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    PX NN Cranial

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    ZenithaMeida
    1. The document describes how to examine the 12 cranial nerves, including techniques to assess sensory and motor function for each nerve. 2. Key signs are described to evaluate the cranial nerves, such as visual acuity and visual fields for CN II, pupil size and eye movements for CN III/IV/VI, and taste for CN VII. 3. Reflexes like the corneal reflex and jaw jerk are also outlined to help localize cranial nerve lesions.

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    PX NN Cranial

    Uploaded by

    ZenithaMeida
    167 views35 pages
    1. The document describes how to examine the 12 cranial nerves, including techniques to assess sensory and motor function for each nerve. 2. Key signs are described to evaluate the cranial nerves, such as visual acuity and visual fields for CN II, pupil size and eye movements for CN III/IV/VI, and taste for CN VII. 3. Reflexes like the corneal reflex and jaw jerk are also outlined to help localize cranial nerve lesions.

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    1. The document describes how to examine the 12 cranial nerves, including techniques to assess sensory and motor function for each nerve. 2. Key signs are described to evaluate the cranial nerves, such as visual acuity and visual fields for CN II, pupil size and eye movements for CN III/IV/VI, and taste for CN VII. 3. Reflexes like the corneal reflex and jaw jerk are also outlined to help localize cranial nerve lesions.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    167 views35 pages

    PX NN Cranial

    Uploaded by

    ZenithaMeida
    1. The document describes how to examine the 12 cranial nerves, including techniques to assess sensory and motor function for each nerve. 2. Key signs are described to evaluate the cranial nerves, such as visual acuity and visual fields for CN II, pupil size and eye movements for CN III/IV/VI, and taste for CN VII. 3. Reflexes like the corneal reflex and jaw jerk are also outlined to help localize cranial nerve lesions.

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    © All Rights Reserved
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    of 35

    MENINGEAL SIGN

    Dr. Steven, M.Si .Med, Sp.S


    Meningeal sign
    1. Neck stiffnes
    2. Kernig`s sign
    3. Brudzinski I (neck sign)
    4. Brudzinski II (contralateral leg sign)
    5. Brudzinski III (cheek si gn)
    6. Brudzinski IV (symphisis sign)
    Neck Stiffnes
    + : resistance

    Kernig`s sign
    + : < 135º pain or resistance /
    Contralateral leg flexion
    Brudzinski I-IV
    + : leg flexion

    Neck sign Contralateral leg sign

    Cheek sign : press os zygomaticum


    Symphisis sign : press symphisis pubis
    CRANIAL NERVES
    EXAMINATION

    Dr. Steven, M.Si .Med, Sp.S


    Olfactory Nerve (I)

    Examination Technique :
    • patient should not be able to see
    the stimulus
    • test one nostril at a time with the
    opposite side occluded
    • stimulant should be non -irritating
    (avoid stimulation of N. V)
    • Tobacco, tea, coffee, etc
    Normal Response:
    · to perceive the scent with either nostril

    Abnormal Response:
    1. a unilateral loss is more likely to be significant
    and may imply a structural brain lesion af fecting
    the olfactory bulb or tract, but could also be due
    to local causes such as a deviated septum or
    blocked nasal passage
    2. bilateral loss can occur with rhinitis or damage
    to the cribriform plate
    • Anosmia
    • Hipo / Hiperosmia
    • Parosmia
    • Kakosmia
    • Halusinasi (epilepsy)
    • Foster kenedy: Anosmia ipsilateral
    Atrofi optic ipsilateral
    Papil Oedema contralateral
    Optic Nerve (II)

    Examination :
    1. Visual Acuity
    2. Visual fields
    3. Color
    4. Fundoscopy
    Visual Acuity

    Examination Technique :
    • each eye is tested separately
    • Improvement of vision through a
    pinhole indicates that the error is
    refractive.
    • Using a Snellen chart ( …/6), count
    fingers (…/60), hand movements
    (1/300), perceive light (1/~)
    Visual Fields
    Gross testing by Confrontation
    Examination technique :
    • the examiner compares the patient’s visual field
    to their own and assumes that theirs is normal
    • test each eye separately
    • the examiner places himself approximately 30 –
    40 cm away from the patient
    • advises the patient to look directly at the
    examiner’s eye
    • The test object (either a wiggling finger, one or
    two fingers, or a white pin head) is presented
    equidistant from the patient’s and examiner’s
    eye
    • the patient is asked either to state the num ber of
    fingers or say "yes" when they first see a moving
    target
    GOLDMANN Perimeter

    Campimeter
    Color

    • Use Ishihara chart


    • Color woll yarn
    Fundoscopy

    • Fundoscopy is the assessment of the fundus using an


    ophthalmoscope

    Normal papil Edema papil


    Oculomotor (III), Trochl ear (IV), Abducens
    (VI) nerves
    • Observe eyelid
    - Palpebra superior retraction
    - Ptosis
    - Blink
    - Open and close the eye
    • Observe pupil
    - Size and shape pupil
    - equality
    - Reflex
    • Observe eye movement
    Observe eyelid
    • Palpebra superior retraction if it`s too much elevated
    • Normal retraction if can`t see white sclera and limbus
    cornea superior from palpebra superior edge
    • Ptosis is present if the eyelid droops over the pupil when
    the eyes are fully open
    • Frequency blink of eyes : 15x/minute
    Observe pupil

    • Size of pupil
    measure the Ø of each pupil in mm
    • Shape (regular or not)
    • Equality
    Isocoria or not
    • Reflex
    - Direct light ref lex and consensual reflex
    - Accommodation reflex
    Observe eye movement
    • Steady the patient`s head
    • ask him to follow an object held at arm`s length.
    • Observe the full range of horizontal and vertical eye
    movements
    • Conjugate movement
    Note the ability of the eyes to move together
    (conjugately) in horizontal or vertical direction

    • Nystagmus
    Trigeminal nerve (V)

    • N. V à sensory V1, V2, V3


    motor component V3
    • Examination: sensory
    motor
    reflex
    • Sensation is tested to light touch
    with a cotton wisp
    • Temperature with a cold tuning
    fork
    • Pain with a disposable pin
    • Compare side to side
    • Motor à muscle of mastication (m. temporalis, m.
    masseter, m. pterigoideus)
    • Ask patient to clamp jaws together and palpate the
    temporalis and masseter muscle
    • Ask the patient to open their mouth and repeat this
    against resistance. Obeserve f or any deviation of the jaw
    to one side
    • With open mouth, ask the patient to protrude their jaw to
    either side against resistance
    Reflex

    Corneal ref lex

    Afferent à opthalmicus nerve (N. V1)


    Efferent à Facial nerve (N. VII)

    Examination Technique:
    1. Explain to the patient what you will be doing
    2. Avoid a visual threat
    3. Stimulate the limbus cornea by touching with a wisp of
    cotton
    4. Observe the direct (same) eye and consensual
    (opposite eye) blink in response to corneal stimulation
    5. Repeat the opposite side
    Jaw jerk

    Afferent à sensory N. V3
    Efferent à motor N. V3

    Examination Technique:
    1. Ask patient to rwelax jaw
    2. Place our index f inger over the middle of patient`s chin
    with mouth slightly open
    3. Tapped with a reflex hammer
    4. Slight jerk à normal
    Increased jerk à bilateral upper neuron lesion
    Facial nerve (N. VII)

    • The anterior two-thirds of the tongue


    • Tested using salty, bitter, sour or sweet solutions.

    Examination Technique
    1. the tongue is protruded and held gently by the examiner
    2. a small sample of solution is applied to one side of the
    anterior two-thirds of the tongue using a cotton tipped
    applicator
    3. with the tongue still protruded, asked to point to a sign
    displaying one of the four possible tastes
    4. then given a small sip of water and the test is repeated
    with the others
    N. VII à the muscles of facial expression

    Examination Technique :
    1. observe for asymmetry – widening of the palpebral
    fissure or flattening of the nasolabial f old
    2. observe for involuntary facial movements
    3. ask the patient to wrinkle their forehead, close their eyes
    tightly, show their teeth, puff out their cheeks and appose
    their lips

    Normal : symetric
    Abnormal :
    Infranuclear / perifer à weakness of entire side
    of the face
    Supranuclear / central à weakness of lower muscles
    of facial expression
    Vestibulocochlear Nerve (n. VIII)
    Hearing and vestibular function

    Examination Technique:
    1. Hearing (n. cochlear)
    - mask the opposite ear and whisper numbers. The
    patient should not be able to read your lips. Ask the
    patient to repeat the numbers
    - compare air versus bone conduction using the Rinne
    test
    - test for lateralization using the W eber test

    2. Vestibular function (n. vestibular)


    - Observe nystagmus
    - Caloric test
    Glossophariyngeal nerve (N. IX)
    Vagus Nerve (N. X)
    • Tested together
    • Swallowing, phonation, guttural, &
    palatal articulation
    • N. IX à 1/3 posterior tongue

    Examination Technique:
    • check palatial elevation by having
    the patient sustain an " ah." When
    observing palatal movement, look
    at the palate rather than the uvula
    • assess the gag reflex by gentling stroking the sof t palate
    on each side
    • swallowing can be assessed by giving the patient a sip
    of water and observing them swallow
    • listen to the patient ’s speech

    Normal response : the palate should elevate symmetrically,


    Gag reflex +
    Abnormal response: with unilateral palatal weakness, the
    palate fails to elevate on the weak side and the gag
    reflex will be absent on that side
    Accessory Nerve (N. XI)
    The trapezius and sternocleidomastoid muscle

    Examination Technique:
    1. observe for atrophy or asymmetry of the muscles
    2. observe for quickness of shoulder shrug and ask the
    patient to shrug their shoulders against resistance
    3. ask the patient to turn their head to the opposite side
    against resistance, both watch and palpate the
    sternocleidomastoid muscle
    Hypoglossal Nerve (N. XII)

    Motor to the tongue

    Examination Technigue:
    • observe for tongue atrophy or
    enlargement
    • There is fasciculation or not
    • ask the patient to protrude the tongue
    • ask the patient to push the tongue into
    each cheek
    Normal response:
    the tongue should be able to protrude relatively straight.
    Minimal degrees of deviation (i.e. only millimeters)
    affecting only the tip are insignif icant.
    Abnormal response:
    the tongue deviates towards the weak side
    Infranuclear lesion à atrophy / fasciculation

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