‘I’ve been asked to do an examination of your cranial nerves, the nerves that supply your head and neck’

‘Are you in any pain at all?’

• Mark Scheme

CN 1-6 = olfactory, optic, occulomotor, trochlear, trigeminal, abducens

CN 7-12 = facial, vestibulocochlear, glossopharyngeal, vagus, spinal accessory, hypoglossal

Pathology

• Inattention → contralateral parietal lobe lesion
• Monocular Vision Loss → ipsilateral optic nerve lesion (GCA)
• Bitemporal Hemianopia → optic chiasm compression (Pituitary Tumour)
• Homonoymous Hemianopia → contralateral optic tract lesion
• Pupillary Reflexes → afferent defect is CN2 (optic nerve) lesion. Efferent defect (affected pupil persistently dilated) is CN3 (occulomotor nerve) lesion.
• Nystagmus → cerebellar pathology
• UMN Lesion (stroke) is forehead sparing. LMN Lesion (bell’s palsy, ramsay hunt) involves forehead.
• Rinne’s → if BC>AC in one ear then conductive deficit in that ear. If AC>BC in both ears either normal or sensorineural defict (use weber’s to confirm).
• Weber’s → louder on same side as conductive deficit or other side as sensorineural deficit
• Uvula (CN10, Vagus) deviates away from side of lesion. Tongue (CN12, Hypoglossal) deviates towards side of lesion.