfunction: • Atrophy & Weakness • Fasciculations • Neck or shoulder deviation

  20. Cranial Nerves O OO T T A F A G V S H • CN XII – Hypoglossal Nerve • Function: somatic motor • Testing: • Stick out tongue • Press tongue against check while palpating to test muscle strength • Articulation of hard consonants: ‘L’, ‘T’, ‘D’, & ‘N’ • Signs of Dysfunction: • Atrophy & Weakness • Deviation • Dysarthria

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