Cranial Nerve Examination Checklist
Purpose: To provide a structured, reusable guide for performing a thorough yet efficient cranial nerve examination, including relevant disease examples and practical clinical notes.
1. Preparation
- Ensure good lighting and patient comfort.
- Explain the procedure clearly to the patient.
- Ask the patient to remove glasses if necessary.
- Keep the examination systematic: Eyes → Face → Mouth → Hearing → Balance.
2. Cranial Nerve II – Optic Nerve
Visual Fields
- Test binocular visual fields using fingers.
- Both eyes open, test temporal fields simultaneously.
- Identify any field defects (e.g., bitemporal hemianopia, homonymous hemianopia).
Visual Acuity
- Omit for a quick screen unless visual symptoms present.
- If tested, use a Snellen chart or reading card.
Fundoscopy
- Perform at the end due to temporary light blindness.
- Inspect for:
- Papilledema (↑ intracranial pressure)
- Optic atrophy (e.g., multiple sclerosis, glaucoma)
- Retinal hemorrhages (e.g., diabetes, hypertension)
3. Cranial Nerves III, IV, VI – Oculomotor, Trochlear, Abducens
Eye Movements
- Ask patient to keep head still and follow your finger.
- Move finger side to side, up and down, checking for:
- Full range of motion.
- Nystagmus.
- Diplopia or movement limitation.
Trochlear Nerve Check
- Use H pattern if concerned.
- Assess for inability to move eye downward and inward.
Example Conditions:
- Oculomotor palsy – ptosis, dilated pupil, eye deviated down/out.
- Abducens palsy – failure of lateral gaze.
4. Cranial Nerve V – Trigeminal Nerve
Facial Sensation
- Lightly touch forehead, cheeks, and jaw bilaterally.
- Ask: “Does it feel the same on both sides?”
- (Optional) Test corneal reflex with cotton wool.
Example Conditions:
- Trigeminal neuralgia – severe facial pain.
- Sensory loss – may indicate pontine lesion or tumor compression.
5. Cranial Nerve VII – Facial Nerve
Facial Movements
- Observe facial symmetry during:
- Raising eyebrows.
- Closing eyes tightly (“squeeze your eyes up tight, please”).
- Smiling or showing teeth.
- Note weakness, droop, or asymmetry.
Example Conditions:
- Bell’s palsy – unilateral paralysis (LMN lesion).
- Stroke – lower face weakness sparing forehead (UMN lesion).
6. Cranial Nerve VIII – Vestibulocochlear Nerve
Hearing and Balance
- Test hearing with finger rub or whisper.
- Assess vestibulo-ocular reflex (VOR):
- Ask patient to fix gaze on your nose.
- Gently move head side to side; eyes should remain fixed.
Example Conditions:
- Acoustic neuroma – unilateral hearing loss, absent VOR.
- Labyrinthitis/vestibular neuritis – imbalance, vertigo.
7. Cranial Nerves IX, X – Glossopharyngeal & Vagus Nerves
Palatal Movement and Voice
- Ask patient to open mouth and say “Ahh”.
- Observe uvula elevation and symmetry.
- Listen for hoarseness or nasal tone.
Example Conditions:
- Brainstem stroke – asymmetrical palate.
- Vagus palsy – dysphonia, dysphagia.
8. Cranial Nerve XII – Hypoglossal Nerve
Tongue Inspection and Movement
- Ask patient to stick tongue out straight and wiggle it.
- Observe for deviation (toward lesion side) or fasciculations.
Example Conditions:
- Motor neuron disease – fasciculations/wasting.
- Stroke – tongue deviates to one side.
9. Optional Tests
- Pupillary light reflex (visible after eye opening).
- Fundoscopy practice (develop confidence).
10. Completion
- Thank the patient.
- Summarize and document key findings.
- Record abnormalities and interpretations.
Summary Table
| Cranial Nerve | Main Function Tested | Example Pathology |
|---|---|---|
| II | Visual fields, fundoscopy | Optic neuritis, hemianopia |
| III, IV, VI | Eye movements | Oculomotor palsy, Abducens palsy |
| V | Facial sensation | Trigeminal neuralgia |
| VII | Facial muscles | Bell’s palsy, Stroke |
| VIII | Hearing & balance | Acoustic neuroma |
| IX, X | Palate & voice | Vagus palsy |
| XII | Tongue movement | Motor neuron disease |
Reusable Format: Print or import as a digital checklist for repeated clinical use