The document provides instructions for performing a cranial nerve examination, including which equipment is needed and the steps to assess each of the 12 cranial nerves. It details how to test the olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, accessory, and hypoglossal nerves through sensory and motor function tests like smell, vision, eye and facial muscle movement, hearing, taste, swallowing, and tongue movement. The examination assesses for any abnormalities, deficits, or asymmetries in cranial nerve function.

1. Cranial nerve examination
Subject steps
The following equipment is required for a cranial nerve examination:
 Handwash
 Item with distinct odour (e.g. orange/lemon peel, coffee, vinegar, etc)
 Cotton ball
 Pen torch
 Fundoscope
 Tuning fork
 Neurological reflex hammer
 Snellen charts
 Ishihara plates
DR Mohammad Ruhul Amin
www.fb.com/aminacademy.org

2. *Ask the pt to sit edge of the bed,face to face,see any obious findings(ptosisi,squint
,asymmetry,proptosis)
Cranial nerve Examination
Cranial nerve I 1..Evaluate the patency of the nasal passages
bilaterally
2.Do u hv any difficulty in sense of smell. ?
(use perfume)
3.Asking the patient to breath in through their nose
while the examiner occludes one nostril at a time.
Cranial nerve II
Visual acuity
(with Snellen charts. If the patient normally wears
glasses or contact lenses, then this test should be
assessed both with and without their vision aids)
1. Stand the patient at 6 metres from the Snellen
chart.
2. If patient normally uses distance glasses, ensure
they wear them for the assessment.
3. Ask the patient to cover one eye & read to the
lowest line they can manage.
4. Visual acuity is recorded as chart
distance (numerator) over number of lowest line
read (denominator).
5. Record the lowest line the patient was able to
read (e.g. 6/6 which is equivalent to 20/20).
6. You can have the patient read through a pinhole
to see if this improves vision.
7. Repeat above steps with the other ey
Colour vision:
Assess colour vision using Ishihara charts
Visual fields
(Sit directly facing the patient, approximately 1
metre away)
1. Ask the patient to cover their left eye with their left
hand.
2. You should cover your left eye and be staring
directly at the patient (mirror the patient).

3. 3. Ask patient to focus on your face & not move their
head or eyes during the assessment.
4. Ask the patient to tell you when they can see your
fingertip wiggling.
5. Outstretch your arms, ensuring they are situated
at equal distance between yourself & the patient.
6. Position your fingertip at the outer border of one
of the quadrants of your visual field.
7. Slowly bring your fingertip inwards, towards the
centre of your visual field until the patient sees it.
8. Repeat this process for each quadrant – at
10 o’clock /2 o’clock / 4 o’clock / 8 o’clock.
9. If you are able to see your fingertip but the patient
cannot, this would suggest a reduced visual field.
10. Map out any visual field defects you detect.
11. Repeat the same assessment process on the
other eye
Test for central scotoma:
Fundoscopy
Preparation
1. Darken the room.
2. The patient should have their pupils dilated with
short-acting mydriatic eye drops.
3. Ask the patient to fixate on a distant object
3rd
,4th
,6th
nerves
3=eye mov,
eye lid move,
pupil,size,,symmetry
4=eye move
6=eye move
(are involved in movements of the eye)
Ptosis,squint:
Note any evidence of ptosis – oculomotor nerve
pathology
Eye movements
1. Ask the patient to keep their head still & follow
your finger with their eyes.
2. Move your finger through the various axis of eye
movement (“H” shape).
3. Ask the patient to report any double vision.

4. 4. Observe for restriction of eye movement & note
any nystagmus
Cover test
1. Ask patient to focus on a target (e.g. your pen
top).
2. Cover one of the patient’s eyes.
3. Observe the uncovered eye for movement:
o No movement = normal response
o Eye moves temporally = divergent squint
o Eye moves nasally = convergent squint
4. Repeat the cover test on the other eye
Pupils
Size – normal size is approximately 2-4mm in
diameter (bright light)
Position – assess pupil alignment
,misalignment noted in strabismus
Pupillary reflexes
Direct reflex– shine torch into eye – look for
pupillary constriction in that eye
Consensual reflex – shine torch into eye – look for
pupillary constriction in opposite eye
Swinging light test– move light in from side of
each eye rapidly –relative afferent pupillary defect
(RAPD
Accommodation reflex:
1. Ask patient to focus on a distant point (clock on a
wall / light switch).
2. Place your finger/object approximately 15cm in
front of the eyes.
3. Ask the patient to switch from looking at the
distant object to the nearby finger / object.
4. Observe the pupils, you should see constriction &
convergence bilaterally
(involved in sensory supply to the face and motor
supply to the muscles of mastication)

5. The Trigeminal nerve
(CN V)
-facial sense
-corneal ref
-taste
Sensory test:
3 division of nerves,
Corneal reflex
** motor test: ask the patient to clench their teeth
together, observing and feeling the bulk of
the masseter and temporalis muscle
**open their mouth against resistance
** perform the jaw jerk
The Facial nerve (CN
VII) supplies motor
branches to the
muscles of facial
expression
Sensory test:
Ant 2/3rd of tongue-taste
Post 1/3rd of tongue-through glossoph nerve
Finally-external auditory meatus –ramsay hunt
syndrome and hyperacusis
the Vestibulocochlear
nerve (CN VIII)
Vestibulardivision:vertigo,dizziness,giddiness
Cochleardicvision:
Ext ear-wax ,rash
Rub fingers
The Glossopharyngeal
nerve (CN IX)
g-gag reflex
provides sensory supply to the palate. It can be
tested with the gag reflex or by touching the arches
of the pharynx.

6. The Vagus nerve (CN
X)
provides motor supply to the pharynx-palate
ele vation
the Accessory nerve
(CN XI)
gives motor supply to
the sternocleidomastoid and trapeziusmuscles. To
test it, ask the patient to shrug their shoulders and
turn their head against resistance.
The Hypoglossal
nerve (CN XII) .
provides motor supply to the muscles of the tongue