Neurological Exams

Question 1

CN

How do you test CN I?

Answer 1

Ask about any changes to sense of smell

Smell identification test if necessary

Question 2

CN

How do you test CN II?

Answer 2

Ask about trouble with vision, if they have glasses or contacts
Acuity - Snellen chart
Colour vision - Ishihara +/- red pin moved through visual fields
Visual fields
Map blind spot
Opthalmoscopy: red reflex and optic disc
Pupillary response: direct and consensual light reflex, accommodation

Question 3

CN

How do you test CN III, IV and VI?

Answer 3

Ask about double vision
Resting gaze: ptosis, nystagmus
Eye movements: H shape, saccadic movements

Question 4

CN

How do you test CN V?

Answer 4

Light tough (pain, temp and vibration) in ophthalmic, maxillary and mandibular
Muscles of mastication: palpate contracted temporals and masseter, push jaw against pressure
Corneal reflex
Jaw jerk

Question 5

CN

How do you test CN VII?

Answer 5

Facial muscles: raise eyebrows, open eyes wide, blink, screw eyes closed, smile, show teeth, whilst, puff out cheeks
Ask about change in taste

Question 6

CN

How do you test CN VIII?

Answer 6

Simple hearing test
Rinnes and Weber
Vestibular tests: gait, heel to toe walking, Romberg’s, vestibular ocular reflex

Question 7

CN

How do you test CN IX and X?

Answer 7

Ask patient to cough, swallow and say Ah

Gag reflex

Question 8

CN

How do you test CN XI?

Answer 8

Sternocleidomastoid: turn head to each side against resistance
Trapezius: shrug shoulders agist resistance

Question 9

CN

How do you test CN XII?

Answer 9

Tongue: wasting/fasiculations, passive movement

Intrinsic muscles: use tongue against inside of cheek against external pressure of your hand