CRANIAL NERVE EXAMINATION
Mohammad Ruhal Ain (M Pharm, R Ph, PGDPRA)
Department of Clinical Pharmacy
College of Pharmacy
Salman Bin Abdulaziz University
Prof. M.ABD ELAZIZ,
MD, Ph D- Clinical Pharmacology
Department of Clinical Pharmacy
College of Pharmacy
Salman Bin Abdulaziz University
CRANIAL NERVE EXAMINATION
Subject summary 
This station involves examining all the 12 of the nerve. 
Therefore be certain to know which nerve is being tested next and
what tests you must perform for that nerve.

The Olfactory nerve (CN I)
This nerve is simply tested
by offering something
familiar for the patient to
smell and identify.
For example coffee or
vinegar
The Optic nerve (CN II)
Tested in five ways:
Acuity- Snellen charts
Colour- Ishihara plates
Fields
Reflexes
Fundoscopy
Ishihara Color test plates
Visual fields test
Visual fields are tested by asking the patient to
look directly at you and wiggling one of your
fingers in each of the four quadrants.
Ask the patient to identify which finger is
moving.
Visual inattention can be tested by moving
both fingers at the same time and checking the
patient identifies this.
Visual fields test
Visual Fields Test 1
Visual Fields Test 2
Visual reflexes
Visual reflexes comprise direct and concentric
reflexes.
Place one hand vertically along the nose to block
any light from entering the eye not being tested.
Shine a pen torch into one eye and check that
the pupils on both sides constrict.
This should be tested on both sides.
FINALLY FUNDOSCOPY SHOULD BE PERFORMED ON BOTH
EYES.
The Oculomotor nerve (CN III)
The Oculomotor nerve (CN III) is involved in movements of
the eye.
Asking the patient to keep their head perfectly still directly
in front of you, you should draw two large joining H’s in
front of them using your finger and ask them to follow
your finger with their eyes.
It is important the patient does not move their head.
Always ask if the patient experiences any double vision and
if so when is it worse.
The Trochlear nerve (CN IV)
The Trochlear nerve (CN IV) is
tested along with the oculomotor
nerve as it is also involved in eye
movement
The Trigeminal nerve (CN V)
The Trigeminal nerve (CN V) is involved in sensory supply to the face and
motor supply to the muscles of
mastication.
Initially test the sensory branches by lightly touching the face with a piece of
cotton wool and then with a blunt pin in three places on each side – around
the jawline,
on the cheek and on the forehead.
The corneal reflex should also be examined as the sensory supply to the
cornea is from this nerve.
This is done by lightly touching the cornea with the cotton wool.
This should cause the patient to shut their eyelids.
For the motor supply, ask the patient to clench their
teeth together, observing and feeling the bulk of the
masseter and temporalis muscles.
Then ask them to open their mouth against resistance.
Finally perform the jaw jerk on the patient by placing
your left index finger on their chin and striking it with
a tendon hammer.
This should cause slight protrusion of the jaw
Masseter muscles
Temporalis muscles
The Abducent nerve (CN VI)
The Abducent nerve (CN VI) is
tested in the same manner as the
oculmotor nerve, again in eye
movements
The Facial nerve (CN VII)
The Facial nerve (CN VII) supplies motor branches to
the muscles of facial expression.
Therefore, this nerve is tested by asking the patient to
crease up their forehead (raise their eyebrows), close
their eyes and keep them closed against resistance,
puff out their cheeks and show you their teeth
Crease forehead
Closed against resistance
Puff out their cheeks
Showing teeth
The Vestibulocochlear nerve (CN VIII)
The Vestibulocochlear nerve (CN VIII) provides innervation to the
hearing apparatus of the ear and can be used to differentiate
conductive and sensori-neural hearing loss using the Rinne and
Weber tests.
For the Rinne test, place a sounding tuning fork on the patient’s
mastoid process and then next to their ear and ask which is louder,
a normal patient will find the second position louder.
For Weber’s test, place the tuning fork base down in the centre of
the patient’s forehead and ask if it is louder in either ear.
Normally it should be heard equally in both ears.
Rinne test - mastoid process
Rinne test - beside ear
Weber test
The Glossopharyngeal nerve (CN IX)
The Glossopharyngeal nerve (CN IX) provides sensory
supply to the palate.
It can be tested with the gag reflex or by touching the
arches of the pharynx
Glossopharyngeal nerve examination
The Vagus nerve (CN X)
The Vagus nerve (CN X) provides motor supply to
the pharynx.
Asking the patient to speak gives a good indication
to the efficacy of the muscles.
You should also observe the uvula before and during
the patient saying ‘aah’.
Check that it lies centrally and does not deviate on
movement.
The Accessory nerve (CN XI)
The Accessory nerve (CN XI) gives motor
supply to the sternocleidomastoid and
trapezius muscles.
To test it, ask the patient to shrug their
shoulders and turn their head against
resistance.
Accessory nerve examination 1
Accessory nerve examination 2
The Hypoglossal nerve (CN XII)
The Hypoglossal nerve (CN XII) provides motor supply to
the muscles of the tongue. Observe the tongue for any signs
of wasting or fasciculations.
Then ask the patient to stick their tongue out. If the tongue
deviates to either side, it suggests a weakening of the
muscles on that side
Hypoglossal nerve examination