CRANIAL NERVES

NERVE

FUNCTION TEST EXTRA NOTES
I. Olfactory Sense of smell (sensory) Alcohol swab
Food
Not often done

II. Optic Visual pathway (sensory) Cotton wool test
Obstacle course
In conjunction with other parts of neuros not in isolation

Menace reflex:

o Afferent: visual pathway
o Efferent: CN vii ! CN vii (facial) innervates
orbicularis oculi (eyelids) ! Facial nerve paralysis if
lack of blink response

Fixating reflex:

o Afferent: visual pathway
o Efferent: eye movement; CN iii, iv, vi

Pupillary light reflex:

o Afferent: CN ii ! visual tract to optic tract
o Efferent: CN iii ! direct response; parasympathetic
(miosis)


Pupil size & symmetry:

o Mydriasis: sympathetic stimulation / lack of CN iii
(parasympathetic)
o Miosis: excessive parasympathetic / loss of
sympathetic
Horners syndrome:
lesion in sympathetic
supply to the eye
o Miosis
o Ptosis
o Protruding 3
rd
eyelid
o Enopthalmos

Test: Topical application of
phenylepherine into Rt
eye: miosis resolved
rapidly indicating a 3
rd

order lesion in the Rt eye.

III. Oculomotor Parasympathetic to pupillo-
constrictors

Motor to eye muscles

Pupillary light reflex:

o Loss on affected side
o Strabismus: down & out


IV. Trochlear Motor function ! muscles
of the eye
Position of the eyeball:

o Strabismus: dorsomedial

V. Trigeminal 1. Opthalmic branch:
Sensory (cornea, dorsal
nose, forehead)

2. Maxillary branch:
Sensory (face, maxilliary
teeth, palate, nose)

3. Mandibular:
Sensory (lower lip,
mandibualr teeth, tongue)
Motor to muscles of
mastication
Facial sensation:
o Pinching/haemostat

Corneal reflex:
o Blow on eye
o Sensory (V)
o Motor ! blink (VII)

Jaw tone = bilateral = Dropped jaw

Temporal / masseter muscle atrophy


VI. Abducent Motor: lateral rectus muscle
of the eye & retractor bulbi
muscle
Damage: medial strabismus & inability to retract the bulb
Not usually in isolation


VII. Facial Motor to small muscles of
facial expression

Parasympathetic salivary
and lacrimal gland


Sensory (tongue)

Menace reflex:

o Afferent: visual pathway
o Efferent: CN vii ! CN vii (facial) innervates
orbicularis oculi (eyelids) ! Facial nerve paralysis if
lack of blink response

Corneal reflex:
o Blow on eye
o Sensory (V)
o Motor ! blink (VII)


Facial sensation:

o Pinching/haemostat
o Sensory Trigeminal (V)
o Motor Facial (VII)
VIII. Vestibulocochlear Cochlear nerve: hearing

Vestibular nerve:
equilibrium

Cochlear nerve:

o Hand clap
o BAER

Vestibular nerve:

o Nystagmus
o Head tilt
o Circling towards lesion
o Ataxia
Vestibular syndrome:

o Central vs. peripheral

o Is the vestibular
affected in the
brainstem or closer to
the efferent i.e. ears?

*See slides for table?
IX. Glossopharyngeal Sensory to pharynx and
tongue

Motor (with Vagus X) to
pharynx

Parasympathetic to parotid
Gag reflex

Damage: dysphagia

X. Vagus Sensory: Thoracic and
abdominal viscera

Parasympathetic: Thoracic
and abdominal organs

Motor: Pharynx

Moto & sensory: larynx,
trachea, oesophagus
Gag reflex

Cough reflex

Oculo-cardiac reflex (heart rate slows down with pressure
on the eyeball)

Auscultate: borborygmi, tachycardia


XI. Accessory Motor to neck muscles No tests

Atrophy

XII. Hypoglossal Motor to tongue Tongue tone & symmetry

Usually combined with other caudal stem abnormalities


Cranial nerve evaluation:

In clinical practice cranial nerves can be evaluated in groups:

Vision and pupillary light response (II, III, VII)
Palpebral fissure and 3
rd
eyelid symmetry (III, V, sympathetic nerves)
Eyeball position and movement (III, IV, VI, VII)
Vestibular function (VIII)
Facial and trigeminal nerves (V, VII)
Tongue and laryngeal-pharyngeal function (IX, X, XII)

Test in groups/specific signs:

Eyes (Vision, Strabismus, Anisocoria (unequal pupil size), PLR)
Sensation
Movement & position
Swallowing