Checklist Cranial Nerve Examination Detailed
Cranial Nerve Examination Summary
Key Points • The cranial nerve exam assesses nerves 1-12, often examining brainstem function; detailed exams are reserved for patients with suggestive symptoms • Olfactory nerve testing is rarely done but can be performed using scratch and sniff cards to avoid cueing • Vision testing includes acuity, color vision, and visual fields; visual field screening can be done with both eyes open using finger movement detection • Eye movements test cranial nerves III, IV, and VI; internuclear ophthalmoplegia is a key sign of brainstem lesions such as multiple sclerosis • The trigeminal nerve exam includes facial sensation and mastication muscle strength; sensory loss sparing the jaw angle suggests trigeminal lesion • Facial nerve (VII) palsy, such as Bell’s palsy, affects upper and lower face equally; other symptoms like hearing loss suggest more complex pathology • Hearing and balance testing assess the eighth nerve; vestibular ocular reflex testing helps identify vestibular dysfunction • The vagus nerve (X) exam is limited to palate and uvula inspection; tongue examination is important for detecting fasciculations indicative of motor neuron disease • Accessory nerve (XI) testing involves shoulder shrug and head turn; neck muscle abnormalities are usually dystonic rather than nerve lesions • Fundoscopy is performed last due to patient discomfort; practice and breaking the exam into parts improves skill and efficiency
Action Items • Practice fundoscopy and visual field testing regularly to maintain proficiency • Use scratch and sniff cards for reliable olfactory nerve testing when indicated • Employ ergonomic examination sequences focusing on function rather than strict anatomical order to improve efficiency
Open Questions • How often should olfactory nerve testing be incorporated into routine neurological exams? • What are the best strategies to differentiate between functional and organic facial sensory loss? • Are there simplified protocols for vestibular ocular reflex testing suitable for primary care settings?