Neurologic system: cranial nerves
1. Olfactory (C.N.-I): ask patient to close eyes, occlude one nostril, and identify a scented object (e.g. Talcum powder or soap), repeat same with other nostril:
2. Optic (C.N.-II):
• Use a Snellen chart to assess distance vision in each eye:
• Ask patient to read news /drawing to read/identify to assess near vision:
• Confrontation test (performed in eye system):
3. C.N. 111, IV and VI: (Occulomotor, Trochlear and Abducens)
• Assess eyelid margin (presence of ptosis, if any):
• Assess extraocular movements in six cardinal fields:
• Pupillary response to light (direct and indirect):
• Pupil size : _____________________mm in left and_____________mm in right eye
• Papillary reaction: equally reactive to light.
• Nystagmus and drooping of upper eyelid (Ptosis):
4. Trigeminal (C.N.-V):
Motor function
• Ask the patient to clench the teeth, then palpate the temporal and masseter muscle:
Sensory function
• Ask the patient to close eyes, touch with dull and sharp side of the paper at forehead,
cheeks, and chin:
• Test for Light touch with the wisp of cotton:
• Test for corneal reflex (touch the cornea with wisp of cotton):
5. Facial (C.N.-VII):
Motor function
• Ask the patient to smile, frown and wrinkle forehead, show teeth, puff out cheeks, purse lips, raise eyebrows and close eyes tightly against resistance:
Sensory function
• Ask the Patient to identify different flavour of salt/sugar/lemon juice:
6. Vestibulocochlear (C.N.-VIII):
Whispered test:
• Weber and Rinne test (performed in ear system):
Weber’s test:
• Rinnetest:
• Patient can able to listen whisper sound and respond adequately:
7. C.N.-IX & X (Glossopharyngeal & Vagus):
Motor function:
• use a tongue depressor on the patient’s tongue and ask the patient to open mouth widely and say “ah”:
• Gag reflex:
• Patient’s ability to swallow:
8. C.N.-XI (Spinal Accessory):
• Assess the trapezius muscles for contraction against resistance:
• Assess the sternocleidomastoid muscle against resistance:
9. C.N. XII (Hypoglossal):
• Assess the strength and mobility of the tongue, ask the patient to protrude the tongue and move it up, down, right and left:
Neurologic System: Motortor and cerebellar system-
Inspection
• Assess condition and movements of muscles; size, symmetry, strength, tone, unusual involuntary movements:
• Gait and balance:
• Romberg test:
Sensory system:
Assessment of coordination
• Finger to toe test:
• Rapid alternating movements:
Heel to shin test:
Assessment of light touch, pain, and temperature:
Vibratory sensation test
• Tactile discrimination (fine touch):
• Point localization test:
• Graphesthesia test:
• Extinction test:
Reflexes
Superficial reflexes
• Abdominal reflex:
• Cremasteric reflex in male patient:
Test for meningeal irritation:
Brudzinski’s sign:
Kemig’s sign: