Parasympathetic to ciliary & pupillary constrictor muscles
Trochlear
Somatic Motor
Superior oblique muscle
Trigeminal
Branchial Motor
General Sensory
Muscles of mastication
Sensory for head/neck, sinuses, meninges, & external surface of tympanic membrane
Abducens
Somatic Motor
Lateral rectus muscle
Facial
Branchial Motor
Visceral Motor
General Sensory
Special Sensory
Muscles of facial expression
Parasympathetic to all glands of head except the parotid
Sensory for ear and tympanic membrane
Taste anterior two-thirds of tongue
Vestibulocochlear
Special Sensory
Hearing and Balance
Glossopharyngeal
Branchial Motor
Visceral Motor
Visceral Sensory
General Sensory
Special Sensory
Stylopharyngeus muscle
Parotid Gland
Carotid Body
Sensation posterior one-third tongue & internal surface of tympanic membrane.
Taste posterior one-third tongue
Vagus
Branchial Motor
Visceral Motor
Visceral Sensory
Special Sensory
Muscles pharynx & larynx
Parasympathetic to neck, thorax, & abdomen
Sensory from pharynx, larynx & viscera
Sensory from external ear
Spinal Accessory
Branchial Motor
Trapezius & sternocleidomastoid muscles
Hypoglossal
Somatic Motor
Tongue muscles except palatoglossal
Nervous: Cranial Nerves Exam
Setup
Patient sitting over edge of bed.
CN I: Olfactory
Usually not tested.
Rash, deformity of nose.
Test each nostril with essence bottles of coffee, vanilla, peppermint.
CN II: Optic
With patient wearing glasses, test each eye separately on eye chart/ card using an eye cover.
Examine visual fields by confrontation by wiggling fingers 1 foot from pt's ears, asking which they see move.
• Keep examiner's head level with patient's head.
If poor visual acuity, map fields using fingers and a quadrant-covering card.
Look into fundi.
For more detail, See Eye Exam.
CN III, IV, VI: Oculomotor, Trochlear, Abducens
Look at pupils: shape, relative size, ptosis.
Shine light in from the side to gauge pupil's light reaction.
• Assess both direct and consensual responses.
• Assess afferent pupillary defect by moving light in arc from pupil to pupil. unne). Optionally: as do arc test, have pt place a flat hand extending vertically from his face, between his eyes, to act as a blinder so light can only go into one eye at a time.
"Follow finger with eyes without moving head": test the 6 cardinal points in an H pattern.
• Look for failure of movement, nystagmus [pause to check it during upward/ lateral gaze].
Convergence by moving finger towards bridge of pt's nose.
Test accommodation by pt looking into distance, then a hat pin 30cm from nose.
If MG suspected: pt. gazes upward at Dr's finger to show worsening ptosis.
CN V: Trigeminal
Corneal reflex: patient looks up and away.
• Touch cotton wool to other side.
• Look for blink in both eyes, ask if can sense it.
• Repeat other side [tests V sensory, VII motor].
Facial sensation: sterile sharp item on forehead, cheek, jaw.
• Repeat with dull object. Ask to report sharp or dull.
• If abnormal, then temperature [heated/ water-cooled tuning fork], light touch [cotton].
Motor: pt opens mouth, clenches teeth (pterygoids).
• Palpate temporal, masseter muscles as they clench.
Test jaw jerk:
Dr's finger on tip of jaw.
Grip patellar hammer halfway up shaft and tap Dr's finger lightly.
Usually nothing happens,
