Neuro 251 3.

Cranial Nerves
[Complete Neuro PE] I Olfactory Midline septum, (-)
obstruction/lesions, sense of smell,
1. Sensorium intact on both L & R nostrils
- Awake, Alert, conversant, coherent II Optic a. VA
- Drowsy, arouses to name calling but does not b. VF
sustain c. Ophthalmoscopy: intact ROR,
2. MMSE/Higher Corticals AVR 2:3 CDR 0.3-0.4, DDB, (-)
a. Clean and appropriately dressed exudates/hem
b. Oriented to time, place, and person III, Oculomo Pupils 3/3 mm BRTL, (+) intact direct
c. Appropriate affect, euthymic mood IV tor & consensual pupillary light reflex, (+)
d. Intact thought process, good judgement, , accommodation, (-) ptosis
good insight VI Trochlear Full EOM
e. Clear, coherent speech Abducen
s
30-pt Cortical Functioning Test V (S) Facial Sensation:
a. Orientation (10pts) V1 – forehead (ophthalmic) *C2 –
a. Date: month/day/year, day of the week, cape and hood; C3 – angle of jaw
season V2 – cheeks (maxillary)
b. Place: room, building, floor, city, country Trigemin V3 – above mandible (mandibular)
b. Registration (3pts) al
a. Immediate recall “pera, mangga, bola” Corneal reflex: brisk/sluggish
c. Counting (5pts) (M) Temporalis, Masseter – atrophy,
a. Serial 7s or serial 3s asymm/deviation on opening,
b. MUNDO/ODNUM forcefully open/move with resistance
d. Recall (3pts) VI Facial (S) Taste – ant 2/3 of tongue
a. Pera, mangga, bola I
e. Language (4pts) (M) Frontalis, Orbicularis oculi,
a. Naming  point at watch, ballpen (2pts) Zygomatic, Buccinator, Platysma
b. Writing  any sentence (1pt) – agraphia VI Vestibulo Intact, gross hearing, (-) tinnitus,
c. Reading  perform written command (1pt) II chochlea Weber  lateralization, Rinne  AC
(“ipikit ang iyong mata”) r > BC
f. Constructional Apraxia (1pt)  R parietal
IX Glossoph (+) gag, taste pos 1/3
aryngeal
X Vagus Gutterals/good phonation, uvula
g. 3-step command (3pts)
midline, symmetrical palatal
a. “Kunin mo and papel, itiklop mo sa gitna,
elevation
at ibalik mo sa akin”
XI Accessor SCM  (-) wasting, shrug, head
h. Repetition (1pt)
y turning/forward and back
a. “Wala nang papero-pero pa”
XII Hypoglos Tongue midline, (-) atrophy,
sal fasciculations at rest
Special Tests
a. R-L confusion
4. Motor and Sensory
b. Finger agnosia
a. Atrophy
c. Agraphestesia: write number on hand
b. Tone, spasticity  WOF: hypertonic (if with
d. Astereognosia: hold object and name
prev stroke)
e. Hemisensory Neglect: R, L then B
c. Strength
5/5 5/5
*Gerstmann Syndrome (L parietal): R-L confusion,
agraphia, a/dyscalculia, finger agnosia 5/5 5/5
 d. Sensation: pain, light touch,
proprioception, vibration
(4th digit (at least 5 correct answers))
100% 100%
100% 100%
 If spine injury, indicate last normal level

5. Reflexes and Cerebellars

If (+) Babinski
If (+) Clonus, +++

Gait: good posture, stance and normal gait demonstrating

normal balance and coordination; able to execute tandem
walking

Supple neck
(-) Kernig’s – flex knee than nape pain
(-) Brudzinski – flex nape then pain
(-) Chaddock – toe extension, rest flexion
(-) Oppenheim – shin  toe E, rest F
(-) Schaeffer - squeeze Achilles tendon  extensor
plantar reflex
(-) Gordon – calf  toe E, rest F

(-) pronator drift – close eyes

(-) Hoffman – 3rd finger DIP down  pincer
(-) Tromners – 3rd finger DIP up  pincer
(-) Nystagmus (CEREBELLAR)
(-) Finger to nose, dysmetria/terminal tremors
(-) Dysdiadochokinesia
(-) Heel to shin dysmetria/dystaxia
(-) Beevors (T10 below)
(-) Palmomental reflex 
frontal mass/vascular dementia