Cranial Nerve Assessment
CN1: olfactory
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smell test
o Test one nares at a time with eyes closed; normal= correct identification of
smell
o Also test for patency by occluding one nares a time
CN2: optic
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visual acuity
 Use of Snellen Chart
 Have pt. stand 20 feet away and read smallest line of print
they can still see with one eye covered, then the other, and
then with no eyes covered (tests for parallel vision)
o Cover with opaque card
 Line counts if they read half the letters correctly
 Numerator ALWAYS 20 (standard testing distance)
 Denominator is value indicated by chart: Distance the normal
eye can read the letters on the line
o i.e. 20/80, pt reads at 20 feet what someone could see
at 80
 Perform test without corrective lenses, except reading glasses
 Legally blind: 20/200
 Findings: report with or without correction
 Can also test with Jaeger or Rosenbaum chart
 Hold 14 inches away from face, normal =14/14 (tests for
nearsightedness)
Visual fields confirmation test
 Test for peripheral vision, stand behind pt and move object to
periphery
 Normal= visual field equal to examiners
Reaction to light
 Shine light from side to side
 Observe constricting in both direct and consensual eye
 Come in from side, not straight on (pupils will constrict to focus on
near object NOT testing response to light)
 Can also test for accommodation (constriction of pupils as finger
brought from distance to near)
 Documentation: PERRLA (pupils equal, round, reactive to light and
accommodation)
Cranial Nerve Assessment
CN3 oculomotor
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eyes, innervates medial recuts, superior rectus, inferior rectus, and inferior oblique
muscles
o Inspect: palebral fissure, presence of ptosis and lid lag
o Assessment:
 Extraocular muscle function
 Perform test once, not bilaterally, eyes should move in
convergent gaze
o Notice if person turning head to accomidate
 Move finger to position and then back (if coming in from right
side):
o Upper lateral (tests patient’s CNIII of L (Inferior
Oblique) and R (Superior rectus) eye)
o Middle lateral (test patient’s CNVI (lateral rectus) of R
eye and CNIII (medial rectus) of L eye)
o Lower lateral (test patient’s CNIII (Inferior recuts) of R
eye and CN IV (Superior oblique) of L eye)
o Lower medial (tests patient’s CNIV (superior oblique) of
R eye and CNIII (Inferior rectus) of L eye)
o Middle medial (tests patients CNIII (medial rectus) of R
eye and CNVI (lateral rectus) of L eye)
o Upper medial (test patient CNIII (inferior oblique) of R
eye and CNIII (superior rectus) of L eye)
 N= eyes parallel without nystamus (normal in lateral position)
 Reaction to light test (see CNII)
 Deficits: CNIII paralysis can result in ptosis or pupillary dilation, impact
movement diagnol up, medial, diagonal lower lateral)
CN4: trochlear
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Assessment: extraocular muscle function
Abnormalities: superior oblique movement (movement of eye medial
and lower), pt’s complain of not being able to “walk down stairs”
Cranial Nerve Assessment
CN5: trigeminal: 3 branches (ophthalmic, mandibular,
maxillary)
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Put a hand on your face with index finger running along same line of
ear, branches are roughly index, middle and lower (behind ear, on line
of nose, and below/behind mandible)
Assessment: test sensory
 Break cotton tip in two (sharp and dull), tell pt. test on 3
branches
 Have them close their eyes ask what they feel
 Documentation: pt able to appropriately identify all 3 branches,
bilateral and symmetrical
Assessment: test motor
 Palpate masseter and temporal muscles as client bites down,
palpate jaw resistance
 Try to pull down jaw
CN6: abducens
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Assessment: extraocular muscle function
Abnormalities: later rectus movement
CN7: facial
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Inspect and palpate for involuntary movements
Test: sensory (not regularly tested) Apply sugar or salt to ant/ 2/3 of
tongue on each side
Motor: facial movements, wrinkle forehead, close eyes, show teeth,
whistle, observe for tremor
Normal fidnings: appropriate identification of substance, execution of
movements without tremor
CN8: vestibulochoclear
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Test gross hearing: occlude one ear, stand behind whisper a word
Caloric test tests vestibular portion
CN9: glossophaaryngeal:
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swallow, gag reflex
Cranial Nerve Assessment
CN10: vagus
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Watch uvula as patients says ahhhhh
Normal: uvula rises symmetrically, midline, gag reflex intact
CN11: accessory
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Test muscle strength by applying resistance to shoulders (trapezius)
and neck turning
CN12: hypoglossal
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Inspect: extend tongue, iinspect for deviation, tremors, limitation
Tongue strength: move tongue side to side against resistnace
Normal: no deviation/tremor/limitation