There are twelve pairs of cranial nerves. Cranial nerve I is a fiber tract emerging from the brain directly, while cranial nerves II through XII arise from the diencephalon and brain stem. With a thorough understanding of normal cranial nerve function and testing, the examiner can localize lesions when abnormalities are found. For example, if there is facial weakness in a patient with hemiplegia, lateralization (determining whether the facial weakness is on the ipsilateral or contralateral side) will help determine the level of the lesion. Similarly, characterizing facial weakness will help differentiate upper and lower motor neuron patterns.
The following tables outline cranial nerve function and methods of evaluation.
Cranial Nerve | Function |
I. Olfactory | Sense of smell |
II. Optic | Vision |
III. Oculomotor | Pupillary constriction, opening eyes, some extraocular movements |
IV. Trochlear | Downward, inward movement of eye |
V. Trigeminal |
Motor - temporal and masseter muscles (jaw clenching), lateral movement of jaw
Sensory - Three divisions: (1) ophthalmic, (2) maxillary, (3) mandibular |
VI. Abducens | Lateral deviation of eye |
VII. Facial | Motor - facial movements (facial expression, closing eye, closing mouth) |
VIII. Acoustic | Hearing (cochlear division) and balance (vestibular division) |
IX. Glossopharyngeal |
Motor - pharynx
Sensory - posterior portions of eardrum and ear canal, pharynx, and posterior tongue, including taste (salty, sweet, sour, bitter) |
X. Vagus |
Motor - palate, pharynx, and larynx
Sensory - pharynx and larynx |
XI. Spinal accessory | Motor - the sternomastoid and upper portion of trapezius |
XII. Hypoglossal | Motor - tongue |
Cranial Nerve | Evaluation |
I. | Test each nostril separately, have patient sniff and identify common odor (soap, coffee, lemon) |
II. | Evaluate optic nerve, visual fields, visual acuity, pupil response to light (afferent CN II) |
II, III. | Pupillary size and reaction to light (direct and consensual response) |
III, IV, VI. | Evaluate extraocular movements (evaluate for conjugate movement, weakness of individual muscle, nystagmus); evaluate convergence reflex |
V. | Evaluate corneal reflexes, sensation in V1, V2, V3, temporalis and masseter muscle strength, jaw jerk |
VII. | Test strength of muscles of facial expression; can test sweet taste on anterior tongue |
VIII. | Evaluate hearing, compare bone and air conduction and test for lateralization of sound |
IX, X. | Evaluate gag reflex, elevation of palate with "Ah"; quality of voice |
XI. | Test strength of trapezius and sternomastoid muscle |
XII. | Evaluate tongue for atrophy, fasciculations, fibrillations, symmetry, deviation,strength |
Click on the video icon to view a demonstration of the cranial nerve exam. |