CRANIAL NERVE ASSESSMENT
Steps Task Maximum Examinee’s
score score
1. I (olfactory)-Sensory (sense of smell)
- Ensure patency of both nostrils. Ask the patient to close
one nostril, close both eyes, and sniff from a bottle
containing camphor, crushed spices, soap, etc.
2. II (optic)-Sensory (visual field and visual acuity)
Peripheral visual field: Examiner positions himself/herself
directly opposite to the patient (confronting) and asks the
patient to close one eye, look directly at the bridge of the
examiner's nose, and indicate when an object (finger,
pencil tip, or head of a pin) presented from the periphery
of each of the visual field quadrants is seen. The same test
is repeated for the other eye
Visual acuity: Ask the patient to read the Snellen chart
from 20 ft away. The number on the lowest line that the A
patient can read with 50% accuracy is recorded. Test eyes
if individually and together.
Fundoscopy. To detect the physical condition of the optic
disc retina, and blood vessels
3. III (occulomotor), CN IV (trochlear), CN VI (abducens) Ill:
motor and parasympathetic IV and V: motor (movement E of
eyeball)
Movement of eyeball: The patient is asked to follow the C
examiner's finger/pencil tip as it moves horizontally and f
vertically making a cross sign "+) and diagonally (making
an "X")
Check for pupillary constriction: The examiner shines a
light into the pupil of one eye. Also note the size and
shape
Convergence and accommodation Convergence: Ask the
patient to focus on the examiner's fingers (12–15 inches
from the patient) and to remain focused as it moves
toward the patient's nose Accommodation Hold an object
(pencil/pen torch) about 10 cm (4 inches) from the bridge
of the patient's nose. Ask the patient to look at the top of
the object and then at a far object. Alternate gaze from the
near to the far object
Ability to keep the eyelids open
4. V (trigeminal)-Sensory and motor Sensory component 2
Ask the patient to identify light touch (cotton) and pain
(pinprick) in all the three divisions ophthalmic maxillary,
and mandibular) of the nerve on either side of the face. The
patient's eyes should be closed during the examination
Corneal reflex (for patients with decreased LOC only): A
cotton wisp strand is applied to the cornea
Steps Task Maximum Examinee’s
score score
5. VII (facial)-Motor-facial expression
Motor. Ask the patient to:
- Close the eyes tightly
-Raise the eyebrows
-Give an exaggerated smile
-Frown
-Purse the lips
Sensory. Sense of taste Discrimination of salt and sugar)
in the anterior two-third of the tongue
6. CN VIII (acoustic/vestibulocochlear)-Sensory (sense of
hearing)
Vestibular branch (not routinely tested):
- Dix-Hallpike positional test: Seat the patient on the edge
of an examining table and move him/her backward
rapidly so that the head is hanging backward while the
eyes remain open. If no nystagmus or vertigo develops in
20 seconds, return the patient to the sitting position.
Reposition the head to the right and repeat the downward
procedure. If no nystagmus or vertigo develops in 20
seconds, return the patient to the sitting position.
Reposition the head to the left and repeat the downward
procedure
Cochlear branch
- Test for hearing: Ask the patient to close eyes and signal
when the ticking sound of a watch or the rustling of the
examiner's fingertips is heard as the auditory stimulus is
brought nearer to the ear. Each ear is tested individually
and the distance from the patient's ear to the sound Source
when first heard is recorded
- Test for lateralization and air conduction (AC) and bone
conduction (BC)
Weber's test (lateralization): Place a lightly vibrating
tuning fork on the vertex of the patient's head or in the
center of the forehead. Ask whether the patient hears the
vibration more on the right side, on the left side, or in the
middle
Rinne's test (AC and BC): Firmly place the base of
lightly vibrating tuning fork on the mastoid process. Ask
the patient to inform you when the vibration is no longer
heard. Immediately bring the vibrating fork near the ear
canal with the vibrating portion toward the ear. Ask the
patient to inform you when the sound is no longer heard
7. IX (glossopharyngeal)—Sensory and motor
8. X (vagus)—Mixed and parasympathetic
Gag reflex: Bilateral contraction of the palatal muscles
initiated by stroking or touching either side of the
Steps Task Maximum Examinee’s
score score
posterior pharynx or soft palate with tongue blade
strength.
Swallowing reflex: Hold examiner's hands on either side
of the patient's throat and ask the patient to swallow. Note
strength and efficiency of swallowing.
- Ask the patient to say open mouth wide and say "ah"
9. XI (spinal accessory)-Motor
- Ask the patient to shrug the shoulders against resistance
and turn the head to either side against resistance
10 XII (hypoglossal)-Motor
. - Ask the patient to protrude the tongue
- Ask the patient to push the tongue to either side against
the inside of each cheek as the examiner palpates
externally on the cheek for strength and equality
