Be sure to download the FREE PDF Cranial Nerve Exam cheat sheet. Link below.
I: Olfactory
Cranial Nerve Assessment
Normal Response
Documentation
Have the patient close his/her eyes. Using a cotton pad soaked with peppermint oil/coffee/cinnamon, ask the patient to smell and identify the scents with each nostril separately.
Patient is able to identify smells with each nostril separately and with eyes closed. If the patient has a cold, retest at another time.
Patient is able to identify the odor of *** with both nares.
II: Optic
Assessment Technique
Normal Response
Documentation
In an adequately lit room, and with glasses on if he/she uses them, have the patient read while holding the material at a distance of 36 cm. (14 in.). Or use a Snellen chart to assess the optic nerve.
The patient should be able to read with both eyes and with each eye separately.
Patient can read with both eyes and with each eye seperately. Be sure to document if the reading is with or without glasses/contacts.
III: Oculomotor
Cranial Nerve Assessment
Normal Response
Documentation
Reaction to light: Dim the light in the room. Use a penlight and approach the patient from the side. shine a light on the pupil. Observe the response of the illuminated pupil. Shine the light on the pupil again, and observe the response of the other pupil.
Construction of both the Illuminated and non-illuminated pupil.
PERRLA (pupils equally round and reactive to light and accommodation)
Reaction to accommodation: With the room fully illuminated, have the patient look at a near object and then at a distant object. Alternate the gaze from the near to the far object. Next, move an object towards the client’s nose.
Pupils constrict when looking at a near object, dilate when looking at a distant object, converge when near object is moved toward the nose.
PERRLA (pupils equally round and reactive to light and accommodation)
IV: Trochlear
Cranial Nerve Assessment
Normal Response
Documentation
With the room fully illuminated, hold a penlight about 12 inches in front of the patient’s eyes. Ask the patient to follow the movements of the penlight with the eyes only, without moving their head. Move the penlight upward, downward, sideward, and diagonally.
Patient’s eyes should follow the penlight as it moves with smooth/fluid movements.
Movement of both eyes is smooth/fluid in all directions: upward, downward, sideward, and diagonally.
V: Trigeminal
Cranial Nerve Assessment
Normal Response
Documentation
Have the patient look up to the ceiling. With the tip a cotten ball, barely touch the lateral sclera of the eye to elicit a blink reflex. Repeat on the other side.
The patient should have a (+) corneal reflex (blinks when something is close to the eye), differentiate light and deep sensation and hot from cold.
Positive corneal reflex, sensitive to pain stimuli and can distinguish hot from cold.
To test light sensation, have the patient close his/her eyes, then touch a wisp of cotton across the patient’s jaw, cheekbone, and forehead. Compare right and left sides.
see above
see above
To test deep sensation, use alternating blunt and sharp ends of an object. Determine sensation to warm and cold objects by asking the patient to identify warmth and coldness.
see above
see above
VI: Abducens
Cranial Nerve Assessment
Normal Response
Documentation
Holding a penlight 12 inches in front of the patient’s eyes, have the patient follow the movements of the penlight with the eyes only. Move the penlight through the six cardinal fields of gaze.
Both eyes coordinated, move in unison with parallel alignment.
Both eyes move in coordination.
VII: Facial
Assessment Technique
Normal Response
Documentation
Perform the following with the patient: smile, raise eyebrows, frown, puff out cheeks, close eyes tightly. Have patient identify various tastes placed on the tip and sides of tongue, such as salty and sweet.
Patient should be able to smile, raise eyebrows, puff out cheeks, and close eyes without any difficulty. And should also be able to distinguish different tastes.
Patient able to smile, raise eyebrows, puff out cheeks, close eyes without any difficulty, and can distinguish between sweet/salty.
VIII: Vestibulocochlear
Cranial Nerve Assessment
Normal Response
Documentation
Have the patient occlude one ear. With the patient’s eyes closed, place crumpling paper or a tickling watch 1-2 inches from the occluded ear. Ask in which ear they can hear the noise. Repeat with the other ear.
The patient should be able to hear the ticking or crumpling in both ears both times.
Patient can hear crumbling/ticking in both ears.
Have the patient walk back and forth across the room. Assess the patient’s gait.
The patient should demonstrate upright posture and steady gait, while maintaining balance.
The patient can stand, walk in an upright position, and maintain balance.
IX: Glossopharyngeal
Cranial Nerve Assessment
Normal Response
Documentation
Have the patient open mouth wide and say “ah” or yawn to observe the upward movement of the soft palate.
Patient should gag and swallow without difficulty.
Gag reflex present and able to swallow without difficulty.
Elicit gag response with tongue depressor.
see above
see above
Assess ability to swallow by providing a sip of water.
see above
see above
X: Vagus
Cranial Nerve Assessment
Normal Response
Documentation
Ask the patient to swallow and speak, listen for vocal tone/hoarseness.
The patient should swallow without difficulty and speak audibly.
Patient able to swallow without difficulty and speak audibly.
XI: Accessory
Cranial Nerve Assessment
Normal Response
Documentation
Have the patient shrug shoulders against resistance from your hands and turn head to side against resistance from your hands. Repeat on both sides.
Shoulder shrugs and head turns should be equal and strong on both sides.
Strong and equal resisted shoulder shrug and resisted head turn bilaterally.
XII: Hypoglossal
Cranial Nerve Assessment
Normal Response
Documentation
Have patient protrude tongue at midline and then move it right and left.
The patient should move their tongue without any difficulty from side to side.
Tongue protrudes at midline and moves side to side without difficulty.
