Cranial Nerve Examination

Testing the patient's papillary response to light, visual acuity, and visual field evaluation is essential to evaluate cranial nerve II. Conjugate gaze should be observed superiorly, inferi-orly, laterally, and medially, with the presence or absence of nystagmus noted, to test cranial nerves III, IV, and VI. The trigeminal nerve is evaluated by bilateral light touch and pinprick sensation over the forehead (cranial V1), the maxillary process (cranial V2), and the mandibular process (cranial V3). Checking the patient's corneal reflexes provides an assessment not only of cranial nerve V, but also of cranial nerve VII. Evaluation of cranial nerve VII includes observing facial tone and symmetry with eye closure, raising eyebrows, and smiling. Cranial nerve VIII can be assessed with the Rinne and Weber tests using a tuning fork. To assess cranial nerves IX and X, an applicator stick is lightly placed in each tonsillar region to stimulate the patient's gag reflex. Examination of the strength in the trapezius and ster-nocleidomastoideus muscles, by having the patient shrug his/her shoulders and by turning his/her head against resistance, provides an assessment of cranial nerve XI. Finally, tongue protrusion and lateral movements complete the screening examination by assessing cranial nerve XII.

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