Cranial nerve examination
The cranial nerve exam is part of the neurological examination. It is used to identify problems with the cranial nerves by physical examination. Can assist in testing the vestibulocochlear cranial nerve.
This test is usually skipped on a cranial nerve exam.
Visual fields are assessed by asking the patient to cover one eye while the examiner tests the opposite eye. The examiner wiggles the finger in each of the four quadrants and asks the patient to state when the finger is seen in the periphery. The examiner's visual fields should be normal, since it is used as the baseline.
Pupillary light reflex The patient stares into the distance as the examiner shines the penlight obliquely into each pupil. Pupillary constriction is tested for on the eye examined (direct response) and on the opposite eye (consensual response). The swinging flashlight test involves moving the light between the two pupils. Normally both direct and consensual responses are ellicited when the light shines on an eye, and some dilation will occur during the swing between.
The examiner tests ocular movements by standing one meter in front of the patient and asking the patient to follow a target with eyes only, and not the head. The target is moved in an "H" shape and the patient is asked to report any diplopia. Then, the target is held at the lateral ends of the patient's visual field. Nystagmus is tested for. One or two beats is a normal finding. The accommodation reflex is tested by moving the target towards the patient's nose. As the eyes converge, the pupils should constrict. The optokinetic nystagmus test is optional and involves asking the patient to look at a moving strip of horizontal lines. Nystagmus is normally observed.
Corneal reflex is conducted along with the facial nerve section of the test. Note the sensory innervation of the cornea is provided by the trigeminal nerve while the motor innervation for blinking the eye is provided by the facial nerve.-
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