1--olfactory

2--optic

3--oculomotor

4--trochlear

5--trigeminal

6--abducens

7--Facial

8--Auditory (vestibulochoclear)

9--glossopharyngeal

10--Vagus

11--accesory

12--hypoglossal

Cranial nerve

(motor or sensory)

1--sensory

2--sensory

3--motor

4--motor

5--both

6--motor

7--both

8--sensory

9--both

10--both

11--motor

12--motor

Spinothalamic (pain and temp and crue touch)

Posterior Column (postion and vibration and fine touch)

visual acuity and fields....also optic fundi

SNELLEN chart (20/20)

Pupil testing

Shinning light in each pupil(direct and consesual raction)

• eye movements
• finger 2-3ft away following with eye in the shape of an H
• look for nystagmus
• test for convergenc (cranial nerve 4)
• lateral look (cranial nerve 6)

• assessment of fine and crude touch and bil. (light touch and pain vs dullness)
•     three separte branches
• testing jaw clench and temporal muscles
• Corneal reflex

CN 7 Assessment

• Want to test the action by raising eyebrows, frowning, smilling, closing eyes and tell patient to keep you from opening them, and puffing cheeks and trying to push air out
• Taste sensation of front 2/3 of tongue

• Whispering words 1-2 ft from patient with opposite ear occluded and have them repeat
• Weber test--lateralization test on top of head
• Rhine test--bone vs air conduciton

• Saying "ah" and watch soft palate raise bil. (10
• Gag reflex of side of pharynx (9)
• Swallowing (10)
• Taste sense posterio 1/3 of tongue (9)

CN 11 assessment

• Have patient shrug sholders against hands
• bilateral strength
• Later head turn with SCM contraction

• mediating tongue motor funciton
• inspect how tongue lies on floor of mouth
• observe fasiculations
• have patient stick tongue straight out
• Articulate letters "L T D N"

• Pain
• Temperature
• Light touch
• Crude touch
• Position

Evaluation of Patients peripheral sensory.

(fine, crude, and vibration)

• Laying down and closing eye
• knowing when light touch occurs
• symmetric apprciation of light touch
• proximal to distal light touch
• diffrentiation of crude touch (sharp/dull)
• symetric crude touch
• proximal to distal crude touch
• vibration of low pitch tunning fork (toe and finger joint)
• determination of when it stops

Peripheral sensory exam

(postion)

• Both finger and toe secure finger and move DIP joint with patients eyes closed and have them tell if the stopping position is up or down
• Compare bil.

• placing familiar object in patients hand with eyes closed for identification

• Number ID
• have patient close eyes and use blunt instrument to draw a number without lifting instrument in the correct refrence frame of the patient to ID
• Check BIL.

• using two ends of a paper clip repeatedly touch the figner pads with the patients eyes closed...move ends of clip closer together and have the patient tell you how many points he percieves (1 or 2)
• determine minimal distance

Point localization

• patients eyes close touch a poitn on his skin and have patient open eyes and point to where you touched
• variouis places on skin

• Touch patient in two areas on the skin simutaneously (with thier eyes closed) and have them point to both places

• conpression of the lateral femoral cutaneous nerve
• pain/numbness/tingling--ant. and lat. thigh
• Sensory loss
• NO motor loss
• [image]

• Originates in the lumbar plexus (L4-5)
• can involve lower nerve roots
• Pain/weakness/numbness--anywhere along low back, butt, thing and below knees to toes
• decreased feet supination and DTR's

• compression of the peripheral nerve fibers in the cauda equina region (L1-2 begins)
• low back pain/saddle sensory loss/ bowel&bladder loss
• LMN disruption so DTR decrease
• exlude this if the DTR's increase b/c UMN

[image]

--Remember that the Median nerve (forearm and hand) supplies the palm and over laps the tips of the fingers to the dorsal side of the hand

• Reflex activities
• position in space
• autonomic funcitons (BP, HR, etc.)

• Peripheral nerves-->posterior roots--> travels up the spinal corde via two patheways:
• 1.Spinothalamic
• 2.Posterior Column

• pain temp and crude touch
• Cross over immediatly at anterior collumn
• (poor localization)

• Position, vibration and fine touch
• Accurate localization
• directly to posterior collumn and travel to medulla where the cross over and procede to thalmus

Sensory cortex damage

(findings)

• contralateral loss of sensation of limb and trunk

ie cerebral stroke

Brainstem Damage

(sensory findings)

• no typical sensory findings

Spinal Cord Damage

(Sensory findings)

• Dermatomal sensation loss at and below sight of injury
• Typicall Bil.

Basal Ganglia damage

(Sensory Findings)

• Typically no sensory findings

Cerebellum Damage

(sensory findings)

• typically no sensory findings

• Peripheral never--polyneropathy
• when multiple nerves are effects and sensation is lost in a region such as the foot

in contrast to a mononeropathy that would jsut cause sensory deficite in a signle dermatome

Acending Tracts

(all)

Sensory

• Lateral and anterior spinal thalamic
• Posterior column
• Anterior and dorsospinal cerebellar

Unexpected gait patterns

(pic for reveiw)

• refelx flexion of the lower legs while laying down and having neck flexed
• Meningeal irritation

• Pain elicited along the thigh and posterior knee with attempt at lower leg extension.
• Indicative of meningeal irritation or subarachnoid hemorrhage.

 [image]

• AKA: Doll's eyes
• normal response is eyes turn toward side of head opposite rotation to look straight ahead
• normal = intact brainstem

• typicall nystagmus occurs when cold water is introduced to the external ear
• lack of = brainstem problem
• CN 8 normally keeps eyes focused straight ahead via sensation

CN3 (this is an eyelid droop)