CRANIAL NERVE ASSESSMENT

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About cranial nerves
1. Olfactory
2. Optic
3. Occulomotor
4. Trochlear
5. Trigeminal
6. Abducens
7. Facial
8. Vestibulocochlear
9. Glosso-pharyngeal
10. Vagus
11. Spinal accessory
12. Hypoglossal
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About cranial nerves
Sensory
Olfactory(1)
Optic(2)
VC(8)

Motor
Occulomotor(3)
Trochlear(4)
Abducent (6)
Spinal
accessory(11)
Hypoglossal (12)
Mixed
Trigeminal(5)
Facial(7)
G.pharyngeal(9)
Vagus (10)
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Olfactory
Location of Nucleus: Frontal lobe
Function :Smell
Test :
Close eyes
Select non irritating odors
Test the sense of smell on each side nostril with
closing of opposite side.
Abnormal : Anosmia
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Optic
Location of Nucleus: Occipital Lobe
Function :Vision
Test :
Snellens chart
Abnormal : Blindness , Myopia (impaired
far vision), Presbyopia (impaired near
vision)
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Occulomotor
Location of Nucleus: Midbrain
Function : Eyeball movements (all muscles
except Lateral rectus , Superior
Oblique)(LR
6
SO
4
)
3
Test :
Check eyeball movements in all direction .
Abnormal : Strabismus , Diplopia

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Trochlear
Location of Nucleus: Midbrain
Function : Eyeball movement of Superior
Oblique(LR
6
SO
4
)
3
Test :
Check eyeball movements in all direction .
Abnormal : Strabismus , Diplopia

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Trigeminal
Location of Nucleus: Pons
Function :
Sensory : Sensation of Face
Motor : Muscles of Mastication

Test :
Check all types of sensation of face .
Check movement of TMJ
Mentalis reflex and corneal reflex
Abnormal : Dysarthria , loss of sensation

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Abducens
Location of Nucleus: Pons
Function : Eyeball movements Lateral
rectus (LR
6
SO
4
)
3
Test :
Check eyeball movements in sideways direction
Abnormal : Strabismus , Diplopia

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Facial
Location of Nucleus: cerebello pontine
angle
Function :
Sensory : Taste of Anterior 2/3 of Tongue
Motor :Facial expression and facial movements.

Test :
Check all facial expression
Apply sugar or saline solution with cotton swab
Abnormal : Bells or facial palsy

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Vestibulo - cochlear
Location of Nucleus: cerebello pontine
angle
Function :
Vestibular function : Balance of body , receive
impulse from semi circular canal.
Cochlear function : Audition ( Air and Bone)

Test :
For vestibular : Check for balance with closing
of eyes
For cochlear : 1. whisper test 2. Rinnes test 3.
Webers test.
Abnormal : Conduction deafness

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About Ear
Ear consist three parts Outer , Midlle and
Inner.
Air conduction uses the apparatus of the
ear are located in middle ear (pinna,
eardrum and ossicles) used to amplify and
direct the sound.
whereas bone conduction bypasses some
or all of these and allows the sound to be
transmitted directly to the inner ear.
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Rinne s test
is performed by placing a vibrating tuning fork (512 or
256 Hz) initially on the mastoid process until sound is
no longer heard.
The fork is then immediately placed just outside the
ear.

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Description Relative Positive/negative
In a normal ear, air conduction (AC) is better
than bone conduction (BC)
AC > BC
This is called a positive
Rinne
In conductive hearing loss, bone conduction
is better than air
BC > AC negative Rinne
In sensorineural hearing loss, bone
conduction and air conduction are both
equally depreciated, maintaining the
relative difference
AC > BC positive Rinne
Weber Test
It can detect unilateral (one-sided)
conductive hearing loss and unilateral
sensorineural hearing loss.
In the Weber test a vibrating tuning fork
(either 256 or 512 Hz) is placed in the
middle of the forehead equidistant from
the patient's ears.
The patient is asked to report in which ear
the sound is heard louder.
In a normal patient, the sound is heard
equally loud in both ears
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Glosso - Pharyngeal
Location of Nucleus: Medulla
Function :
Sensory: sensation of posterior 1/3 of tongue
Motor : voice production , swallowing , palate
movement

Test :
Sensory : apply saline or sugar with cotton
swab
Motor : test of voice production, test
swallowing with glass of water , open mouth
check the position uvula.
Abnormal : Dysphonia, dysphagia
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Spinal Accessory
Location of Nucleus: Cranial and Spinal
Roots
Function :
Controls the movement of Trapezius , Sterno
cleido mastaoid.

Test :
Check contraction of Trapezius and
Sternocleido mastoid.
Abnormal : Paralysis
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Hypoglossal
Location of Nucleus: Medulla
Function :
Tongue movements
Test :
Sensory :Examine the resting position of
tongue.
Protrude out and move side to side
Abnormal : if LMN : Atrophy and
fasciculation loss of movement on same
side , if UMN : loss of movement on
opposite side.

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