NEUROLOGICAL ASSESSMENT

• CN I - OLFACTORY

  CN II - OPTIC

  CN III, IV, VI - OCCULOMOTOR, TROCHEAL, ABDUCENS

  CN V - TRIGEMINAL

  CN VII - FACIAL

  CN VIII - ACOUSTIC/VESTIBULOCOCHLEAR

  CN IX, X - GLOSSPHRAYNGEAL, VAGUS

  CN XI - SPINAL ACCESORY

  CN XII - HYPOGLOSSAL
• GLASGOW COMA SCALE

  • EYE OPENING RESPONSE
  • MOST APPROPRIATE VERBAL RESPONSE
  • MOST INTEGRAL MOTOR RESPONSE
• CONSCIOUSNESS LEVEL

  1. ALERT
  2. LETHARGIC
  3. SPOROTOUS
  4. COMMATOSE
• EYE OPENING RESPONSE

  • Spontaneous opening - 4
  • To verbal command - 3
  • to pain - 2
  • no response - 1
• MOST APPROPRIATE VERBAL RESPONSE

  • oriented - 5
  • confused -4
  • inappropriate words - 3
  • incoherent - 2
  • no response - 1
• MOST INTEGRAL MOTOR RESPONSE

  • obeys verbal command - 6
  • localized pain - 5
  • withdraws fro pain - 4
  • flexion (decorticate rigidity) - 3
  • extension (decerebrate rigidity) - 2
  • no response -1
• CN I - (coffee, vanilla soap)

  NORMAL : client correctly identifies scent presented at each nostril

  ABNORMAL : neurogenic anosmia - inability to smell or identify the correct scent

  • olfactory tract lesion
  • fontal lobe tumor
  • congenital nasal or sinus problem
  • nerve tissue injury
  • smoking or use of cocaine
• CN II topics


  • Snellen chart
  • Pocket vision
  • Visual fields
  • Retina & optic disc
• Normal vision

  20/20 vision right eye and the left eye
• Abnormal vision (snellen chart)

  • Difficulty reading the snellen chart
  • Missing letters
  • Squinting
• Normal reading ( pocket vision)

  Reads print at 14 inches without difficulty
• Abnormal reading (pocket vision)

  • Reads print closer than 14 inches or farther away (presbyopia, occurs in aging)
• Abnormal visual fields

  • Lost of visual fields may be seen with retinal damage and detachment
  • lesion of the parietal cortex
  • lesion of the optic nerve
• Normal optic disc

  • 1.5 mm, round/slightly oval
  • well defined margin
  • creamy pink with paller physiologic cup
  • retina pink
• Abnormal optic disc

  • Papilledema, optic atrophy
• CN III, IV, VI

  • margins of the eyelids
  • occulomotor movements
  • cover/uncover test
  • puppilary response & accomodation
• Normal eyelid

  • Covers 2mm of the iris
• Abnormal eyelid

  • ptosis - Drooping of the eyelid, weakness of eye muscle
• Normal occulomotor movement / 6 cardinal fields

  • Eye moves in Smooth coordinate movement in all six directions
• Abnormal occulomotor movement

  • Increased ICP
  • cerebrall disorder
  • paralytic strabismus
• Normal cover n uncover

  • Steady gaze
• Abnormal cover n uncover

  • Shift in gaze
  • movement of gaze to refocus
  • weak eye muscle
  • weak CN 3,4,6 (dolls eye phenomenon)
• Normal pupillary response


  • Bilateral illuminated pupils constrict simultaneously
  • pupil opposite the one illuminated constricts simultaneously
• Abnormal pupillary response

  • Occulomotor nerve paralysis
  • Argyl robertson pupil
  • Nacotics abuse
  • CN3 damage
  • CN 5 lesion
  • lesion of the sympathetic nervous system
  • CNS or PNS dysfunction
• CN V TOPICS

  • clench teeth
  • facial stimuli
  • corneal reflex
• NORMAL clench teeth: temporal and masseter muscles contracts billateraly

  ABNORMAL :

  • decreased contraction in one of both sides
  • assymmetric strength in moving the jaw may be seen with injury or lesion on the 5th cranial cerve
  • pain in clenching the teeth
• FACIAL STIMULI NORMAL: correctly identifies dull or sharp stimuli and light touches to forehead, cheeks, or chin

  ANBORNAL : inability to determine facial stimuli

  • lesion of the trigeminal nerve
  • lesion of the spinothalamic tract or posterior colums
• CORNEAL REFLEX NORMAL : eyelids blink bilateraly

  ABNORMAL : negative corneal reflex, lesion of the trigeminal nerve, lesion of the motor part of CN 7
• CN VII

  • facial reaction
  • 2/3rd of the tongue
• FACIAL REACTION NORMAL: symmetric movements

  ABNORMAL:

  • inability to close eye, raise eyebrow, wrinkle forehead, along with paralysis on the lower part of the affected side (BELLS PALSY)
  • paralysis of the lower rat of the face on the opposite side affected may be seen with central lesion that affects the upper motor neurons (STROKE)
• 2/3RD OF THE TONGUE NORMAL : correctly identifies the flavor

  ABNORMAL : inability to identify the flavor at anterior 2/3rd of the tongue

  • impairement of cranial nerve 7
• CN VIII

  • weber
  • rinne
  • romberg
• WEBER NORMAL: vibration heard equally well in both ears

  ABNOMAL : vibratory lateralizes to good ear in sensorineural loss
• RINNE NORMAL : AC>BC

  ABMORMAL : BC>AC\
• ROMBERG NORMAL : patient is able to maintain her position for 20 seconds without swaying or with minimal swaying, maintains balanve, negative romberg

  ABNORMAL: moves feet apart to regain balance or starts to fall from out of balance = vestibular disorder

  loss of balance = inner ear damage, cerebral damage, ingestion of intoxicants
• CN IX, X

  • "ah"
  • gag reflex
  • swallow voice quality
• "ah" NORMAL: uvula and soft palate rise symmetrically and bilaterally during phonation

  ABNORMAL: soft palate does not rise = bilateral lesion of the cranial nerve 10

  unilateral rising of soft palate and deviation of uvula to the normal side = unilateral lesion of the cranial 10
• gag reflex NORMAL: gag reflex intact

  ABNORMAL : absent gag reflex = lesion of the cranial nerve IX & X
• SWALLOW NORMAL: swallows without diffculty, no hoarseness noted

  ABNORMAL: dypaghia or hoarseness = lesioin of the CN IX, X, neurologic disorder
• CN XI

  • trapezius muscle
  • sternocleidomastoid muscle