PE I CranialNerveExam 2007 Students

7/29/2019 PE I CranialNerveExam 2007 Students

1/42

PHYSICAL EVALUATION IPHYSICAL EVALUATION I(Dent 5121)(Dent 5121)

Cranial Nerve ExaminationCranial Nerve Examination


2/42

Lecture ObjectivesLecture ObjectivesAfter todayAfter todays lecture, the student will be ables lecture, the student wil l be able

to:to:Describe how to examine the function ofDescribe how to examine the function of

the cranial nervesthe cranial nerves

Describe the more common abnormalDescribe the more common abnormalfindings associated with function offindings associated with function of

the cranial nervesthe cranial nerves

Describe abnormal findings that mayDescribe abnormal findings that mayindicate a systemic diseaseindicate a systemic disease


3/42

CRANIAL NERVE EXAMINATIONCRANIAL NERVE EXAMINATION

Objectives of the cranial nerve examinationObjectives of the cranial nerve examination

Recognize signs and symptoms ofRecognize signs and symptoms of

cranial nerve disorderscranial nerve disorders

Recognize signs and symptoms ofRecognize signs and symptoms of

systemic diseasessystemic diseases

Distinguish between dental and neurologicalDistinguish between dental and neurologicaldisordersdisorders

Referral to physician for evaluation


4/42

CRANIAL NERVE EXAMINATIONCRANIAL NERVE EXAMINATION

nnEvaluate function of the cranialEvaluate function of the cranialnerves during interview and clinicalnerves during interview and clinicalexaminationexamination

nnNot test routinelyNot test routinely


5/42

CN ICN I Olfactory NerveOlfactory Nerve

nn Assess patency of nostrilsAssess patency of nostrils


6/42


nn Present aromaticPresent aromaticsubstancesubstance

nn

Patient should bePatient should beable to identify theable to identify theodor with eachodor with eachnostrilnostril


7/42


nnAltered smell or tasteAltered smell or tastennAnosmiaAnosmia decrease or loss of smelldecrease or loss of smell

-- BilateralBilateral smoking, allergic rhinitis,smoking, allergic rhinitis,cocaine, agingcocaine, aging

-- UnilateralUnilateral neurogenic, frontal lobeneurogenic, frontal lobemassesmasses

nnPhantom smellsPhantom smells


8/42

CN IICN II Optic NerveOptic Nerve

nn Visual acuityVisual acuity-- Usually assessUsually assess

during interviewduring interview

Snellen chartfor far vision


9/42


nn Visual acuityVisual acuity

-- Usually assessUsually assess

during interviewduring interview


10/42



-- RosenbaumRosenbaum

near vision chartnear vision chart-- Over 40 yrs oldOver 40 yrs old


11/42


nn

Visual acuityVisual acuity-- Health HistoryHealth History


12/42


nnVisual acuityVisual acuity-- MyopiaMyopia -- nearsightednessnearsightedness

-- HyperopiaHyperopia -- farsightednessfarsightedness

-- PresbyopiaPresbyopia loss of accommodationloss of accommodation


13/42



-- Diabetic retinopathyDiabetic retinopathy


14/42


nn Visual fieldsVisual fields-- Confrontation testConfrontation test


15/42


nn Pupillary light reflexPupillary light reflex-- direct light reflexdirect light reflex

-- consensual light reflexconsensual light reflex


16/42


nn Pupillary light reflexPupillary light reflex

-- direct light reflexdirect light reflex

-- consensual lightconsensual lightreflexreflex

Absent or delayed

pupillary light reflexCNS trauma,Increased

intracranialpressure


17/42

CN IIICN III Oculomotor NerveOculomotor Nerve

nn AccommodationAccommodation

Contraction of pupillaryconstrictor ms

Contraction of ciliary msincreases curvature oflens

Contraction of medialrectus ms causesconvergence


18/42


nn Extraocular movementsExtraocular movements

z Oculomotor nerveelevates upper eyelid

z Innervates levator palpebrae superioris ms

z Ptosisdrooping upper eyelid

z Myasthenia gravis

z Horners syndrome


19/42

CN III, IV, and VICN III, IV, and VI Oculomotor,Oculomotor,

Trochlear, and Abducens nervesTrochlear, and Abducens nerves

nn

Extraocular movementsExtraocular movements-- Cardinal fields of gazeCardinal fields of gaze


20/42


nn Extraocular movementsExtraocular movements

-- Cardinal fields of gazeCardinal fields of gaze

z Oculomotor nerve

turns eye up,down and medially.

z Innervates superior rectus ms

medial rectus msinferior rectus msinferior oblique ms


21/42

CN IVCN IV Trochlear NerveTrochlear Nerve

nnExtraocular movementsExtraocular movements-- Cardinal fields of gazeCardinal fields of gaze

z Trochlear nerve turns the

eye downward and inward.

z

Innervates superior oblique ms


22/42

CN VICN VI Abducens NerveAbducens Nerve

nnExtraocular movementsExtraocular movements-- Cardinal fields of gazeCardinal fields of gaze

z Abducens nerve turns

the eye laterally

z Innervates

lateral rectus ms


23/42

CN III, IV, and VICN III, IV, and VI Oculomotor,Oculomotor,Trochlear, and Abducens NervesTrochlear, and Abducens Nerves

nnNystagmusNystagmus -- fine oscillation (tremor) offine oscillation (tremor) ofthe eyesthe eyes

-- Multiples etiologiesMultiples etiologies

Vision impairment as childVision impairment as child Vestibular disordersVestibular disorders

Cerebellar disordersCerebellar disorders

Drug toxicity (sedatives, anticonvulsants, alcohol)Drug toxicity (sedatives, anticonvulsants, alcohol)

nnDiplopiaDiplopia double visiondouble vision


24/42

CN VCN V Trigeminal NerveTrigeminal Nervenn SensorySensory

-- PatientPatients eyes closed,s eyes closed,

test light touch ontest light touch onface with cotton wispface with cotton wisp

Test forehead,cheeks, and chin

Assess patients

ability to detect sharp,dull, light pressure,hot and cold


25/42

CN VCN V Trigeminal NerveTrigeminal Nervenn SensorySensory

-- Corneal reflexCorneal reflex

-- IntraIntra--oral:oral:mucosamucosateethteeth


26/42

CN VCN V Trigeminal NerveTrigeminal Nerve

nn

MotorMotor

-- Muscles of masticationMuscles of mastication

-- Have patient bite againstHave patient bite againstresistanceresistance

-- Have patient protrudeHave patient protrudemandible against resistancemandible against resistance

-- Have patient go into lateralHave patient go into lateralexcursive movementsexcursive movementsagainst resistanceagainst resistance


27/42

CN VCN V Trigeminal NerveTrigeminal Nerve

nnMotorMotor-- RareRare

nnSensorySensory

-- ParesthesiaParesthesia following oral surgeryfollowing oral surgery

--Trigeminal neuralgiaTrigeminal neuralgia


28/42

CN VIICN VII Facial NerveFacial Nerve

nnMotorMotor

-- Muscles of facialMuscles of facialexpressionexpression


29/42

CN VIICN VII Facial NerveFacial NervennMotorMotor

-- Damage to the peripheral nerve presentsDamage to the peripheral nerve presentsas paralysis to the entire side of faceas paralysis to the entire side of face

-- A central lesion (e.g., stroke) on one sideA central lesion (e.g., stroke) on one sideaffects mainly the lower face on the side ofaffects mainly the lower face on the side ofthe lesionthe lesion

-- BellBells palsys palsy


30/42

CN VIICN VII Facial NerveFacial NervennSensorySensory

-- Taste to the anterior 2/3 of the tongueTaste to the anterior 2/3 of the tongue

-- Loss or altered taste following a stroke orLoss or altered taste following a stroke ordamage to the lingual nerve (localdamage to the lingual nerve (localanesthetic injection, laceration of tongue)anesthetic injection, laceration of tongue)


31/42

CN VIIICN VIII VestibulocochlearVestibulocochlear NerveNerve

-- Observe if the patient turns one ear towards youObserve if the patient turns one ear towards you

-- Evaluate hearing using a ticking watch, rubEvaluate hearing using a ticking watch, rubfingers together, whisper.fingers together, whisper.


32/42


-- Observe equilibriumObserve equilibrium

as patient walks oras patient walks orstandsstands


33/42


nnDeafnessDeafness complete or partial,complete or partial,

unilateral or bilateralunilateral or bilateral

nn

Dysfunction of vestibular apparatusDysfunction of vestibular apparatus(e.g.,(e.g., MMninirere Syndrome)Syndrome)

-- DizzinessDizziness

-- FallingFalling-- Abnormal eye movementsAbnormal eye movements

-- Nausea and vomitingNausea and vomiting


34/42

CN IXCN IX

GlossopharyngealGlossopharyngeal

NerveNerve

nn

SensorySensory

-- Sensation to the posterior 1/3 of the tongueSensation to the posterior 1/3 of the tongue

including taste and to the mucousincluding taste and to the mucousmembranes of the pharynxmembranes of the pharynx

-- Sensory part of gag reflexSensory part of gag reflex


35/42

CN IXCN IX

GlossopharyngealGlossopharyngeal

NerveNervennMotorMotor

-- Middle constrictor muscle of pharynxMiddle constrictor muscle of pharynx

-- StylopharyngeusStylopharyngeus musclemuscle


36/42

CN XCN X Vagus NerveVagus NervennSensorySensory

Sensation to the inferior pharynx, larynx, heart,Sensation to the inferior pharynx, larynx, heart,lungs, and gut.lungs, and gut.

Not testedNot tested


37/42

CN XCN X Vagus NerveVagus NervennMotorMotor

-- Soft palate, pharynx, and larynxSoft palate, pharynx, and larynx

-- Patient sayPatient say AahAahand watch soft palateand watch soft palate

riserise


38/42

CN XCN X Vagus NerveVagus NervennMotor dysfunctionMotor dysfunction

-- Recurrent laryngeal nerveRecurrent laryngeal nerve hoarseness or weakness in the voicehoarseness or weakness in the voiceinability to cough voluntarilyinability to cough voluntarily

-- DysphagiaDysphagia difficulty swallowingdifficulty swallowing


39/42

CN XICN XI Accessory NerveAccessory Nerve

nn

Sternocleidomastoid msSternocleidomastoid ms


40/42

CN XICN XI Accessory NerveAccessory Nerve

nnTrapezius musclesTrapezius muscles


41/42

CN XIICN XII Hypoglossal NerveHypoglossal Nerve

nnMotorMotor-- Muscles of tongueMuscles of tongue

-- GeniohyoidGeniohyoid andand thyrohyoidthyrohyoid musclesmuscles


42/42

CN XIICN XII Hypoglossal NerveHypoglossal Nerve

nn Have patient stickHave patient stick

out tongue. Shouldout tongue. Shouldbe symmetrical. Nobe symmetrical. Notremors or wasting.tremors or wasting.

nnTongue will deviateTongue will deviatetoward side of lesiontoward side of lesion

when tonguewhen tongueprotruded.protruded.

Documents

PE I CranialNerveExam 2007 Students