CRANIAL NERVE TESTING

C
N
12

TRIGEMINAL NERVE
a.
b.
c.
-

MAXILLARY DIVISION
Pure Sensory
MANDIBULAR DIVISION
Mixed
OPTHALMIC DIVISION
Pure Sensory

Hypoglossal
nucleus

NUCLEUS AMBIGUUS
-

Connects CN 9 and CN 10

EXIT
1. ANTERIOR CRANIAL FOSSA
CN 1: Perforation in Cribriform Plate Ethmoid
Bone
2. MIDDLE CRANIAL FOSSA
CN 2: Optic Canal
CN 3,4,5,6: Superior Orbital Fissure
CN 5 (MAXILLARY): Foramen Rotundum
CN 5 (MANDIBULAR): Foramen Ovale
3. POSTERIOR CRANIAL FOSSA
CN 7,8: Internal Acoustic Meatus
a. COCHLEAR: Anterior
b. VESTIBULAR: Posterior
CN 9,10, 11: Jugular Foramen
CN 11: Foramen Magnum
CN 12: Hypoglossal Canal
ORIGIN
C
N
C
N
3
C
N
4
C
N
5
C
N
6
C
N
7

C
N
9

C
N
10
C
N
11

CN
CN
CN
CN
CN

1: Telencephalon
2: Diencephalon
3-4: Midbrain
5-8: Pons
9-12: Medulla Oblongata

NUCLEUS

CONTROL

Edinger-Westphal
Oculomotor
Nucleus
Trochlear
Nucleus

Ciliary Muscle

FUNCTIO
N
Pupil
Constrictio
n

OLFACTORY NERVE
-

Transmit olfactory impulses to the olfactory

epithelium of the nose to the brain
Most Common Contused Nerve
Not a real nerve (outgrowth of the
telencephalon)
Function: For smelling
Test: Non-noxious odors
Clinical Implications:
1. Rhinorrhea
Excretion of white fluid due to head trauma
Paano malalaman kung sipon or CSF ang
lumabas?
a. *CSF: sweet due to glucose
b. Sipon: Salty and and Wet
2. ANOSMIA
Inability to smell
Bilateral (Both Nostrils)
a. Increase Mucous in nasal septum
b. Coryza: Sipon
c. Pertussis: Whooping Cough (if child 100
days of coughing)
Unilateral
OPTIC NERVE
a.
b.
a.
b.

Trigeminal
Nucleus
Abducens
Nucleus
Superior
Salivatory
Nucleus
Lacrimal Nucleus
Facial Nucleus

Submandibula
r & Sublingual
Gland

Production
of Saliva

Lacrimal Gland

Tearing

Inferior
salivatory
Nucleus
Glossopharyngea
l Nucleus
Dorsal motor
nucleus of CN 10
Vagus Nucleus
Lateral Horn Cell
in Cervical Spinal
Cord

Parotid Gland

Abdominal
Viscera

Optic Pathway transmits visual impulse of

retina to the brain
Not a real nerve (Outgrowth of the
Diencephalon)
Macula: Highest Resolution
Retina: Rods (Non-color) and Cones (Color)
Function: Vision
Test:
VISUAL ACUITY: Snellen Chart
CONFRONTATION TEST: Patient will cover his
eyes then PT put object towards the midline
and then patient will identify object.

CLINICAL IMPLICATIONS
1.
-

MONOCULAR BLINDNESS
Ipsilateral Optic Nerve
Left Monocular Blindness
Right Monocular Blindness

2. BITEMPORAL
HEMIANOPSIA
Optic Chiasma
a. Bitemporal
b. Binasal

3. HOMONY
MOUS HEMIANOPSIA
AKA: Contralateral Homo Hemi
Optic Tract
Optic Radiation
Bicipital Lobe
Naming: Right Homonymous Hemianopsia

4.

QUADRANT
ANOPSIA

a.

Calcarine Sulcus
Superior/Coneal/Parietal Fibers of Optic
Radiation
b. Inferior/Lingual/Temporal Fibers of Optic
Radiation
Naming: Contralateral
Damaged:
a. Superior: Inferior Quadrant Anopsia
b. Inferior: Superior Quadrant Anopsia
EXAMPLE
5.
6.
7.
8.
a.
b.
c.

Right Cuneal is damaged: Left Inferior

Quadrant Anopsia
Left Temporal Fibers is damaged: Right
Superior Quadrant Anopsia.
ANISOCORIA
Unequal size of pupils
DYSCORIA
Different shape of pupils
CORRECTOPIA
Different position of Pupils
HETEROCHROMIA
Iridum or Iridis
Different color of Iris
Complete: Full (2 iris)
Sectoral: Part of Iris (1 iris)
Central: Spikes radiating from pupils (1 iris)

VESTIBULOCOCHLEAR NERVE
-

AKA: Statoacoustic Nerve

Function:

I.
II.
a.
b.
c.

a. Hearing (Cochlea)
b. Balance (Vestibule)
VESTIBULAR ASPECT
UTRICLE AND SACCULE
Detects linear head movement
MNEMONIC: HUVS
HU= Horizontal Utricle
VS= Vertical Saccule
SEMICIRCULAR CANAL
Detects rotatory head movement
3 pairs = 6
SUPERIOR/ANTERIOR: HEAD FLEXION
INFERIOR/POSTERIOR: HEAD EXTENSION
HORIZONTAL/LATERAL: HEAD ROTATION

TEST:
1. DIX-HALLPIKE TEST
Benign Paroxysmal Positional Vertigo
The test is performed by having the patient
long-sit on a plinth with the head rotated
approximately 30 to 45. The examiner stands
behind the patient with one hand supporting
the head/ neck and the other hand supporting
the trunk. The patient is then assisted into a
supine position with the patients head slightly
below the horizontal plane, and the position is
maintained for 30 to 60 seconds
(+) Dizziness and Nystagmus
2. TEMPERATURE (CALORIC) TEST
For Inner Ear Problem
The examiner alternately applies hot and cold
test tubes several times just behind the
patients ears on the side of the head; each
side is done in turn
(+) Inducement of Vertigo
MNEMONIC: COWS
a.
COLD = Left Nystagmus
b. HOT = Right Nystagmus
AUDITORY ASPECT
a. OUTER EAR
External Surroundings Collect Sound Waves
External Auditory Meatus Eardrum

b.
c.
1.
2.
-

MIDDLE EAR
Ossicles
Malleus, Incus, Stapes
Vibrate to Inner Ear
INNER EAR
Interpret Soundwaves to Electrical Impulse.
Soundwaves travel in 2 ways
Air Conduction
Outer and Middle Ear
Bone Conduction
Inner Ear (By passes outer & Middle Ear)

CLINICAL IMPLICATION
1.
a.
b.
c.
-

HEARING LOSS
CONDUCTIVE
Reduction of all sounds
SENSORINEURAL
Inner Ear
Different Interpreting of Sounds.
CORTICAL
Brain
2. MNIRES DISEASE
Inner Ear
Fullness of Ear & Tinnitus (Vibrate pero si
patient lang nakakarinig ng sounds)
3. PRESBYACUSIS
Deafness due to old age.
TEST
1. RINNES TEST
The Rinne test is performed by placing the
base of the vibrating tuning fork against the
patients mastoid bone.
The examiner counts or times the interval with
a watch.
The patient tells the examiner when he or she
no longer hears the sound, and the examiner
notes the number of seconds.
The examiner then quickly positions a stillvibrating tine 1 to 2 cm (0.5 to 0.8 inch) from
the auditory canal and asks patient to indicate
when he or she no longer hears the sound.
The examiner then compares the number of
seconds the sound was heard by bone
conduction and by air conduction. The counting
or timing of the interval between the two
sounds determines the length of time that
sound is heard by air conduction
Air-conducted sound should be heard twice as
long as bone-conducted sound. For example, if
bone conduction is heard for 15 seconds, the
air conduction should be heard for 30 seconds
2. SCHWABACH TEST
This test compares the patients and
examiners hearing by bone conduction.
The examiner alternately places the vibrating
tuning fork against the patients mastoid
process and against the examiners mastoid
bone until one of them no longer hears a
sound.
The examiner and patient should hear the
sound for equal amounts of time.
3. WEBER TEST

The examiner places the base of a vibrating

tuning fork on the midline vertex of the
patients head.
The patient should hear the sound equally well
in both ears If the patient hears better in one
ear (i.e., the sound is lateralized), the patient is
asked to identify which ear hears the sound
better.
To test the reliability of the patients response,
the examiner repeats the procedure while
occluding one ear with a finger and asks the
patient which ear hears the sound better.
It should be heard better in the occluded ear
4. BING TEST
Vibrating tuning fork is applied to the mastoid
bone and then the external auditory canal is
occluded by pressing on the tragus.
If hearing is Louder, test is (+) seen in normal
person ore one with SNHL
If hearing remains same or less, test is (-)
indicating CHL
This test is useful in mixed hearing loss where
conducting impairment is minimal and
tympanic membrane is intact as in
osteosclerosis.
5. TICKLING WATCH TEST
The ticking watch test uses a nonelectric
ticking watch to test high-frequency hearing.
The examiner positions the watch
approximately 15 cm (6 inches) from the ear to
be tested, slowly moving it toward the ear.
The patient then indicates when he or she
hears the ticking sound. The distance can be
measured and will give some idea of the
patients ability to hear high-frequency sound.
6. WHISPHERED VOICE TEST
The patients response to the
examiners whispered voice can be used to
determine hearing ability.
The examiner masks the hearing in one of
the patients ears by placing a finger gently
in the
-

patients ear canal.

Standing approximately 30 to 60 cm
(12 to 24 inches) away from the
patient, the examiner whispers one- or
two-syllable words and asks the
patient to repeat them.
If the patient has difficulty, the examiner
gradually increases his or her volume until
the patient responds appropriately.
The procedure is repeated in the other ear.
The patient should be able to hear
whispered words in each ear at a distance
of 30 to 60 cm
(12 to 24 inches) and respond correctly at
least 50% of the time

PURE MOTOR CRANIAL NERVE

OCULOMOTOR NERVE
Tested together with CN 4 and 6
a. SUPERIOR DIVISION: Lateral Palpebrae
Superioris & Superior Rectus

b. INFERIOR DIVISION: Medial Rectus, Inferior

Rectus and Inferior Oblique.
TROCHLEAR NERVE
-

Smallest Cranial Nerve in the body

Longest and Most Slender intracranial
nerve.
SO4LR6
Function: Movement of the eyeball

ABDUCENS NERVE
-

Lateral Rectus
Function: Movement of the eyeball

Clinical Indication
A. CN 3 Incomplete Lesion
1. INTERNAL OPTHALMOPLEGIA
(-) Pupil Constriction
(+) Extraocular Muscle
2. EXTERNAL OPTHALMOPLEGIA
(-) Extraocular Muscle (weak)
(+) Pupil Constriction
B. CN 3 COMPLETE LESION
Extraocular Muscle Weakness
External Strabismus
(-) Pupil Constriction
(+) Ptosis (80% only)
*FULL OPENING OF THE EYE
80% = Parasymphathetic (CN 3)
20%= Symphatetic (Muelier mm = LPS)
C. WEAK SUPERIOR OBLIQUE MUSCLE
Eyes are downward and Inward
D. DIPLOPIA

1. Vertical = Cranial Nerve 4

2. Horizontal = Cranial Nerve 6
E. STRABISMUS
Banlag
1. ESOTROPIA
CN 6
Internal Strabismus
2. EXOTROPIA
CN 3
External Strabismus
F. WEAK LATERAL RECTUS
Eyes on the middle
ACCESSORY NERVE
-

2 Parts
Cranial & Spinal Nerve Roots (CN 2,3,4)
SCM & Upper Trapezius
Function: Shoulder Elevation
Test: Resist the action of the muscle.

HYPOGLOSSAL NERVE
a.
b.
c.
d.

Tongue muscle and movement

4 Muscles
Genioglossus: Forward
Hyoglossus: Downward
Styloglossus: Curves
Palatoglossus: Upward

CLINICAL INDICATION
Ipsilateral
1. LOWER MOTOR NEURON LESION DAMAGE
(L) CN 12
Tongue will deviate toward left side
Uvula: Contralateral Cranial Nerve 9
2. UPPER MOTOR NEURON LESION CVA
- Contralateral