i bc27f85be50b71b1 (87 page)

Oculomotor (CN lII)bmd.

Upward, inward, Jnd mfero-

eNs III, IV, and VI are

Ophthalmoplegia with eye

hrdm

medial cyc movemcllf

tcsted rogcther.

dcviation downward and

outward

Eyelid eleva non

Pupd reaction [Q light: Shme

ProSIS

a flashlight inro one eye

and observe bilateral

pupil reaction.

Pupil (onstricflon

Gaze: Hold oblect (e.g., pcn)

Loss of ipsilateral pupillary

Visual focuslllg

at arm's length from the

light and accommodation

patient, and hold the

refle"(es

patient'S head steady, Ask

the patient to follow the

object with a full honzon·

tal, vertical, and diagonal

gaze.

Trochlear (eN N)/I/I/dbra/ll

Inferolateral e}'c movement

See Oculomotor (eN III),

Diplopia

and proprioception

above.

Head nit to unaffected side

Weakncss in depression of

ipsilateral adducted eye

Trigeminal (eN V)/pOIIS

Sensation of face

Conduct rouch, pam, and

Loss of facial sensation

z

'"

temperature sensory test·

"

i§

ing over the patiem's face.

5i

Mastication

Observe for deviation of

Ipsilateral deviation of opened

�

-<

Jaw.

Jaw

�

;:

...

00

'"

Table 4-13. Continued

N

'"

0

Nerve/Origin

Purpose

How to Test

SignS/Symptoms of Impairment

>

()

Cornea I reflex

Wisp of cotton on [he

Loss of ipsilateral corneal

�

patient's cornea.

reflex

()

>

'"

Jaw jerk""

Palpate masseter as the

'"

patient clamps his or her

J:

>

z

jaw.

"

Abducens (eN VI)lpons

Lateral eye movement and

See Oculomotor (eN III),

Diplopia

15

0

proprioception

above.

Convergent strabismus

'"

Ipsilateral abductor paralysis

d

'"

Facial (eN VII)lpons

Taste (anterior rwo-thirds of

Ask the patient to smiJe,

Paralysis of ipsilateral upper

�

�

tongue)

wrinkle brow, purse lips,

and lower facial muscles, loss

�

and close eyes tightly.

of lacrimation, dry mouTh,

n

>

r

Facial expression

Inspect closely for

loss of taste on ipsilateral

:i

symmetry.

two-thirds of tongue.

'"

'"

Autonomic innervation of

>

�

lacrimal and salivary

�

glands

VeStibulocochlear (eN VIII)I Vestibular branch: sense of

Oculocephalic reAex (Doll's

Vertigo, nystagmus,

pons

equilibrium

eyes): Rotate the patient's

disequilibrium, neural

head and watch for eye

deafness

movement.

Cochlear branch: sense of

Cochlear: Vibrate a tuni,ng

(Normal oculocephalic reflex is

hearing

fork, place it on the mid

that the eyes will move in the

forehead, and ask the

opposite direction of the

patient if sound is heard

head prior [0 return ro

louder in one ear.

midline)

Glossopharyngeal (eN [Xli

Gag reflex

Test CNs IX and X coger her.

Loss of gag reflex, dysphagia,

medulla

Motor and proprioception

Induce gag with tongue

dry mouth, loss of taste ipsiof superior pharyngeal

depressor (one side at a

lateral one-third of tongue

muscle

time),

Autonomic innervation of

Patient phonates a prosalivary gland

longed vowel sound or

Taste (posterior one-third of

talks for an extended

tongue)

period of rime.

Blood pressure regulation

Listen for voice quality and

pitch.

Vagus (eN X)/medulla

Swallowing

See Glossopharyngeal (eN

Dysphagia, soft palate

Proprioception of pharynx

IX), above.

paralysis, contralateral

and larynx

deviation of uvula, ipsi

Parasympathetic innerlateral anesthesia of pharynx

vation of hearr, lungs, and

and larynx, hoarseness

abdominal viscera

�

(§

c

�

�

-<

�

N

'D

�