Case 1 – Cranial Nerve Examination

Tim Milligan Neurology

You are seeing Mr. Grimson, a 39 year old man, for numbness of the face as well as a right facial droop. Please examine cranial nerves V and VII

Physical Examination

CN V

  • Examines for light touch in all three nerve distributions (forehead, cheek, chin)
  • Examines for pain/temperature in all three nerve distributions (forehead, cheek, chin)
  • Palpates masseter and temporalis muscles and comments on bulk
  • Tests masseter muscle power by opposing jaw opening
  • Tests right and left pterygoids muscle power by opposing lateral movements of the jaw
  • Tests the jaw reflex using reflex hammer
  • States that the corneal reflex (afferent V, efferent VII) should be tested and explains the procedure

CN VII
Motor:

  • Comments on the presence/absence of facial asymmetry/droop
  • Tests frontalis by asking patient to raise eyebrows
  • Tests orbicularis oculi by asking patient to tightly shut eyes (and tries to open them)
  • Tests orbicularis oris by asking patient to tightly close lips (and tries to open them)
  • Shows upper and lower teeth
  • Puffs cheeks (and tries to deflate them)
  • Shows the lower teeth only (platysmus)
  • States that the corneal reflex should be tested and explains the procedure (efferent limb)
  • States that lacrimation and salivation should also be tested

Sensory:

  • States that taste on the anterior 2/3 of the tongue should be tested, and describes how this examination could be performed
Case 1 – Cranial Nerve Examination