CN Name Type Function Testing Lesions/Results

I Olfactory Sensory Smell Ask pt. to close both eyes, examiner occlude Anosmia- sinus conditions, head
each nostril, let pt. smell (cloves, coffee, soap, trauma, smoking, aging, use of
vanilla) cocaine and Parkinson’s disease
II Optic Sensory Vision a. Visual Acuity 20/200-legally blind (higher 2nd
-Snellen chart or handheld card number worse the vision)
-pt. 20 ft away

b. Visual Fields Bitemporal hemianopsia- optic

-Static Finger Wiggle Test chiasm, pituitary tumor
-hands 2 ft. apart lateral to pt’s ear
-both eyes first then one eye Homonymous hemianopsia-
stroke
-Kinetic Red Target Test
-facing the pt., move a 5mm red topped Enlarged blind spot- optic nerve,
pin, ask pt. when the pin first appears red glaucoma, optic neuritis and
papilledema
c. Optic Fundi
-Opthalmoscope

III Occulomotor Motor III-constrict pupils, eye OPENING, Stand 2 ft directly in front of patient. III- diplopia, loss of parallel gaze,
IV Trochlear all extraocular movements EXCEPT Ask pt. to follow your finger or pencil making a dilated pupil, loss of light reflex
VI Abducens wide “H” in the air. with II, PTOSIS
IV-superior oblique
IV-weakness looking down with
VI-lateral rectus adducted eye

VI-diplopia, loss of parallel gaze

Binocular diplopia -III,IV,VI

neuropathy, MG, trauma, thyroid
opthalmopathy and internuclear
opthalmoplegia

V Trigeminal
Opthalmic(V1) Sensory V1- General sensation(touch, pain,
temperature) of forehead, scalp,
cornea
Maxillary(V2) Sensory V2-General sensation of palate,
nasal cavity, maxillary face,
maxillary teeth
Mandibular(V3) Mixed V3-General sensation of
mandibular(skin and teeth)
Motor to muscles of
mastication/chewing(TEMPORALIS,
MASSETER, MEDIAL AND
LATERAL PTERYGOIDS) and
anterior belly of digastric,
mylohyoid, tensor tympani, tensor
veli palatini
Pause during upward and lateral gaze to detect
nystagmus.
Pt’s eyes both closed. Test the forehead, cheeks
and jaw on each side.
Use suitable sharp object, occasionally switch to
blunt end.
Ask pt to report “sharp” or “dull” and compare
sides.
Palpate temporal and masseter muscles and ask
pt. to clench teeth.
Ask pt to move jaw side to side.
Corneal Reflex- for coma pts onleh
Nystagmus- named after direction
of FAST component, cerebellar
disease(inc with retinal fixation),
vestibular disorders(dec with
retinal fixation) and internuclear
opthalmoplegia
Trigeminal neuralgia – isolated
facial sensory loss (usually V2 or
V3)
Difficulty clenching- masseter ms
weakness
Difficulty side to side- pterygoid
ms weakness
Unilateral weakness-pons
Bilateral weakness-bilateral
hemispheres
Stroke-loss of sensation
IPSILATERAL face and body
Brainstem-loss of sensation
CONTRA face and body
VII Facial Mixed Motor-muscles of face, posterior Inspect face both at rest and during conversation. Facial weakness-flat nasolabial
belly of digastric, stylohyoid, Note for asymmetry. fold and drooping of lower eyelid
stapedius
Ask patient to: Bell’s Palsy- upper and lower
Sensory- ANTERIOR 2/3 of tongue 1. Raise both eyebrows. face drooping, loss of taste,
Tears-lacrimal glands 2. Frown. hyperacusis and increased or
3. Close both eyes tightly and don’t let decreased tearing
examiner open them.
4. Show both upper and lower teeth. Stroke-lower face drooping, hiwi
5. Smile. ang mouth
6. Puff out both cheeks.
Unilateral facial paralysis- one
sides muscle weakness or
drooping only
VIII Acoustic or Sensory Hearing Whispered voice test Normal:
Vestibulocochlear Linear acceleration(gravity) and -Stand 2 ft behind the seated pt. -pt. repeats initial sequence
Angular acceleration(head turning) -Occlude non-test ear with a finger. correctly
-Exhale before whispering. -pt. wrong at first then correct at
-Whisper a three digit or letter combo. 2nd; repeats at least 3 out of 6
correctly
*Failed whispered voice proceed to R & W
Abnormal: 4 out of 6 incorrect

Weber- lateralization
Tuning fork on top of head or midforehead
Compare vibration
Conductive hearing loss- BC=AC
Rinne- air and bone conduction or BC>AC

Sensorineural- AC>BC
IX Glossopharyngeal Mixed Taste of POSTERIOR 1/3 tongue, Listen to pt’s voice. Hoarsness or nasal quality? Hoarseness- vocal cord paralysis
motor to stylopharyngeus ms Nasal voice- palatal paralysis
Difficulty swallowing?
X Vagus Sensation and motor to larynx, Difficulty swallowing-pharyngeal
palate and pharynx, DILATES Ask pt to say “AHHHH” and observe movements or palatal weakness
pupils of soft palate and pharynx. Palate fails to rise- bilateral CN X
lesion
Gag Reflex
XI Spinal Accessory Motor Innervates Observe for atrophy and fasciculations. Peripheral nerve disorder-
sternocleidomastoid Resist actions of the muscles. weakness with atrophy and
and trapezius fasciculations of trapz

XII Hypoglossal Motor Moves tongue Listen to articulation. (V,VII,X,XII) Unilateral cortical lesion- tongue
Inspect atrophy, fasciculations,asymmetry, deviates away from side of
deviation. Ask pt to stick tongue out. cortical lesion

REVIEW:
I Olfactory Sensory
II Optic Sensory
III Occulomotor Motor
IV Trochlear Motor
V Trigeminal Both
VI Abducens Motor
VII Facial Both
VII Vestibulocochlear Sensory
IX Glossopharyngeal Both
X Vagus Both
XI Spinal Accessory Mo
XII Hypoglossal Mo

Cranial nerves and Types

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