Neurological Testing
Neuroscience, Year 2
Clinical Neurology, Year 3
, Cranial Nerves
Mnemonic No. Name Nuclei Type Sensory function Motor function Parasympathetic function Muscle Innervation
On I Olfactory Cerebrum Sensory ● Smell (olfactory)
On II Optic Cerebrum Sensory ● Vision
On III Oculomotor Midbrain Motor + ● Movement of eyeball ● Accommodation = rounding of ● Superior/medial/inferior rectus
parasymp. ● Eyelid elevation lens for near/far vision by ● Inferior oblique
contracting ciliary muscles ● Levator palpebrae superioris (eyelid)
● Pupillary constriction by
sphincter pupillae
They IV Trochlear Midbrain Motor ● Movement of eyeball: downwards & ● Superior oblique
inwards
Travelled V Trigeminal Pons Both ● Facial sensation (incl. anterior 2/3rd of tongue): ● Mastication ● Muscles of mastication: masseter,
soft touch & pin-prick (+ corneal reflex) temporalis, pterygoid
● Proprioception (somatosensory)
And VI Abducens Pons Motor ● Movement of the eyeball: lateral ● Lateral rectus
rotation (abduction)
Found VII Facial Pons Both + ● Taste: anterior 2/3rd of tongue (gustatory) ● Facial expression ● Secretomotor innervation: ● Muscles of facial expression: frontalis,
parasymp. ● Sensation of posteromedial outer ear ● Sound dampening salivary (submandibular & orbicularis oculi, buccinator, orbicularis
● Raising of hyoid bone sublingual), lacriminal & oris, platysma
nasal/palatine glands ➔ dry ● Stapedius (sound)
eye/mouth ● Stylohyoid & digastric (hyoid)
Voldemort VIII Vestibulocochlear Pons Sensory ● Hearing (auditory)
● Balance inner ear (vestibular)
Guarding IX Glossopharyngeal Medulla Both + ● Taste: posterior 1/3rd of tongue (gustatory) ● Swallowing ● Secretomotor innervation: ● Stylopharyngeus of pharynx (upper
parasymp. ● Sensation to posterior 1/3rd of tongue, tonsils, salivary gland (parotid) ➔ dry part throat)
pharynx, tympanic area mouth
● Gag reflex
● Visceral sensation to carotid body
(chemoreceptors: blood O2/CO2/pH) & carotid
sinus (baroreceptors: arterial BP)
Very X Vagus Medulla Both + ● Sensation to ear, pharynx & larynx ● Branchiomotor innervation to laryngeal ● Parasympathetic motor supply ● Pharyngeal & laryngeal muscles
parasymp. ● Visceral sensation to thoracic/abdominal (neck) & pharyngeal (throat) muscles ➔ to smooth muscle & glands of (lower parts throat)
viscera (heart/GIT) voice, resonance, swallowing pharynx, larynx, ● Soft palate
● Taste: epiglottis & tongue root (gustatory) ● Gag reflex thoracic/abdominal viscera
Ancient XI Accessory Medulla Motor ● Head movement: cervical rotation, ● Sternocleidomastoid (neck)
flexion/extension & lateral flexion ● Trapezius (shoulder)
● Shoulder movement: scapula rotation,
retraction, elevation & depression
Horcruxes XII Hypoglossal Medulla Motor ● Tongue movement ➔ swallowing, ● Muscles of tongue
speech articulation
,1. CN I - Olfactory
o Smell
2. CN II - Optic
o Vision
3. CN III - Oculomotor
o Movement of eyeball, eyelid, lens & iris
4. CN IV - Trochlear
o Movement of eyeball ➔ downwards & inwards
5. CN V - Trigeminal
o Facial sensation ➔ soft touch + pin prick
o Proprioception
o Mastication
6. CN VI - Abducens
o Movement of eyeball ➔ lateral rotation (abduction)
7. CN VII - Facial
o Taste ➔ anterior 2/3rd of tongue
o Outer ear sensation & sound dampening
o Facial expression
o Secretomotor innervation ➔ salivary (except parotid) & lacrimal glands
8. CN VIII - Vestibulocochlear
o Hearing
o Balance/equilibrium in inner ear
9. CN IX - Glossopharyngeal
o Taste ➔ posterior 1/3rd of tongue
o Sensation ➔ tonsils, pharynx, tympanic area, carotid body & sinus
o Gag reflex (sensory)
o Swallowing
o Secretomotor innervation ➔ parotid gland
10. CN X - Vagus
o Sensation ➔ ear, pharynx, larynx & thoracic/abdominal viscera
o Branchiomotor innervation ➔ laryngeal (neck) & pharyngeal (throat) muscles ➔ swallowing, voice & resonance
o Gag reflex (motor)
o Parasympathetic motor supply ➔ pharynx, larynx & thoracic/abdominal viscera
11. CN XI - Accessory
o Head movement
o Shoulder movement
12. CN XII - Hypoglossal
o Tongue movement ➔ allows swallowing & speech articulation
, Cranial Nerve Test Abnormal
CN1: Olfactory Smell (not routinely tested) • Anosmia = loss of sense of smell ➔ could be due
• Q: Have you recently experienced any changes to your sense of smell? to common cold or head injury
• Test 1 nostril at the time, using strong scents (coffee, chocolate, ammonia) • Temporal lobe epilepsy = olfactory hallucination
CN2: Optic Responsible for visual acuity (how clear vision is) Visual acuity
• Use Snellen chart or a newsprint (small font) • Look for blurring (scotoma)
• Keep glasses on ➔ not testing for myopia (near-sight) & hyperopia (far-sight) Four quadrants
Confrontation test / Visual fields test / Four quadrants test • Loss full visual field (monocular blindness)
• Ask PT to cover right eye + keep their gaze on you + tell you when they see your finger • Loss of half visual field (hemianopia)
• Stand in front of PT and mirror image • Loss of a quadrant (quadrantanopia)
• Start with hand behind PT head with 2 fingers sticking out & move hand towards yourself • Enlargement of blind spot
• Test both sides (1 for lateral/peripheral & 1 for medial field of vision) at head & waist height • Tunnel vision = loss of peripheral vision
• First view should be just in front of PT shoulder (for lateral field) Visual neglect
Visual neglect test • PPC (posterior parietal cortex) lesion = loss of
• Ask PT to cover 1 eye + tell you when you are moving your finger & point to which hand half of the world, particularly during bilateral
• Stand further from PT, make bunny ears with hands, move each hand individually, then simultaneously stimulus
Refer to fundoscopy Fundoscopy
• Uses an ophthalmoscope to find papilledema’s • Papilledema = optic disc swelling caused by
increased intracranial pressure (ICP)
CN3: Oculomotor Visual observation Visual observation (CN3)
CN4: Trochlear • Check eyelid & pupil size • Ptosis = eyelid drop
CN6: Abducens Smooth pursuit • Anisocoria = unequal size of pupils
• Testing eye movement • Miosis = excessive constriction of pupils
• Ask PT to hold head still + follow your finger with their gaze + ask if it causes double vision • Mydriasis = dilation of pupils
• Stand in front of PT, far enough that PT can’t “kick you” & draw a ‘H’ with slowly with your finger • Strabismus = misalignment of eyes
• Movements should be full, smooth & coordinated in full ROM Smooth pursuit / convergence / saccadic / VOR:
Convergence test • Saccade = jumping eye movements between 2
• Immediately after smooth pursuit end point, bring finger slowly to PT face & back points (also with VOR)
• Eyes should converge/constrict when getting closer & divergence/dilation when moving away • Diplopia = double vision (CN4)
Saccadic test • Nystagmus = involuntary eye oscillations
• Ask PT to look at object, then instruct to look R/L/up/down rapidly & fixate back on object (dancing eyes)
• Eyes should fixate immediately. No slow initiation, slow speed or inaccurate fixation • Reduced ROM, uncoordinated
Vestibulo-ocular reflex (VOR) Abduction problem = CN6
• Ask PT to look at fixed distant point Intorsion problem = CN4
• Turn head L/R/up/down, gaze should be maintained Rest = CN3
